About SNPs

The Basics about Special Needs Plans

The Medicare Modernization Act of 2003 established a new type of Medicare Advantage coordinated care plans called special needs plans (SNPs) to focus on individuals with special needs.

 

“Special needs individuals” are defined as individuals who are:

  • institutionalized in a NF, SNF, ICF/MR or psychiatric facility or persons living in the community with similar needs.
  • dually eligible for Medicare and Medicaid.
  • afflicted with severe or disabling chronic conditions.

Congress intended for SNPs to exclusively or disproportionately enroll persons with serious chronic conditions to more effectively serve high-risk populations through specialization. SNPs must offer Medicare Parts A, B, and D benefits. SNPs function under most of the same Medicare Advantage regulations, with some exceptions, and use the same payment methodology as other MA plans. The most significant exception relates to enrollment. Dual and institutional beneficiaries can enroll in and disenroll from a SNP anytime throughout the year. Chronic Condition beneficiaries have a one-time special election period, based on their being diagnosed with a condition that qualifies them for SNP enrollment.

 

As of mid-February 2010, CMS had approved 361 MA contracts offering 562 Special Needs Plans (SNPs) with a total enrollment of 1,272,780 beneficiaries. Of these 562 Special Needs Plans, 153 were Chronic or Disabling Condition SNPs serving 226,093. 335 Dual-Eligible SNPs were serving 947,004 beneficiaries. And 74 Institutional SNPs were serving 99,683 beneficiaries. (Click to view the most recent monthly CMS' Comprehensive Report. 

 

This site contains access to application material, identifies SNPs approved for 2009, and includes government-sponsored SNP reports and other information about SNP development and implementation.

 

The Basics

CMS Fact Sheet on SNPs

CMS Guidance on MA Special Needs Plans

February 2010 SNP Report

 

Special Needs Plans Reports

June 2006 Report to Congress on SNPs, MedPAC

2006 SNP Site Visit Report, Mathematica Policy Research, Inc.

Integrating Medicare and Medicaid Through Managed Care, CRS

 

CMS Guidance on SNP Integration Issues

CMS Fact Sheet on Improving Medicare & Medicaid Integration

CMS "How to Guide" on integrating enrollment rules

CMS "How to Guide" on integrating marketing rules

CMS "How to Guide" on integrating quality rules

CMS State Guide on Integrating Medicare and Medicaid

 

NHPG Policy Guidance

NHPG Issue Brief on Medicaid's Most Complex and Costly

NHPG Position Paper on Advancing Medicare/Medicaid Integration

SNP Alliance Recommendations on Performance Measurement for SNPs