Institute for International Research

Monday, June 19th, 2006

Establishing and Managing a Successful Special Needs Program to Leverage Opportunities Created by the 2003 Medicare Modernization Act

The MMA established SNPs for high-risk beneficiaries with complex care needs, including those dually eligible for Medicare and Medicaid, those living in nursing homes and those with severe or disabling chronic conditions. In 2005, CMS approved 270 Special Needs Plans for operation beginning January 1, 2006. In this seminar participants hear strategies for implementation and management from State representatives and SNP executives who successfully launched Special Needs Program in 2006. Specifically seminar leaders provide:

Part I: Overview

• Status of SNPs launched January 1st, 2006
• Experience of States applying for waivers to integrate SNPs into Medicaid
• Different payment models between SNP, Medicare, and Medicaid
• Strategies for transitioning members between FFS, Medicare, Medicaid, and Special Needs Plans

Part II: Clinical Management

• Strategies for selecting which populations to serve and which markets to focus on
• Pharmacy management for dual eligibles
• Managing benefits and managing the special healthcare need of this population including medication management for individuals with 5 co-morbidities

Part III: Operational and Financial Management

• Integration of Medicare and Medicaid – integration of operations, differences and requirements, appeals and grievances, marketing requirements
• Determining SNP Market Strategy for your Medicaid Managed Care Company
• Degree of federal-state cooperation vs. confusion and sometimes even worse
• Developing enough scale for SNPs to cover administrative expense and have a stable actuarial pool

Who Should Attend
Executives responsible for the development and management of a Special Needs Plan and State representatives looking for ways to more effectively work with Special Needs Plans.

Seminar Leaders
James M Verdier, Senior Fellow
MATHEMATICA POLICY RESEARCH, INC. (Moderator)

Patrick Blair, Senior Vice President, Performance Improvement
AMERIGROUP CORPORATION

Alan Lazaroff, MD, Director of Geriatric Medicine
CENTURA SENIOR LIFE CENTER

Robert J Master, MD, President and Chief Medical Officer
COMMUNITY CARE ALLIANCE

Pam Parker, Director, Integrated Purchasing Service
MINNESOTA DEPARTMENT OF HEALTH AND HUMAN SERVICES

Patricia Smith, Director Health Plans Benefits Group
CENTERS FOR MEDICARE AND MEDICAID SERVICES (invited)