GAO releases report on dual-eligible special needs plans
Posted on September 21, 2012 | No Comments
9 percent or 1.2 million of the population eligible to enroll in both Medicare and Medicaid are enrolled in the 322 Medicare dual-eligible special needs plans (D-SNP), a type of Medicare Advantage plan. The Democratic members of the House Ways and Means and Energy and Commerce committees asked the Government Accountability Office (GAO) to examine these dual eligible SNPs.
GAO (1) analyzed the characteristics of dual-eligible beneficiaries in D-SNPs and other MA plans, (2) reviewed differences in specialized services between D-SNPs and other MA plans, and (3) reviewed how D-SNPs work with state Medicaid agencies to enhance benefit integration and care coordination. GAO analyzed CMS enrollment, plan benefit package, projected revenue, and beneficiary health status data; reviewed 15 D-SNP models of care and 2012 contracts with states; and interviewed representatives from 15 D-SNPs and Medicaid agency officials in 5 states.
The GAO report found that although D-SNPs spend a greater proportion of their Centers for Medicare & Medicaid Services (CMS) rebates on supplemental benefits as compared to other MA plans, these plans offer fewer such benefits on average. According to the report, “Of the 10 supplemental benefits offered by more than half of D-SNPs, 7 were offered more frequently by other MA plans and 3 were offered more frequently by D-SNPs.”
The models reviewed describe how the D-SNP planned to provide specialized services, such as health risk assessments, and meet other requirements, such as measuring performance. However, the CMS, which administers Medicare and oversees Medicaid, did not require D-SNPs to use standardized measures in the models of care, which would make it possible to compare the performance of D-SNPs. The report stated that such information would be useful for future evaluations of whether D-SNPs met their intended results, as well as for comparing D-SNPs.