Institutional SNP (I-SNP)

I-SNPs are SNPs that restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for the mentally retarded (ICF/MR), or an inpatient psychiatric facility. I-SNPs may also enroll MA eligible individuals living in the community, but requiring an institutional level of care, known as Institutional Equivalent SNPs. For more information on the eligibility of these individuals, please see section 20.3.2 of Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual.

We provide more information below on the level of care (LOC) assessment, as well as information on requirements for change of residence, service areas, contracting for LTC, and marketing for I-SNPs.

Level of Care (LOC) Assessment

Determination of institutional level of care (LOC) must be based on the use of a State assessment tool. The assessment tool used for persons living in the community must be the same LOC tool used for individuals residing in an institution. In States and territories without a specific tool, SNPs must use the same LOC determination methodology used in the respective State or territory in which the SNP is authorized to enroll eligible beneficiaries. Refer to section 50.2.2 of Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual for more information on the LOC assessment.

Change of Residency

If an I-SNP enrollee changes residence, the SNP must have appropriate documentation that it is prepared to implement a CMS-approved MOC at the enrollee's new residence in another institution, or in another setting that provides an institutional level of care. Refer to section 30.3.4 of Chapter 2 of the Medicare Managed Care Manual for information on special enrollment procedures for institutionalized individuals.

Service Area Requirements

CMS may allow an I-SNP that operates either single or multiple facilities to establish a county-based service area as long as it has at least one LTC facility that can accept enrollment and is accessible to the county residents. As with all MA plans, CMS will monitor the plan's marketing/enrollment practices and LTC facility contracts to confirm that there is no discriminatory impact in terms of excluding either "sicker," lower-income or minority beneficiaries in its service area.

Contract Requirements for LTC

I-SNPs that serve residents of LTC facilities must own, operate, or have a contractual arrangement with the LTC facility that includes delivery of its SNP MOC. Refer to section 40.5.4 of Chapter 16b (Special Needs Plans) of the Medicare Managed Care Manual for the contract requirements.

Marketing

Marketing materials and outreach for new enrollees must clearly indicate that enrollment is limited to the targeted population and to those beneficiaries who live in, or are willing to move to, contracted LTC facilities. Further guidance on marketing within a health care setting and other I-SNP marketing policies is available in Chapter 3 (Medicare Marketing Guidelines) of the Medicare Managed Care Manual.