San Diego Long Term Care Integration Project

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Medicare Special Needs Plans Lessons from
Dual-Eligible Demonstrations for CMS, States,
Health Plans, and Providers Mark R. Meiners Ph.
D. Director, Center for Health Policy Research
and Ethics George Mason University The 59th
Annual Scientific Meeting of the Gerontological
Society of America, Dallas Texas, November
20,2006
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Special Needs Plans (SNPs)

• Allows a SNP to restrict enrollment for certain
  categories of special needs individuals
• Institutional Beneficiaries (in or expected to
  reside gt90 days Community NHC)
• Dually Eligible (subsets of duals OK working
  with State goals)
• Beneficiaries with Severe and Disabling Chronic
  Conditions (untested to be evaluated on case by
  case e.g. disease specific)
• SNP Lumpers vs. Splitters!

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SNPs are Medicare plans that may or may not
contract with Medicaid

• Plan Growth - 11 in 04 125 in 05 276 in 06
• Total plans/patients - 276 / 602,881 /45 States
  DC/ PR
• Institutional 37 / 39,323 (89 EC/U)
• Dually Eligible 226 / 491,877
• Chronic and Disabling condition 13 / 71,635
  (98 PR)
• 88 of enrollees in 9 states and PR PA, AZ,
  MN, TX, CA, NY, TN, FL, OR
• Most plans are small 167 have fewer than 500

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SNP Challenges and Opportunities

• Passive Enrollment Large Factor -- 42 plans
  approved and over 300,000 enrolled
• PE only allowed in 2006 to support a smooth
  transition of Medicaid / Medicare drug coverage
• 94 of Duals in stand-alone PDPs the rest in
  MA-PD, mostly SNPs
• Duals can change Part D plans any time
• Alone, SNPs have trouble marketing to duals

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SNPs, Duals, and States

• States can help SNPs identify Duals for
  marketing
• Duals without States Medicaid benefits value
  limited LTC is major value added
• State models / experience exist AZ, FL, MA,
  MN, NY, TX, WI
• Little known about DE care except in State DDI

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CMS Guidance for MMIP

• How to coordinate marketing of Medicare and
  Medicaid to duals.
• How to do streamlined MC enrollment of duals.
• How to do MC quality integration for duals.
• How to support State targeted SNP enrollments.
• Clarity in bidding process to enable State
  savings.
• Model SNP/State/CMS integrated relationship
• Improved quality measures for SNP populations

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CMS Guidance for MMIP

• State Guide to Integrated Medicare and Medicaid
  Models http//www.cms.hhs.gov/DualEligible/Downlo
  ads/StateGuide.pdf
• Enrollment "How To" Guide for Special Needs
  Plans http//www.cms.hhs.gov/DualEligible/Downloa
  ds/EnrollmentGuide.pdf
• Marketing "How To" Guide for Special Needs Plans
  http//www.cms.hhs.gov/DualEligible/Downloads/Mar
  ketingGuide.pdf
• Quality "How To" Guide for Special Needs Plans
  http//www.cms.hhs.gov/DualEligible/Downloads/Qu
  alityGuide.pdf
• State Medicaid Directors' Letter re Special
  Needs Plans http//www.cms.hhs.gov/DualE
  ligible/downloads/specialneedsplanletter.pdf

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• MMIP Development Issues and Options
• Duals/Medicaid-only Aged/Disabled Both?
  Timing?
• Benefits Comprehensive/ Carve Outs
• Well, Community Frail, Nursing Home
• Mandatory or Optional
• Budget Neutral or Cost Saving
• Statewide or regional pilot (large vs. limited)
• National MCOs or Local Safety-Net Providers
• Provider Networks open or closed?
• M/M Integration or Coordination
• Waivers, Risk Adjustment, Enrollment Strategy