What are I-SNPs?
What is an I-SNP and how do they operate?
An I-SNP is a specialized Medicare Advantage plan that is designed to care for individuals who reside permanently in nursing facilities, typically frail seniors. They are not post-acute patients, they’re individuals who are there 90 days or longer, and who are living within the nursing facility setting. These individuals are often referred to as custodial residents.
I-SNPs also provide services to individuals who reside either in the community or in assisted living facilities that meet the state definition of institutional level of care. I-SNPs can choose to enroll only nursing facility residents or they can file a plan model to also serve nursing facility eligible individuals who reside in the community and/or in assisted living facilities.
There are three types of SNPs that are defined in the Medicare Advantage program.
1. Institutional Special Needs Plan (I-SNP) – These are the plans we are discussing. They serve individuals living in a nursing facility or meet the state definition for NF care and reside in the community.
2. Chronic-Condition Special Needs Plan (C-SNP) – These plans are designed for individuals with chronic care needs who require specialized services to address their specific conditions, i.e., COPD, CHF, diabetes, etc. They have focused programs and benefits based upon the diagnosis they are serving in the C-SNP. C-SNPs are usually community focused.
3. Dual-Eligible Special Needs Plans (D-SNP) – These plans serve people who have both Medicare and Medicaid benefits.
How do I-SNPs work?
How do I-SNPs work with nursing homes?
I-SNPs work within the nursing facility setting, where they market to and enroll individuals who reside in the nursing home. If a nursing facility chooses to enroll in the I-SNP plan, they receive a clinical program which is based upon a Nurse Practitioner, Social Worker, RN and physician collaboration. Each I-SNP designs its own specific Model of Care and works with facility staff to provide an extra layer of on-site clinical expertise and support.
I-SNPs are filed as Medicare Advantage plans. They must meet all the Medicare Advantage regulations including marketing, enrollment, claims processing and more. They are regulated just like any Medicare Advantage plan, but have special requirements because of the populations they serve. I-SNPs have a Model of Care that they design and submit to CMS for approval. The Model of Care lays out the special services, programs and approach to achieve improved outcomes, enhanced quality of life and reduced cost for the individuals they serve.
In a contracted nursing facility, an I-SNP provides reimbursement for the provision of skilled nursing care and Part B services. An I-SNP provides early intervention programs to provide treatment in place whenever possible. They offer a variety of different payment models to help establish a good economic relationship with partners, in addition to clinical programs that are 24/7 provided by Nurse Practitioners and physicians. The nurse practitioners routinely communicate with facility staff, members and their families. The program is based upon both a financial and a clinical model.
How to Leverage an I-SNP
As the Founder/CEO of LightBridge, and you serve a very complex resident population. How do you manage that today?
By using our clinical programs, members have access to 24/7 support. We have quality programs that track quality and utilization. We have close partnerships with the nursing facilities and assisted living facilities where we train and educate their staff on our program. We come in and become a partner, and effectively achieve the success that we’re talking about with quality and clinical outcomes, by really looking at the care that we’re providing.
There is an intense focus on providing the right care at the right time, in the right place. We do as much early intervention as we can, hoping that our nursing home partners will call us even on something subtle. For example, a CNA knows that Mrs. Smith always gets out of bed for breakfast every day, but for the last few days she hasn’t wanted to get out of bed. Well, something’s going on.
We want them to call us so we can come in and take a look. Because we’re a managed care plan, we bring systems to the bedside to provide care and support to keep the individual in their home. Which, in this case, is the nursing home or assisted living facility.
Should SNFs consider creating I-SNPs?
I-SNPs in the right sitting settings and the right relationships are valuable. We have been doing this work for over 20 years now. It’s important to remember that I-SNPs are managed care models, and they are insurance companies. I-SNPs have opportunities and challenges like every sector. They are certainly something providers should explore, depending on their market and their capacities.
If you’re a big provider with lots of financial depth and market position, it makes sense to potentially think about doing this on your own. But again, it’s another business with specific State and Federal laws and regulations that govern their operations.
What makes a skilled nursing facility a good network provider day to day? What can a facility do to make themselves more likely to succeed in an I-SNP arrangement?
A facility that is willing to work collaboratively with an I-SNP in marketing the program to their residents (following CMS guidelines), to implement an effective clinical program and partner with the I-SNP to achieve both clinical and quality outcomes through reduced ER and hospital admissions and early intervention programs.
About the Author
Jill Mendlen is the Founder and serves as President/CEO of LightBridge Hospice and Palliative Care and the Vice President of LightBridge Medical Associates. She also chairs the Board of Directors for LightBridge Hospice Community Foundation. She is a nationally recognized expert in clinical program development, health care management, reimbursement and strategic direction. She has developed and managed a variety of programs designed specifically to provide care to seniors and those with clinically complex medical conditions in a variety of settings including hospitals, skilled nursing facilities, and the community.
Ms. Mendlen is a recipient of the Thomas E. Spindle Award by the California Association of Health Facilities, in recognition of tireless devotion to the long-term care profession. She has been recognized as one of San Diego’s “Most Admired CEOs” and a “SD METRO Mover.”
To learn more about Lightbridge Hospice & Palliative Care, click here.