Performance Improvement 2010. Provide for Special Needs


After the passage of the Medicare Improvements for Patients and Providers Act of 2008, eighteen state Medicaid programs contracted with dual eligible special needs programs.  These arrangements raised important questions about the contracting mandate established under the statute.  A dual special needs program (SNPs) is often operated as a distinct product within a larger corporate entity.  The corporate parent may or may not also operate a Medicaid managed care contract that includes dually eligible beneficiaries.  Determining what types of contracts between states and special needs programs or their corporate parents meet the statutory requirement is ambiguous in many situations.  These relationships were reviewed, with particular attention to provisions of interest to state Medicaid programs that have, or are considering entering into contracts with SNPs to integrate or coordinate Medicaid long-term care services with Medicare primary, acute and prescription drug services for dually eligible beneficiaries.  SNPs have been promoted as a "mainstream" vehicle for integrating Medicare and Medicaid services, but to date, most SNPs have had no formal relationships with state Medicaid programs.  In the future, SNPs proposing to serve dually eligible beneficiaries will be required to have contracts with state Medicaid programs. (9309

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