Medicare Advantage Special Needs Plans:
A Beneficiary Perspective

A working conference convened by the Center for Medicare Advocacy, Inc., and supported by The Commonwealth Fund, an independent foundation working toward health policy reform and a high performance health system.

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Introduction

 

On October 18, 2007, the Center for Medicare Advocacy (the Center) convened a one-day working conference in Washington, DC to discuss and evaluate Medicare Advantage Special Needs Plans (SNPs) from a beneficiary perspective. 

 

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) created a new type of Medicare Advantage coordinated care delivery vehicle called SNPs.  The purpose of SNPs, as envisioned in the MMA, is to give special attention to the health care needs of particular subpopulations of the Medicare beneficiary community and to save health care delivery dollars.  Since 2004, the number of SNPs has grown exponentially and yet the Centers for Medicare & Medicaid Services (CMS) has issued very little guidance to identify what is required to become a SNP. 

 

The conference brought together beneficiary advocates, health policy advocates, researchers, SNP providers, officials from CMS, and Congressional staff.  Invitees met for one day to discuss and frame a set of recommendations to present to Congress and CMS.  The proceedings were anchored by three background papers that described what is known about SNPs and the issues they raise for beneficiaries.  

 

Two background papers written by health policy researchers and commissioned by The Commonwealth Fund helped provide a framework for discussing the topics at hand.  The first paper provided a primer on SNPs for dual eligibles.  The second paper provided a snapshot of the enrollment and participation levels in SNPs, and described the opportunities and challenges presented by this new type of specialty health plan.  The Center commissioned a third background paper to present issues encountered by beneficiaries who enrolled in SNPs, either voluntarily or through actions authorized by CMS.  The paper, written from the perspective of an attorney for older people and people with disabilities, outlined specific problems raised by SNP enrollment and provided examples from Pennsylvania SNP enrollees.

 

The Center’s recommendations, the conference proceedings, the background papers, and other materials related to the conference are presented here for the public.