CMS, NCQA Seek Public Comment On Proposed Quality Measures For Medicare Special Needs Plans, USA

Main Category: Medicare / Medicaid / SCHIP
Article Date: 18 Dec 2007 - 2:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

As part of its continuing efforts to improve the quality of care provided to people with Medicare, the Centers for Medicare & Medicaid Services (CMS), with the National Committee for Quality Assurance (NCQA), released for public comment a proposed set of structure and process measures for Medicare Special Needs Plans (SNPs).

The proposed measures are part of the initial implementation of a strategy to evaluate the structure, processes and performance of SNPs.

"This is a first step in evaluating the quality of care that is provided to Medicare beneficiaries who are receiving care from these new Medicare Advantage plans," said CMS Acting Administrator Kerry Weems. "It's important that we get the right measures in place to protect the vulnerable beneficiaries who are enrolled in or looking to enroll in Special Needs Plans."

The SNPs are one of the fastest growing health plan options available as part of Medicare Advantage and were created by Congress as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). These Medicare managed care plans serve certain vulnerable groups of Medicare beneficiaries including those living in institutions such as nursing homes, beneficiaries with severe or disabling chronic conditions and beneficiaries eligible for both Medicare and Medicaid. SNPs provide special clinical programs to help people with distinct health care needs, reducing the need for them to be hospitalized or placed in an institution such as a nursing home. As of 2007, more than 470 SNPs are serving more than 1 million beneficiaries, and more than 760 SNPS will be available in 2008.

"Because they care for some of our most vulnerable citizens, Special Needs Plans must demonstrate that they are providing quality care and protecting the rights of Medicare and Medicaid beneficiaries," said NCQA President Margaret E. O'Kane.

The measures released for comment today build upon existing NCQA standards and performance measures used to evaluate health plans serving more than 84 million Americans.

The measures examine how SNPs set up case management programs for members with complex needs and how they act to improve clinical care and patient experience. The CMS will also require SNPs to begin reporting on 13 Healthcare Effectiveness Data and Information Set (HEDIS®) measures that will assess clinical performance.

"We need to establish clear expectations that enable SNPs to use innovative approaches in serving vulnerable populations," said Weems. "That is why we are looking for input and comment before we implement specific quality measurements for these plans."

Interested parties are invited to comment on the proposed measures, posted on NCQA's Web site at http://www.ncqa.org, through January 18, 2008. NCQA will summarize the comments and provide proposed final requirements to CMS for final approval in March. Final requirements and data collection tools will be available to SNPs in mid-April. SNPs will be required to submit HEDIS data by June 30, 2008.

More information about Medicare Special Needs Plans is available here.

Centers for Medicare & Medicaid Services