Filed Under:Health Insurance, Ltci

Executive: Let more Medicare plans offer LTC

U.S. Capitol (AP Photo/Jacquelyn Martin)
U.S. Capitol (AP Photo/Jacquelyn Martin)

The private Medicare Advantage plans that serve people with serious chronic health problems could disappear after Dec. 31, 2013.

Karen Ignagni, president of America's Health Insurance Plans (AHIP), reported Thursday at a Medicare Advantage hearing organized by the House Ways and Means Committee's health subcommittee that the law authorizing the existence of Medicare Advantage special needs plans (SNPs) is set to expire at the end of next year.

Congress included the law that created the SNP program in the Medicare Prescription Drug, Improvement and Modernization Act of 2003. 

A SNP is supposed to provide an alternative to traditional Medicare for "dual eligibles" -- consumers who are both poor enough to qualify for Medicaid and either old enough or sick enough to qualify for Medicare; for people who suffer from severe or disabling chronic conditions; or for Medicare enrollees who already live in nursing homes or other long-term care (LTC) institutions or are getting a comparable level of LTC services in the community.

Ignagni testified at the hearing that Congress should act promptly to reauthorize the program, and to provide a longer term reauthorization that covers several years.

The authors of a SNP diabetes care study published in 2012 found that people with diabetes enrolled in a SNP had 7 percent more primary care physician office visits, a 9 percent lower hospital admission rate and 19 percent fewer days in the hospital than comparable patients enrolled in the traditional Medicare program, Ignagni testified, according to a version of her remarks posted on the Ways and Means website.

Dr. Tim Schwab, chief medical officer at SCAN Health Plan, a company that runs SNPs and other Medicare Advantage plans, said he would like to see Congress let all SNPs offer LTC services.

Today, Medicaid pays for nursing home services for the poor.

Traditional Medicare pays for a limited amount of skilled nursing care for enrollees who are recuperating from acute health problems, but it is not supposed to pay for long-term care.

SNPs that serve dual-eligibles can provide LTC benefits, but chronic condition and institutional care SNPs cannot, Schwab said.

Research has shown that providing well-managed LTC services for people with chronic health problems and disabilities can improve those patients' health and lower Medicare costs, Schwab said.

"Extending the availability of these [LTC] services to all SNPs would amplify these results and improve the care available to Medicare beneficiaries," Schwab said.

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