1. Special Needs Plans (SNP) Overview of SNP Assessment and S&P Measures June 2010

2. 2 ACAP Presentation June 2, 2010 Objectives of SNP Assessment Program Develop a robust and comprehensive assessment strategy Evaluate the quality of care SNPs provide Evaluate how SNPs address the special needs of their beneficiaries Provide data to CMS to allow plan-plan and year-year comparisons

3. 3 ACAP Presentation June 2, 2010 Three-Year Strategy Phase 1 -FY 2008Phase 2 - FY 2009Phase 3 - FY 2010 SNPs Effective as of January 2007SNPs Effective as of January 2008SNPs Effective as of January 2009 HEDIS 2008HEDIS 2009HEDIS 2010 Measure Development 13 existing measures Same as 2009 Introduced 2 new measures -- Care for Older Adults -- Medication Reconciliation Post-discharge In development for 2011 Plan all-cause readmissions Structure & Process Measures SNP 1: Complex Case Management SNP 1-3 Refinement of existing measures: SNP 4 & 6 SNP 2: Improving Member Satisfaction SNP 4: Care Transitions Begin work to focus on evidence of implementation SNP 3: Clinical Quality Improvements SNP 5: Institutional SNP Relationship with Facility SNP 6: Coordination of Medicare & Medicaid

4. 4 ACAP Presentation June 2, 2010 Delivered Final SNP Report to CMS (HEDIS & S&P measures data) SNP Conference-January 8, 2010 – Nearly 200 attendees – Focus on best practices (SNP 4-6) & academic rationale for S&P measures Finalized & Published 2010 Reporting Requirements Since We Last Met

5. 5 ACAP Presentation June 2, 2010 S&P measures: What’s New for 2010 – Modified the structure of a few existing elements – Clarified required data sources – An actual analysis of performance managing and supporting transitions for SNP 4 Elements A and B is required

6. 6 ACAP Presentation June 2, 2010 S&P Measures: What’s New for 2010 SNP 4: Care Transitions – Refined Measures Split 4A into two elements – All SNP Types – Focus on how SNPs manage and support members through planned and unplanned transitions in care SNP 6: Coordination of Medicare and Medicaid Coverage – Refined Measures Split 6A into two elements – Different requirements for Duals and I & C SNPs – Focus on coordination and administration of benefits for Duals

7. 7 ACAP Presentation June 2, 2010 Who Reports HEDIS measures – All SNP plan benefit packages with 30+ members as of February 2009 Comprehensive Report (CMS website) S&P measures – All SNP plan benefit packages – Plans with zero enrollment are exempt for certain elements

8. 8 ACAP Presentation June 2, 2010 What to Report S&P measures Returning Survey — All SNPs that were operational as of January 1, 2009, reported in 2009 AND renewed in 2010. Previously submitted. – SNP 4 & 6 only Initial Survey — All SNPs operational as of January 1, 2009, renewed in 2010 AND did not previously report. – SNP 1-6

9. 9 ACAP Presentation June 2, 2010 Project Time Line – Phase III February 8 - Final S&P measures released March through May – Training for SNPs March 29 - Release ISS Data Collection Tool for S&P Measures April - Release IDSS Data Collection Tool for HEDIS measures June 30 - HEDIS submissions and S&P measures submissions due to NCQA October 29 - NCQA delivers SNP Assessment Report to CMS

10. 10 ACAP Presentation June 2, 2010 Project Timeline—Phase IV S&P measures submission date will change in 2011 Release Phase IV S&P measures-3 rd Qtr 2010 Conduct trainings/tech assistance-4 th Qtr 2010 Phase IV S&P measures due- February 28, 2011

11. 11 ACAP Presentation June 2, 2010 2012 and Beyond Section 3205 of The Patient Protection and Affordable Care Act signed into law on March 23, 2010 states: AUTHORITY TO REQUIRE SPECIAL NEEDS PLANS BE NCQA APPROVED.— For 2012 and subsequent years, the Secretary shall require that a Medicare Advantage organization offering a specialized MA plan for special needs individuals be approved by the National Committee for Quality Assurance (based on standards established by the Secretary).’’ What does this mean for the SNPs?

12. SNP Structure and Process Measures

13. 13 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 1: Complex Case Management All SNP Types; Initial SNP Surveys only Focuses on how SNPs assist members with multiple or complex conditions obtain access to care and services and coordinate their care. What’s new for 2010? – No changes from 2009

14. 14 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 2: Improving Member Satisfaction – All SNP Types; Initial SNP Surveys only – Focuses on how the SNP assesses and improves member satisfaction. – What’s new for 2010? – Not requiring SNP 2C (SNP 7A) this year.

15. 15 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 3: Clinical Quality Improvement – All SNP Types; Initial SNP Surveys only – Focuses on how the SNP works to improve the quality of clinical care for members – What’s new for 2010? – Not requiring SNP 3B (SNP 7B) this year.

16. 16 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 4: Care Transitions – All SNP Types – Focuses on how SNPs manage planned and unplanned transitions of care for members – What’s new for 2010: Split Element A into two elements: – Focus on activities directed toward providers, care settings – Focus on activities directed at patients/caregivers Clarified documentation requirements—two data sources required for each factor Actual analyses required Actual reports required—no shells, templates, formats

17. 17 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 5: Institutional SNP Relationship with Facility – (Institutional-SNPs only) – Focuses on ensuring SNP members in Institutional facilities receive comprehensive quality care – No Changes to requirements in 2010

18. 18 ACAP Presentation June 2, 2010 Structure & Process Measures SNP 6: Coordination of Medicare and Medicaid – Different requirements for Duals and Institutional &Chronic SNPs – Focuses on how SNPs help members obtain benefits/services regardless of payer. – What’s new for 2010: Split Element A into two elements: – Focus on patient-directed actions – Focus on internal plan actions

19. 19 ACAP Presentation June 2, 2010 What happens after submission? NCQA Analysis of HEDIS and S&P measures – Comparison to MA plans (HEDIS) and to other SNPs – Demographic (size, type, region) – Statistical significance Deliver report to CMS – CMS will make all decisions regarding the use of the data – NCQA will not publicly report any of the SNP data

20. 20 ACAP Presentation June 2, 2010 Questions?

21. Additional Resources

22. 22 ACAP Presentation June 2, 2010 Additional Resources NCQA SNP Web page www.ncqa.org/snp www.ncqa.org/snp –S&P measures –Training materials (Webex audio and slides) –Scoring Guidelines and ISS Toolkit –FAQs NCQA Policy Clarification Support (PCS) http://app04.ncqa.org/pcs/web/asp/TIL_ClientLogin.asp