MedPAC Adopts Suggested Changes for SNPs, but Does That Matter?

By James Gutman - January 25, 2013

Medicare Payment Advisory Commission (MedPAC) Chairman Glenn Hackbarth runs a tight ship. Without a single dissenting vote from the many commissioners present — and without any comments allowed from the many stakeholders attending the meeting — MedPAC on Jan. 10 adopted four major recommendations prepared by the chairman for the future of Medicare Advantage Special Needs Plans (SNPs). One of them would involve the expiration of the authorization for chronic care SNPs (C-SNPs) after the end of 2013, except those for a small number of conditions. Now the question is whether Congress will adopt — or even vote on — these recommendations.

MedPAC was created by Congress and reports to it, and by all accounts Congress respects the commission’s work. But Congress often doesn’t adopt MedPAC’s recommendations, and, in the current case, it partly pre-empted the C-SNP one by including in this month’s “fiscal cliff” law a provision extending the authorization for all SNPs by one year through 2014. The MedPAC recommendations on SNPs did get changed, partly in ways the MA industry wanted, as they made their way through the commission’s process and dealt with concerns raised by both individual commissioners and the SNP Alliance trade group. However, the recommendations, which will be included in MedPAC’s report to Congress in March, still would mean some major changes for the industry.

C-SNPs, for instance, would be folded after a three-year transition period into regular MA plans, which would be allowed to enhance benefit designs so that benefits can vary based on the medical needs of members with chronic conditions. And SNPs for Medicare-Medicaid dual eligibles (D-SNPs) would be reauthorized permanently — but only those that fit the definition of an integrated product, which many current D-SNPs don’t for various reasons. Those D-SNPs would have to change, and some of these changes would depend on actions states would have to take.

What do you think Congress will do with these recommendations? What should Congress do with these recommendations? Does Congress even care enough about SNPs, given all the time-sensitive financial game-changing items on its plate, to look into this issue in 2013? If not, is that good news or bad news for the SNP industry?

http://aishealth.com/blog/medicare-advantage-and-part-d/medpac-adopts-suggested-changes-snps-does-matter