Chronic Condition Special Need Plans (C-SNP)

Chronic Condition Special Needs Plans (C-SNPs) restrict enrollment to special needs individuals with specific severe or disabling chronic conditions. C-SNPs 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. CMS has approved 15 SNP-specific chronic conditions for which C-SNPs can target enrollment.

Please visit the following sections for more information on D-SNPS.  

List of Chronic Conditions

C-SNPs enroll special needs individuals “who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.” The SNP Chronic Condition Panel developed a list of 15 SNP-specific chronic conditions:

 

The SNP Chronic Condition Panel developed a list of 15 SNP-specific chronic conditions:
  1. Chronic alcohol and other drug dependence
  2. Autoimmune disorders limited to:
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Polymyositis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
  3. Cancer, excluding pre-cancer conditions or in-situ status
  4. Cardiovascular disorders limited to:
    • Cardiac arrhythmias
    • Coronary artery disease
    • Peripheral vascular disease
    • Chronic venous thromboemolic disorder
  5. Chronic heart failure
  6. Dementia
  7. Diabetes mellitus
  8. End-stage liver disease
  9. End-stage renal disease requiring dialysis
  10. Severe hematologic disorders limited to:
    • Apastic aneima
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodysplatic syndrome
    • Sickle-cell disease (excluding sickle-cell trait)
  1. HIV/AIDS
  2. Chronic lung disorders limited to
    • Asthma
    • Chronic bronchitis
    • Emphysema
    • Pulmonary fibrosis
    • Pulmonary hypertension
  3. Chronic and disabling mental health conditions limited to:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
  4. Neurologic disorders limited to
    • Amyotrophic lateral sclerosis (ALS)
    • Epilepsy
    • Extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia)
    • Huntington’s disease
    • Multiple sclerosis
    • Parkinson’s disease
    • Polyneuropathy
    • Spinal stenosis
    • Stroke-related neurologic deficit
  5. Stroke
  • The list of SNP-specific chronic conditions is not intended for purposes other than clarifying eligibility for the C-SNP coordinated care plan (CCP) benefit package. CMS will periodically re-evaluate the fifteen chronic conditions as evidence is gathered on the effectiveness of care coordination through the SNP product, and as health care research demonstrates advancements in chronic condition management.

    For more information on C-SNP chronic conditions, please visit Section 1859(b)(6)(B) (iii) of the Social Security Act, Medicare Managed Care Manual (MMCM), chapter 16b (mc86c16b), section 20.1.2 and the SNP Frequently Asked Questions (FAQ) which can be accessed below in the Download Section below.

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    C-SNP Plan Benefit Packages

    C-SNPs are expected to have specially-designed Plan Benefit Packages (PBPs) that offer benefits and services that go beyond the provision of basic Medicare Parts A and B services and care coordination required of all CCPs.

    These specially-designed PBPs should include, but not be limited to:

    1. Supplemental health benefits specific to the designated chronic conditions
    2. Specialized provider networks specific to the designated chronic conditions
    3. Appropriate enrollee cost sharing structured around the designated chronic conditions and co-morbidities for all Medicare-covered and supplemental benefits.

    Grouping Chronic Conditions in Plan Benefit Packages

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

    1. A single CMS-approved chronic condition;
    2. A CMS-approved grouping 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 applications with the following five CMS approved 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. MA organizations pursuing this customized option must verify that individual enrollees have ALL of the qualifying conditions in their multi-condition SNP combination. MA organizations interested in pursuing this option for multi-condition C-SNPs are limited to groupings of the same 15 CMS-approved chronic conditions. 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.

    For more information on C-SNP PBPs, please visit the Medicare Managed Care Manual (MMCM), chapter 16b (mc86c16b), section 20.1.2 and the SNP Frequently Asked Questions (FAQ) which can be accessed below in the Download Section below.

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    Verification of Eligibility for Chronic Condition Special Needs Plans

    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 to verify that the enrollee has the qualifying conditions. C-SNPs must reconfirm a beneficiary's eligibility at least annually.

    MA organizations may request CMS approval to use a Pre-enrollment Qualification Assessment Tool to verify that a beneficiary is eligible to enroll in a particular C-SNP. C-SNPs that enroll applicants based on the information collected using a CMS-approved Pre-enrollment Qualification Assessment Tool must obtain confirmation of the qualifying chronic condition(s) from the existing provider during the first month of enrollment. The organization must inform each enrollee that he/she will be disenrolled from the plan by the end of the second month if his/her eligibility cannot be verified during the first month of enrollment.

    For more information on C-SNP PBPs, please visit the Medicare Managed Care Manual (MMCM), chapter 16b (mc86c16b), section 20.1.2 and the SNP Frequently Asked Questions (FAQ) which can be accessed below in the Download Section below.

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