Special Needs Plan (SNP)
A Special Needs Plan (SNP) is a type of coordinated care plan (CCP) under Medicare Advantage (MA) that is tailored to cater to the needs of special needs individuals. These individuals may include those who are institutionalized, dual eligible, or have a severe or disabling chronic condition as specified by CMS. SNPs can be of various types of CCPs, such as local or regional preferred provider organization (LPPO or RPPO) plans, health maintenance organization (HMO) plans, or HMO Point-of-Service (HMO-POS) plans. There are three types of SNPs, namely, Chronic Condition SNP (C-SNP), Dual Eligible SNP (D-SNP), and Institutional SNP (I-SNP).
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The Medicare Modernization Act of 2003 created a Medicare Advantage Coordinated Care Plan (MA CCP) that focuses on providing targeted care to individuals with special needs. These special needs individuals include those who are institutionalized, dual eligibles, or have severe or disabling chronic conditions as defined by CMS. The plans established to serve these individuals are called "Specialized MA plans for Special Needs Individuals," or SNPs, and are defined in 42 CFR 422.2. SNPs were first introduced in 2006 and were authorized to operate until December 31, 2008, by the MMA.
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​In accordance with Medicare program regulations, SNPs are expected to adhere to existing rules for both Medicare-covered services and the Prescription Drug Benefit program. As individuals with special needs require access to prescription drugs for managing their healthcare needs, all SNPs are obligated to provide Part D prescription drug coverage. In the absence of any specific guidance, it is assumed that existing rules for Part C and D apply to SNPs. The payment procedures for SNPs are the same as those for non-SNP MA plans. Additionally, all SNPs must comply with the current CMS guidance on cost-sharing requirements.