Mobile Menu - OpenMobile Menu - Closed

#SubHealth Discusses Bipartisan Legislation Extending Medicare Advantage’s Special Needs Plans

Jul 26, 2017

WASHINGTON, DC – The Subcommittee on Health, chaired by Rep. Michael C. Burgess, M.D. (R-TX), today held a hearing examining the extension of Special Needs Plans (SNPs) under Medicare Advantage.

Kicking off the hearing, #SubHealth Chairman Burgess highlighted the bipartisan support for SNPs, saying the provide "comprehensive, coordinated care to about two million Medicare beneficiaries." Chairman Burgess also stated the subcommittee's goals in improving SNPs for dual eligibles, since the vast majority of SNP enrollees are enrolled in both Medicarea and Medicaid. A copy of the discussion draft considered is available here.

“Duals often have multiple chronic conditions, physical disabilities, and cognitive impairments such as dementia, developmental disabilities, and mental illness,” said Chairman Burgess. “Yet, too often, these very beneficiaries are forced to navigate two government programs with benefit structures, rules, and incentives that are often less than simple and intuitive.”

Ms. Melanie Bella, Consultant and Former Director, Federal Coordinated Health Care Office, CMS, reinforced the differences in the programs and urged more coordinated care, saying, “As the number of people who rely on both programs grows and with annual costs exceeding $350 billion, there is an increasing need to align these programs. Today, the majority of Medicare-Medicaid enrollees are not in programs that integrate their Medicare and Medicaid benefits. Medicare covers acute care needs, such as hospitalization and post-acute care, and prescription drugs. Medicaid provides supplemental benefits, particularly long-term care supports and services, and helps with Medicare premiums and cost-sharing as well as in the financing of prescription drugs via the Part D ‘clawback.’ The lack of alignment between the two programs can lead to fragmented care, cost shifting, inefficient spending, and poor outcomes.”

Dr. Lawrence Atkins, President, National MLTSS Health Plan Association, testified in support of the discussion draft stating, “We encourage the committee to further consider allowing states that enroll dually-eligible individuals in Medicaid managed care to require those dual members to receive all of their benefits from a plan that fully integrates Medicare and Medicaid services…”

Mr. Chris Wing, CEO, SCAN Health Plan, concluded his opening statement by remarking on the important nature of today’s hearing, saying, “The legislation you are considering is hugely important and holds the potential to make life better for millions.”

For more information on todays hearing, including a background memo, witness testimony, and archived webcast, click HERE.