ACAP Proposes 5 Demonstration Projects Leveraging D-SNPs

The Association for Community Affiliated Plans (ACAP) has proposed five demonstration programs to leverage Dual-Eligible Special Needs Plans (D-SNPs) to improve the quality and accessibility of coverage, better manage chronic conditions and promote aging in place.

ACAP-member plans cover more than 30 million people through Medicaid, Medicare, Health Insurance Marketplaces, the Children’s Health Insurance Program (CHIP) and other publicly supported government programs.

ACAP notes that D-SNP beneficiaries — people who qualify for both Medicaid and Medicare services — often have complex sets of needs, including chronic conditions, behavioral health and long-term care support, aging in place limitations, and more.

ACAP has published a paper after identifying pathways for health plans to improve the health outcomes of beneficiaries as well as non-dually-eligible patients. As the report notes, “effective chronic care management, behavioral health management, and aging in place are complex and challenging propositions. But effective care management is an imperative: in 2021, the last year for which comparable data are available, dually eligible beneficiaries accounted for 31 percent of Medicare spending and 29 percent of Medicaid spending.”

In the report, ACAP encouraged the Centers for Medicare & Medicaid Services (CMS) to engage in five demonstrations aimed at identifying the best strategies for elevating important aspects of care. They include:
 
• “Near-Duals” Demonstration: Designed to improve care coordination and access to care for the “near-duals” population: low-income Medicare beneficiaries who are not currently eligible for Medicaid.
• D-SNP Housing Supports Demonstration: Designed to test the role and impact of D-SNPs partnering and coordinating with housing providers for Medicare beneficiaries to provide enhanced supportive housing services.
• Behavioral Health and SUD Risk Model Innovations: Designed to test risk-adjustment innovations that can improve the accuracy of risk adjustment for Medicare beneficiaries with behavioral health conditions, including severe and persistent mental illness (SPMI) and substance use disorder (SUD) diagnoses.
• Medicare Advantage Coding Reform: Offers solutions for CMS to address coding differences between MA and Medicare fee-for-service (FFS).           
• D-SNP-Specific Quality Measurement System: Designed to correct the measure and quality of care received by D-SNPs beneficiaries.


“Our Safety Net Health Plans are pivotal to the success and sustainability of D-SNPs, as they comparatively direct more money to medical care and less to overhead costs,” ACAP CEO Margaret A. Murray said in a statement. “These proposed demonstrations will improve plans’ management of chronic conditions, and leverage plans’ expertise to improve the sustainability of the Medicare Advantage for Medicare beneficiaries with high levels of medical need.”