Congressional Gridlock Is SNPs’ New Best Friend — for Now

By James Gutman - August 16, 2013 Sometimes you want inertia, as long as it doesn’t last indefinitely. That seems to be the case these days for Medicare Advantage Special Needs Plans (SNPs) in their dealings with Congress. But they’ll need the legislative branch to get out of its gridlocked slumber by the beginning of next year in order to know whether they will be alive long enough to offer products for 2015 and beyond. The friendly inertia now pertains to congressional inactions on the controversial recommendations, adopted in January and submitted to Congress in March, of the Medicare Payment Advisory Commission (MedPAC). In a nutshell, MedPAC wants Congress to phase out most chronic care SNPs by the end of 2016 and allow no new C-SNPs after Jan. 1, 2014, as well as permit only those SNPs for Medicare-Medicaid dual eligibles (D-SNPs) that are fully integrated to get reauthorized. While some of the other MedPAC SNP recommendations are more to the industry’s liking, it’s probably safe to say that adopting none of them would please the SNP Alliance trade group more than would adopting all of them. And none is not only what has happened on the MedPAC recommendations so far, but also what is likely to come out of Congress in the next three months or so, as the at-loggerheads legislators must find a way to act on more pressing matters, such as raising the debt ceiling and keeping the federal government running. But Congress by year’s end — or at least by the very beginning of next year — needs to act to stave off a huge Medicare physician fee cut that would take effect next Jan. 1 under the much-hated Sustainable Growth Rate (SGR) formula. Congress did act in January 2013 to furnish a “doc fix” for this year and has discussed adopting a multi-year fix, which would be favorable for the pay of all MA plans, but there is that slight problem of how the legislators would pay for it. And SNPs usually look to the “doc fix” bill to include their reauthorization, as was the case this January to extend their life through 2014. Without congressional action by next January, SNPs would have a problem, since their applications for 2015 are due to CMS in February 2014. What do you think is likely to happen on the MedPAC SNP recommendations and the SNP reauthorization? Will the general support the SNP concept appears to have in both political parties be enough to get reauthorization again while heading into an election year when health care will be a big issue? Is it enough to thwart the more controversial SNP recommendations of MedPAC, which was created by and reports to Congress but often has its recommendations go unadopted by its overseer? When does congressional inability to agree on much of anything become more of an albatross than an ally for SNPs? http://aishealth.com/blog/medicare-advantage-and-part-d/congressional-gridlock-snps-new-best-friend-now