Reps. Stark and Waxman Release GAO Report Calling for Improvements to Medicare Special Needs Plans

Press Release

Today Ways and Means Subcommittee Ranking Member Pete Stark and Energy and Commerce Committee Ranking Member Henry A. Waxman and released a report they requested of the Government Accountability Office (GAO) that calls on Medicare Special Needs Plans (SNPs) that serve dual eligible beneficiaries to provide better and more standardized reporting on quality and performance measures and increased transparency of care coordination models.

In the past year, much attention has been placed on better coordinating services for dual eligible beneficiaries- those individuals eligible for both Medicare and Medicaid. About 9% of these very vulnerable beneficiaries are enrolled in a Medicare Advantage plan specifically designed to serve the special needs of dual eligible beneficiaries called Dual Eligible Special Needs Plans (D-SNPs).

D-SNPs were created to serve specific populations with unique care needs and help them better negotiate the two healthcare systems they rely on for care. GAO's analysis indicates that D-SNPs are serving these vulnerable populations and provide some additional services and care coordination, but to accurately assess their effectiveness in improving care for beneficiaries relative to other Medicare Advantage plans, to other D-SNP plans, or traditional fee for service Medicare, more information is needed.

"Special Needs Plans are serving the vulnerable Medicare and Medicaid eligible individuals, particularly those that have disabilities" said Rep. Stark. "However, it remains unclear whether they are worth the extra money that we pay. GAO makes specific recommendations to CMS to improve monitoring and reporting of services provided by SNPs. This would be an important step forward to help ensure that taxpayer dollars are being wisely spent by D-SNPs."

"This report reinforces the fact that our work is not done," said Rep. Waxman. "The Affordable Care Act made a number of improvements in the Medicare and Medicaid programs to enhance care for beneficiaries. Today's report indicates that we still don't have a clear picture of the quality of care beneficiaries in Dual Eligible Special Needs Plans receive. To truly improve care for this population, we must be able to hold the plans accountable for the patients they serve through public reporting of more detailed quality and performance information."

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