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.
- Measures that evaluate structure and process requirements through submission of documentation (Structure & Process measures)
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. For the Structure & Process measures NCQA refined the existing measures and required all SNPs to submit the full slate of S&P measures along with the HEDIS® measures.
2012 Reporting Requirements
Now available here.
NCQA released of 2012 Structure and Process Measures in ISS and hardcopy Spring 2012
Registration opened for SNP Training and Technical Assistance Sessions Early May
SNP HEDIS and IDSS Training Sessions held February and April
Organizations received their 2012 ISS Survey Tools Mid- April
HEDIS Submission Deadline June 15, 2012
S&P Measures and ISS Training and Sessions held June, July, August, September
NCQA Open Door Forums held September
S&P Survey Tool Submission Deadline October 15, 2012
NCQA Performs SNP Assessments Mid-October through March 2013
NCQA Delivers Final Report to CMS Late June 2013