Milestone: Revisit relationships with SNPs in the context of Medicare Advantage Program reforms
Some states contract with Medicare Special Needs Plans to enable them to provide Medicare and Medicaid services to enrolled dual eligibles. The ACA changed the SNP program. States may need to revise the contracts so dual eligibles may continue to receive integrated care.
*Full name: Revisit relationships with SNPs in the context of Medicare Advantage Program reforms.
*Relevance to the ACA:
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan permitted to target enrollment to beneficiaries who are dual eligibles, nursing home residents, and/or have chronically disabling conditions. Not all dual eligible SNPs have contracts with Medicaid agencies. Among those that do, the scope of benefits covered varies considerably.
The ACA does not require specific actions by states in this area. However, the statute does make several adjustments to previous law that will be relevant to states.
§3201 – Modifies the bidding process for Medicare Advantage Plans (including SNPs). If SNPs receive lower capitated rates from Medicare and reduce the benefits they provide, state Medicaid programs may need to adjust their rates or service level expectations.
§3205 – Specifies that SNPs are reauthorized through December 31, 2013, and that by December 31, 2012, all dual eligible SNPs in a state must have contracts with the state Medicaid agency.less