CMS issues new guidelines for Medicare Advantage Special Needs Plans

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The Centers for Medicare & Medicaid Services last Thursday laid out new guidelines governing Medicare Advantage Special Needs Plans that serve Medicare beneficiaries with chronic conditions.  

"Based on the panel's recommendations, we are defining the chronic conditions that certain Medicare special needs plans must use to identify the beneficiary populations eligible for enrollment," said CMS Acting Administrator Kerry Weems.

Special needs plans 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 new guidelines, which are based on recommendations from the Special Needs Plan Chronic Condition Panel, will take effect in 2010. They identify 15 chronic conditions that will dictate eligibility for a Chronic Care Medicare Advantage Special Needs Plan. The 15 chronic conditions include dementia, chronic heart failure, diabetes mellitus, and stroke.

To view the panel's full report, go to