Special Needs Plans (section 231 of the Medicare Modernization Act of 2003) are a cost-cutting measure targeting "Institutionalized, dual eligibles and beneficiaries with severe or disabling chronic conditions." New to the scene and using lots of governmental dollars to establish their paperwork rules, the public was invited to comment on proposed structure and process measures--um...that date just passed.
The fact that most of us did not know about the public comment period, should raise a red flag for SNP's that are going to cost-cut by implementing closer scrutiny of treatment management, medication management and eligibility in conjunction with the goal of reducing costs for those eligible for SNP's.
While the plans are fairly new and are "phasing-in", note that the different private companies offering the plans is neither listed nor are they compared to one another (so much for quality assurance). Further, while the plans may be linked to certain long term care insurers, it is not clear what will happen with other long-term care policies sold prior to eligibility nor is it clear what will happen if a provider is sold during the enrollment period.
Private insurers offering SNP's will have new hoops for their members to jump through in order to effectively manage costs (and hopefully treatment) for insureds (including ongoing determination of eligibility for enrollment in SNP's: determined by whom? Nursing homes? Long term care contractors?). However, back to the public comment period....If it's impossible to get the word out that the public's opinion is desired regarding SNP's, how on earth are quality assurance surveys going to effectively reach those living the reality of this insurance product? And when those who receive services are too sick to be bothered are their nearest relatives asked to fill out the form?
Mostly it seems like the SNP's are going to try to reduce hospital stays, any service that seems remotely duplicative, and unnecessary medical expenses, hopefully both controlling cost and contributing to better health---but how will this occur? With new money to be made (and the reimbursement schedule will be modified to cover these greater risks), it seems to be just a new tier of bureaucracy with new opportunities for wasted tax dollars and abuses within the private organizations biting into this new piece of pie.
