Medicare Includes Serious Hematologic Diseases in Definition of Chronic Conditions for Special Needs Plans

November 20, 2008 – Medicare identified 15 chronic conditions that Medicare Advantage Special Needs Plans (SNPs) must use to determine beneficiary populations that are eligible for enrollment.   

SNPs are a type of Medicare Advantage plan that serve only beneficiaries living in institutions, eligible for both Medicare and Medicaid, or living with severe or disabling chronic conditions.  The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) directed CMS to convene a panel of clinical advisors to determine the specific chronic conditions that met the statutory definition of a severe or disabling chronic condition in regard to SNPs.

In September, Medicare sought public input on conditions that should be included and ASH commented, recommending Hemophilia, Sickle Cell Disease and Myelodysplastic Syndrome be included as eligible populations for SNPs. 

In addition to the conditions recommended by ASH, the following conditions treated by hematologists/oncologists were included on the list:

• Cancer excluding pre-cancer conditions
• Certain severe hematologic disorders, including:
  • Aplastic anemia
  • Hemophilia
  • Immune thrombocytopenic purpura
  • MDS
  • Sickle-cell Disease (excluding sickle-cell trait)
  • Chronic venous thromboembolic disorder

The panel’s recommendations were based on public input and panelists’ clinical experience, as well as the prevalence of these conditions among people with Medicare.  The full report as well as the complete list of conditions can be found on the CMS Web site.