Background
ACAP supports the development of strong quality standards for Medicare Advantage Special Needs Plans (MA-SNPs). Quality standards provide incentives for health plans to improve access to and quality of care, and lead to better health outcomes for the populations served. However, it must be stressed that any quality standards must be tailored to the needs of the specific population.
The dual eligible SNP population served by ACAP member plans differs significantly from the general enrollment Medicare Advantage population. Dual eligible SNPs often have long term disabilities, as well as a higher incidence of mental illness or behavioral issues than the general MA population. Overall, dual eligible SNP beneficiaries have a much poorer health status than the rest of the MA population. In addition, standards developed for an elderly population may be less appropriate for SNPs with a higher proportion of disabled members.
ACAP Position and Legislative Action
Comparisons of quality measures for SNPs and MA plans serving members with less complex medical needs requires further examination. While ACAP has always strongly supported quality standards, they must take into account demographic differences in SNP populations, particularly concerning dual eligible populations.
ACAP encourages the Center for Medicare and Medicaid Services to consider population differences while formulating the Star quality rating system that determines the MA Quality Bonus for 2012. Not doing so could harm health plans that offer SNPs and result in a decrease in the availability and quality of care for one of the most vulnerable populations.
ACAP Documents Relating to Medicare Quality