Special Needs Plans

What's New

The 2013 Structure & Process Measures will be available soon.

The S & P trainings will begin on Tuesday, June 25 and will run throughout the summer; Click here for the training schedule. Registration is now available.

Quickly approaching is the S&P submission deadline, which is on Tuesday, October 15, 2013.

Background

Special Needs Plans (SNPs) were created by Congress in the Medicare Modernization Act (MMA) of 2003 as a new type of Medicare managed care plan focused on certain vulnerable groups of Medicare beneficiaries: the institutionalized, dual-eligibles and beneficiaries with severe or disabling chronic conditions. These beneficiaries are typically older, with multiple comorbid conditions, and thus are more challenging and costly to treat.

In early 2008, the Centers for Medicare & Medicaid Services (CMS) contracted with the National Committee for Quality Assurance (NCQA) to develop a strategy to evaluate the quality of care provided by SNPs. This strategy relies on a phased, multi-year approach, beginning with defining and assessing desirable structural characteristics and followed by assessing processes and eventually, outcomes. The evaluation approach includes two types of assessment.

  • HEDIS® measures and
  • Measures that evaluate structure and process requirements through submission of documentation (Structure & Process measures)

Phased Approach

The first phase of this effort focused on core SNP requirements—those that apply to all SNPs, regardless of type (i.e., dual eligible, chronic care, institutional)—using existing measures. The focus of the second and third phases was measures that address the special needs of SNP populations and on more mature quality improvement efforts. Phase II (2009) included two additional HEDIS measures, three new Structure & Process measures and two additional elements for the existing Structure & Process measures. Phase III (2010) continued to focus on the HEDIS® and Structure & Process measures introduced in 2009.

In 2011, NCQA developed one new HEDIS® measure, plan all-cause readmissions. NCQA also refined the Structure & Process measures for the year. CMS then required all SNPs to submit the full slate of S&P measures along with the HEDIS® measures.

Although the HEDIS measures remained the same for the 2012 SNP Assessment, NCQA added three elements focusing on case management outcomes for Returning SNPs along with another element focusing on Improving Member Satisfaction, SNPs were also scored based on the achievement of significant improvement in their HEDIS measures for the first time in 2012.

2013 Reporting Requirements

Coming Soon.

Timeline

NCQA will release the 2013 Structure and Process Measures in hardcopy and via ISS in the Summer 2013

Registration will open for SNP Training and Technical Assistance Sessions Mid June

SNP IDSS Training Sessions held in May

Organizations will receive their 2013 ISS Survey Tools Summer 2013

HEDIS Submission Deadline June 15, 2013

S&P Measures and ISS Training Sessions, Open Door ForumsSee schedule

S&P Survey Tool Submission Deadline October 15, 2013

NCQA Performs SNP Assessments Mid-October 2013 through April 2014

NCQA Delivers Final Report to CMS June 2014