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Special Needs Plans | CMS

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what is a special needs plan?

a special needs plan (snp) is a medicare advantage (ma) coordinated care plan (ccp) specifically designed to provide specific care and limit enrollment to people with special needs. a person with special needs could be any of the following:

  1. an institutionalized person,
  2. a dual eligibility, or
  3. a person with a serious or disabling chronic condition, as specified by cms.
  4. an snp can be any type of ma ccp, including a local or regional preferred provider organization plan (i.e., lppo or rppo), a health maintenance organization (hmo) plan, or a point of service of hmo (hmo-pos) plan. there are three different types of snps:

    Reading: What does snp stand for in insurance

    1. chronic condition snp (c-snp)
    2. dual eligible snp (d-snp)
    3. institutional snp (i-snp)
    4. legal and regulatory history

      the medicare modernization act of 2003 (mma) established a ma ccp designed specifically to provide specific care for people with special needs. in the mma, congress identified “persons with special needs” as: 1) institutionalized persons; 2) dual eligibility; and/or 3) people with severe or disabling chronic conditions, as specified by cms. MA CCPS established to serve these people with special needs are called “MA Specialized Plans for People with Special Needs” or SNPs. 42 cfr 422.2 defines people with special needs and ma specialized plans for people with special needs. snps were first offered in 2006. mma granted the snp program the authority to operate until december 31, 2008.

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      The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Extension Act of 2007 later extended the SNP program from December 31, 2008, to December 31, 2009, but imposed a moratorium that prohibited cms will approve new snps after jan 1, 2008. consequently, cms did not accept snp requests in 2008 for contract year (cy) 2009.

      The Medicare Patient and Provider Improvement Act of 2008 (MIPPA) lifted the moratorium on the Medicare, Medicaid, and Schip Extension Act of 2007 to approve new SNPs. mippa further extended the snp program until december 31, 2010, which allowed cms to accept ma requests for new snps and expansions of the snp service area through cy 2010. cms accepted snp requests from ma requestors to create new snps and expand existing snps approved by cms for the three types of specialized snps in accordance with additional snp program requirements specified in mippa. CMS regulations implementing and further detailing mippa enforcement requirements for snps can be found at 42 cfr 422.501-504.

      Effective immediately after its enactment in 2011, section 3205 of the Patient Protection and Affordable Care Act (“ACA”) extended the SNP program through December 31, 2013. Section 607 of the 2012 american taxpayer relief (atra) extended the snp program through december 31, 2014. section 1107 of the bipartisan budget act of 2013 (pub. l. 113-67) extended the snp program through december 31 of 2015. Section 107 of the Medicare Access Protection Act of 2014 extended the SNP program through December 31, 2016. Most recently, Section 206 of the Medicare Access and Chip Reauthorization Act of 2015 (macra ) extended the snp program until December 31, 2018.

      payment requirements and procedures

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      SNPs are expected to follow existing MA Program rules, including MA Regulations at 42 CFR 422, as amended by the Guide, regarding Medicare-covered services and prescription drug benefit program rules. All SNPs must provide Part D prescription drug coverage because people with special needs must have access to prescription drugs to manage and monitor their special health care needs. snps should assume that if no modifications are included in the guide, the existing rules in parts c and d apply.

      Payment procedures for snps mirror the procedures cms uses to make payments to non-snp ma plans. SNPs must prepare and submit offers like other MA plans, and are paid the same as other MA plans based on the plan’s risk adjustment and enrollment payment methodology. all snps must comply with current cms guidance on cost sharing requirements.

      site overview

      Specific information on each of the three snp types (c-snps, d-snps, and i-snps), as well as information on the snp application and snp care model, can be found by clicking on the links corresponding. on the left side of this page. in addition, there is a link below to the medicare managed care manual online, which contains chapter 16b : the current cms sub-regulatory guidance on snps.

      Source: https://amajon.asia
      Category: Other

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