Also see http://communitycatalyst.org/index.php?doc_id=32&PHPSESSID=1624dab17ae61987038f51483113f844
Community Catalyst is pleased to announce a new undertaking - the Special Needs Plan Consumer Education Project - which is supported by the Retirement Research Foundation.
Through this project, Community Catalyst will partner with Commonwealth Care Alliance to educate consumers about the opportunities and risks offered by Special Needs Plans (SNPs). The project will also identify and promote SNP best practices while strengthening the consumer voice on state and federal policy issues related to SNPs.
Read on for more background and information about the Special Needs Plan Consumer Education Project...
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| Background: The Medicare Modernization Act of 2003 did more than add prescription drug coverage to Medicare. It also established a new coverage option for Medicare beneficiaries with serious or chronic illnesses. The Special Needs Plan (SNP) option was created to offer better coordinated care for the most medically vulnerable beneficiaries. SNPs differ from traditional Medicare managed care plans in that they are able to limit enrollment to specific categories of beneficiaries, e.g. those who are living in nursing homes or living in the community but who require a nursing home level of care, those that are dually eligible for Medicare and Medicaid, and people with chronic conditions such as diabetes, mental illness, and HIV/AIDS. SNP benefits and provider networks must be tailored to the needs of the specific population the SNP has chosen to serve. |
| For people with chronic illnesses, SNPs offer an opportunity to address the shortcomings of the current fee-for-service system. That system is set up to address discrete short-term episodes of illness, but it does less well at providing optimal care for people who need more flexible benefits and integration of acute and long-term care services. At their best -- and if truly integrated at the state and federal level -- SNPs have the potential to offer� comprehensive and coordinated care, resulting in better health outcomes, improved quality of life, and fewer high-cost hospitalizations. Additionally, by reducing avoidable hospitalizations and institutionalization, SNPs may offer a mechanism for moderating state Medicaid expenditures without harming recipients. |
At the same time, SNPs present a number of risks and potential problems both for beneficiaries and state Medicaid programs.� Medicare and Medicaid managed care beneficiaries have sometimes experienced unstable provider networks and marketing abuses. Additionally, there are concerns that the capitation mechanism of financing may lead to reductions in service and quality. For state Medicaid programs, lack of coordination between SNPs and Medicaid could result in increased costs rather than savings.�
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