CMS Pub. 100-16, ch. mc86c16b, § 10.2

The Medicare Modernization Act of 2003 (MMA) established an MA CCP specifically designed

to provide targeted care to individuals with special needs. In the MMA, Congress identified

“special needs individuals” as: 1) institutionalized individuals; 2) dual eligibles; and/or 3)

individuals with severe or disabling chronic conditions, as specified by CMS. MA CCPs

established to provide services to these special needs individuals are called “Specialized MA

plans for Special Needs Individuals,” or SNPs. 42 CFR 422.2 defines special needs individuals

and specialized MA plans for special needs individuals. SNPs were first offered in 2006. The

MMA gave the SNP program the authority to operate until December 31, 2008.

The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) Extension Act

of 2007 subsequently extended the SNP program from December 31, 2008, to December 31,

2009, but imposed a moratorium that prohibited CMS from approving new SNPs after January 1,

2008. Accordingly, CMS did not accept SNP applications in 2008 for contract year (CY) 2009.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the

Medicare, Medicaid, and SCHIP Extension Act of 2007 moratorium on approving new SNPs.

MIPPA further extended the SNP program through December 31, 2010, thereby allowing CMS

to accept MA applications for new SNPs and SNP service area expansions until CY 2010. CMS

accepted SNP applications from MA applicants for creating new SNPs and expanding existing

CMS-approved SNPs for all three types of specialized SNPs in accordance with additional SNP

program requirements specified in MIPPA. CMS regulations that implement and further detail

MIPPA application requirements for SNPs are located at 42 CFR 422.501-504.

Effective immediately upon its enactment in 2011, section 3205 of the Patient Protection and

Affordable Care Act (“ACA”) extended the SNP program through December 31, 2013, and

mandated further SNP program changes as outlined below. Section 607 of the American

Taxpayer Relief Act of 2012 (ATRA) extended the SNP program through December 31, 2014.

Section 1107 of the Bipartisan Budget Act of 2013 (Pub. L. 113-67) extended the SNP program

through December 31, 2015. Section 107 of the Protecting Access to Medicare Act of 2014

extended the SNP program through December 31, 2016. Most recently, section 206 of the

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the SNP program

through December 31, 2018.

Section 3205 of the ACA amended sections 1859(f)(7), 1853(a)(1)(B)(iv), and 1853(a)(1)(C)(iii)

of the Act to:

• Require all SNPs to be approved by the National Committee for Quality Assurance

(NCQA) (based on standards established by the Secretary) (see section 30.2 of this

chapter);

• Authorize CMS to apply a frailty adjustment payment for Fully Integrated Dual Eligible

(FIDE) SNPs (see section 20.2.5.1 of this chapter); and

• Improve risk adjustment for special needs individuals with chronic health conditions (see

section 20.1.4 of this chapter).