CMA issues report and recommendations aimed at protecting members of Medicare private “Special Need Plans.”

In fulfillment of a grant from The Commonwealth Fund, the Center for Medicare Advocacy recently issued a report and recommendations aimed at protecting members of Medicare private plans known as “Special Need Plans.”  The documents are available from the Center’s website at http://www.medicareadvocacy.org/SNP%20Conference/Home.htm.

According to the Center’s recommendations, all Medicare Special Needs Plan (SNP) enrollees must be assured that their special needs are actually met by SNPs. To that end, the Center recommends that these plans guarantee SNP-specific beneficiary protections, standards for care, and coverage. Further, all of these SNP-specific protections must be enforceable, and actively enforced, by the Centers for Medicare & Medicaid Services (CMS).

Created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Special Needs Plans (SNPs) have proliferated since 2004, the first year of operation, due in part to the revenue they generate for plans. In 2004, 11 SNPs were approved by CMS. In 2007, 477 SNPs were approved, enrolling over 800,000 beneficiaries.  As of November 2007, CMS has approved 775 plans to be SNPs in 2008, with enrollment now exceeding 1 million beneficiaries.  On December 29, 2007, President Bush signed a law  which placed a moratorium on new SNPs through December 31, 2009.

In marked contrast with “regular” Medicare Advantage (MA) plans, which are prohibited from discriminating among Medicare beneficiaries in their enrollment, SNPs are designed to serve, either exclusively or disproportionately, specific Medicare subpopulations. SNPs must be coordinated care plans and they must offer all benefits of Medicare Parts A, B and D. Aside from these two conditions, SNPs operate with few requirements from either the law or implementing regulations and with little oversight of how or whether they deliver what they promise.

We hope that you will find the Center’s recommendations useful and that you will share this information broadly