Special Needs Plans

The Centers for Medicare & Medicaid Services (CMS) has contracted with NCQA to evaluate Medicare Special Needs Plans (SNPs). The evaluation approach includes the collection of SNP-specific HEDIS measures and Structure & Process (S&P) measures.

The evaluation approach is being conducted in phases. The initial phase involves using existing HEDIS measures and S&P measures derived from current NCQA Accreditation standards. For more information on the phased evaluation approach, please read the Approach Overview Memo.

What are Special Needs Plans?

SNPs were created by Congress as part of 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 thus they are more challenging and costly to treat.

SNP Evaluation

HEDIS

SNPs are required to report the following HEDIS measures by June 30, 2008:

  • Colorectal Cancer Screening*
  • Glaucoma Screening in Older Adults
  • Use of Spirometry Testing in the Assessment and Diagnosis of COPD
  • Pharmacotherapy of COPD Exacerbation**
  • Controlling High Blood Pressure*
  • Persistence of Beta Blocker Treatment After a Heart Attack
  • Osteoporosis Management in Older Women
  • Antidepressant Medication Management
  • Follow-Up After Hospitalization for Mental Illness
  • Annual Monitoring for Patients on Persistent Medications
  • Potentially Harmful Drug-Disease Interactions
  • Use of High Risk Medication in the Elderly
  • Board Certification
* SNP benefit packages under PPO Contracts do not have to report these measures because these measures rely on medical record review.
** This first-year measure is optional for all MA reporting, including the SNP benefit packages.

The HEDIS reporting requirements for SNPs are finalized. For more information, please refer to the SNP HEDIS Reporting Requirements Frequently Asked Questions (FAQ) document. If you have unanswered questions after reading the FAQ document, please use the Policy Clarification Support (PCS) system to submit your question to NCQA.

Structure and Process Measures

The Public Comment period for structure and process measures concluded on January 18, 2008. Finalized measures were posted to the Web site by March 14, 2008.

Training Sessions

NCQA conducts training sessions over the Web to inform SNPs about pertinent information on the processes for submitting data through NCQA’s data collection tools and the requirements for SNP evaluation. Dates and times of the training sessions will be released soon. All SNPs are encouraged to participate. The sessions are being provided at no charge.

HEDIS Sessions

Introduction to NCQA & HEDIS
This training is for SNPs that are unfamiliar with NCQA and have never submitted HEDIS data before.
Seminar Slides

SNP Subset of HEDIS Measures
CMS is requiring that SNPs report data for a subset of HEDIS measures for each SNP benefit package. This training will provide an overview of the SNP evaluation program, its intent, the HEDIS measures selection logic, and an overview of the required measures.
Seminar Slides

Interactive Data Submission System (IDSS)
The purpose of this session is to train SNPs on how to use NCQA’s IDSS system, which is NCQA’s HEDIS data collection tool.
Seminar Slides

S&P Measures Sessions

S&P Measures
NCQA has developed S&P measures that evaluate the systems, policies and procedures SNPs have in place to ensure quality of care for their members. These requirements address complex case management, member satisfaction and clinical quality improvements. The purpose of this training is to provide an overview of the S&P measures and information necessary to understand how to provide the required documentation associated with these measures.
Seminar Slides

Interactive Survey System (ISS)
The purpose of this session is to train SNPs on how to use NCQA’s ISS data collection system, which is being used to collect the required S&P data.
Seminar Slides

Open Door Forums

NCQA is holding a series of conference calls to address SNP’s questions related to the SNP Structure & Process measures and ISS Survey Tool.

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