Institutional Special Needs Plans (I-SNPs) remain a small part of the overall Medicare Part C landscape, but they are quickly rising in popularity.
This is a Medicare Part C plan that is exclusively designed to provide dedicated care coordination to a particular individual – this means I-SNP benefits are designed for those with special health care needs. In an I-SNP, the target populace is institutionalized individuals – this means that you must stay in a long-term nursing care facility with no urgent plans to leave.
In effect, an I-SNP is an all-in-one Medicare Advantage plan that usually covers prescription drugs, inpatient services, and outpatient services. The aim is to treat beneficiaries proactively in place and avert unnecessary ED visits, hospitalizations, and readmissions. Long-term hospitalizations can result in frailty and confusion.
For a Medicare Advantage I-SNP to enroll MA eligible individuals, the following conditions must be met:
The institutional level of care is determined based on the use of a state assessment tool. The tool used for those living in a community must be the same as the assessment tool used for those staying in an institution. However, in a location without a specific assessment tool, Institutional Special Needs Plans must utilize the same Level Of Care determination approach used in the respective location in which the plan is authorized to sign up eligible people.
The plan must also make a plan to have the Level Of Care assessment run by an independent party with the mandatory professional knowledge to identify the institutional Level Of Care needs accurately. Importantly, Institutional Special Needs Plans cannot control or own the entity.
What is the Requirement for Change of Residence for I-SNPs?
If, as an Institutional Special Needs Plans enrollee, you change your residence, the Institutional Special Needs Plans must document that it is ready to implement the Centers for Medicare and Medicaid Services (CMS) approved Model of Care (MOC) at your new residence.
If you need more information about Medicare Advantage I-SNPs, contact Kannonball Insurance Solutions today. Our experienced Medicare experts are always available to assist you.