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 November 2008, CMS had approved 441 MA contracts offering 762 Special Needs Plans (SNPs) with a total enrollment of 1,309,293 beneficiaries. Of these 762 Special Needs Plans, 241 were Chronic or Disabling Condition SNPs serving 275,161. 436 Dual-Eligible SNPs were serving 905,701 beneficiaries. And 85 Institutional SNPs were serving 128,531 beneficiaries. (Click to view the most recent monthly CMS' Comprehensive Report.)
This site contains access to application material, identifies SNPs approved for 2008, 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
November 2008 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