National Consumer Health Organization Responds to Special Needs Plans Provisions Contained in Congress’s Medicare Legislation
Boston, MA, December 21, 2007. Community Catalyst, a national nonprofit consumer health organization, today offered a mixed reaction to the minor policy changes for Special Needs Plans (SNPs) contained in the Medicare legislation approved by Congress this week, urging congressional leaders to do more in the coming year. SNPs are a subset of Medicare Advantage plans that serve people with chronic, severe health conditions. Community Catalyst launched the SNP Consumer Education Project earlier this year.
The legislation, which is expected to receive the President’s signature, extended the authority of SNPs for one-year and imposed a moratorium on new SNPs and expanded service areas for existing plans. Unlike a bill approved last summer by the House, the changes in yesterday’s bill did not seek to create SNP-specific quality measures or promote much-needed coordination between Medicare and Medicaid for dually eligible beneficiaries.
“The bill didn’t include most of the reforms essential to making the Special Needs Plans program work,” said Project Director Renée Markus Hodin. “We are pleased with the increased level of congressional scrutiny that the moratorium implies, but we believe that additional quality standards are necessary in order for the program to live up to its potential and, in fact, improve care for the most vulnerable Medicare beneficiaries.”
Community Catalyst also emphasized the importance of promoting improved coordination between Medicare and Medicaid for the over 700,000 beneficiaries dually eligible for both and enrolled in SNPs. “Dually eligible beneficiaries often have multiple health needs that are poorly served in today’s health care system. Establishing formal mechanisms for coordination of the two programs through SNPs is fundamental to providing seamless care for those who need it the most, and we hope this will be a priority for Congress in the coming year as well,” added Hodin.
Community Catalyst recently released a briefing paper for consumer advocates in states across the country to highlight the value of increased coordination of care between Medicare and Medicaid. Integration provides benefits to both the individual beneficiaries of the program and offers the potential for cost savings in state budgets.
SNPs, which were established in the Medicare Modernization Act of 2003 for high-risk Medicare beneficiaries, were created as a way to improve the quality of care for individuals with multiple or chronic health needs where traditional Medicare fee-for-service programs often led to unnecessary hospitalizations or lengthy nursing home stays.
View the paper on Medicare Advantage Special Needs Plans or for more information, visit the Community Catalyst website at www.communitycatalyst.org.
About Community Catalyst
Community Catalyst is a national non-profit advocacy organization dedicated to quality affordable health care for all. Since 1997, Community Catalyst has been working to build the consumer and community leadership required to transform the American health system. With the belief that this transformation will happen when consumers are fully engaged and have an organized voice, Community Catalyst works in partnership with national, state and local consumer organizations, policymakers, and foundations, providing leadership and support to change the health care system so it serves everyone—especially vulnerable members of society. For more information, visit www.communitycatalyst.org.
About the Special Needs Plan (SNP) Consumer Education Project
The Special Needs Plan Consumer Education Project seeks to educate state and federal payers, advocates, health care providers and the public on the opportunities and risks that come with SNPs. Along with education, this project promotes best practices that enhance patient care within a state’s health care framework. Funded by the Retirement Research Foundation, the SNP Consumer Education Project is an initiative of Community Catalyst.