NEW NCQA MEASURES ASSESSING HOW WELL MEDICARE SPECIAL NEEDS PLANS SERVE VULNERABLE POPULATIONS OPEN FOR PUBLIC COMMENT

More Than 1.1 Million Enrolled in Special Needs Plans in 2008; Proposed Measures Address Care Coordination, Integration of Coverage

WASHINGTON—The National Committee for Quality Assurance (NCQA) today released for public comment new structure and process measures to assess the performance of Medicare Special Needs Plans (SNP), serving more than 1.1 million elderly and disabled Americans.

The new measures would be added to a set of requirements for SNPs set by the Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for overseeing Medicare and Medicaid.

In 2008, NCQA, under contract with CMS, assessed the structure, processes and performance of 432 SNPs serving more than 800,000 beneficiaries. More than 700 plans are expected to be evaluated in 2009.

SNPs were created by Congress as part of the Medicare Modernization Act of 2003 to serve vulnerable Medicare beneficiaries, including those who live in nursing homes, beneficiaries with severe or disabling chronic conditions and low-income beneficiaries eligible for both Medicare and Medicaid. Enrollment in SNPs has grown rapidly in recent years.

“Anyone who has a family member with special needs understands how they can benefit from highly coordinated care. Special Needs Plans have the potential to provide such specialized care,” said NCQA President Margaret E. O’Kane. “Expanding the measures we use to assess their performance in areas particularly important for these populations will help us learn more about how well these plans serve their members and highlight areas for improvement.”

In 2008, SNPs were required by CMS to report up to 13 HEDIS clinical performance measures covering such areas of care as colon cancer screening and the appropriate management of antidepressants.  They also reported three structure and process measures that examine how well plans manage complex cases and improve member satisfaction and clinical quality. The measures released for comment today include three new structure and process measures:

• Care Transitions: How well do plans manage the transition of a patient from one setting, such as a hospital, to another?
• Institutional SNP Relationship with Facility: How do plans work with nursing facilities to make sure members’ needs are met?
• Integration of Medicare and Medicaid:  How well do plans coordinate both Medicare and Medicaid coverage for eligible members?

Two additions to existing measures are included for public comment. These assess activities to improve clinical quality and member satisfaction.

Interested parties are invited to comment on the proposed measures, posted on NCQA’s Web site at www.ncqa.org, through November 24. NCQA will analyze the comments and propose final standards to CMS for approval in late 2008. SNPs will be required to submit both structure and process measures and HEDIS measures in 2009.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS^®) is the most widely used performance measurement tool in health care. NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices.         

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