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Chronic Condition SNP (C-SNP)

Chronic condition SNPs (C-SNPs) are SNPs that restrict enrollment to special needs individuals with specific severe or disabling chronic conditions. C-SNPs can focus on monitoring health status, managing chronic diseases, avoiding inappropriate hospitalizations and helping beneficiaries move from high risk to lower risk on the care continuum. Currently, CMS has approved fifteen SNP-specific chronic conditions for which C-SNPs can target enrollment.

This webpage discusses C-SNP related issues, including eligibility verification, prequalification assessment tools, and chronic condition groupings in further detail.

List of Chronic Conditions

A list of these 15 approved chronic conditions, developed by the SNP Chronic Condition Panel and called the "Special Needs Plan Chronic Condition Panel Final Report," is available in the "Downloads" section at the bottom of this page. CMS will periodically re-evaluate the fifteen chronic conditions that meet the definition of severe or disabling as it gathers evidence on the effectiveness of care coordination for chronic conditions through the SNP product.

Verifying C-SNP Eligibility

To determine eligibility for a special needs individual to enroll in a C-SNP, CMS requires that the C-SNP contact the applicant's existing provider or provider's office to verify the enrollee has the targeted condition. C-SNPs must reconfirm a beneficiary's eligibility at least annually. Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual details how MA organizations can use a Pre-enrollment Qualification Assessment Tool, Alternative Verification Methodology, or Expanded Alternative Verification Methodology to verify that a beneficiary is eligible to enroll in a particular C-SNP.

Pre-Enrollment Qualification

All SNPs are required to verify the applicant's special needs status according to the requirements outlined in Chapter 2, "Enrollment and Disenrollment Instructions," of the Medicare Managed Care Manual. C-SNPs have the option of completing this verification process prior to submitting the enrollment to CMS or, as described below, conducting a pre-enrollment assessment and then completing the verification during the first month of enrollment.

CMS may approve an MA organization to use a Pre-enrollment Qualification Assessment Tool to complete the verification process during the first month of enrollment. Refer to section 50.2.1.1 of Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual for details on submitting a Pre-enrollment Qualification Assessment Tool.

MA organizations that have experienced and documented an inordinate delay in getting a timely response from providers may develop and submit an expanded alternative verification methodology that meets CMS recommended practices for CMS approval. Refer to sections 50.2.1.2 and 50.2.1.3 of Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual for details on alternative verification methodology and expanded alternative verification methodology procedures.

Grouping Chronic Conditions in C-SNP Plan Benefit Packages (PBPs)

When completing the SNP proposal application, MA organizations can choose to offer a C-SNP that targets any one of the groups below:

  1. A single CMS-approved chronic condition;
  2. A CMS-approved group of multiple chronic conditions; or
  3. An MA organization-customized grouping of multiple chronic conditions selected from the 15 CMS-approved SNP-specific chronic conditions.

CMS will accept proposals with the following multi-condition groupings:

  • Group 1: Diabetes mellitus and chronic heart failure
  • Group 2: Chronic heart failure and cardiovascular disorders
  • Group 3: Diabetes mellitus and cardiovascular disorders
  • Group 4: Diabetes mellitus, chronic heart failure, and cardiovascular disorders
  • Group 5: Stroke and cardiovascular disorders

For MA organizations that are approved to offer a C-SNP targeting one of the above-listed groups, beneficiaries need only to have one of the qualifying conditions for enrollment.

MA organizations may develop their own multi-condition SNP combinations for enrollees with all of the qualifying chronic conditions in the combination. MA organizations interested in pursuing this option for multi-condition C-SNPs are limited to groupings of the same 15 approved chronic conditions that other C-SNPs must select. CMS will carefully assess the prospective multi-condition SNP proposal to determine the adequacy of its care management system for each condition in the combination.