Community-Based Institutional Special Needs Plan (CBI-SNP)

Summary – Community Based-Institutional Special Needs Plan (CBI-SNP) Demonstration 116th Congress
 
The Community-Based Institutional Special Needs Plan (CBI-SNP) legislation would establish a demonstration program to provide low-income, Medicare-only beneficiaries with additional long-term services and supports (LTSS) to help them avoid institutionalization and remain in their homes.  SCAN Health Plan and a consortium of national health organizations support this legislation.
 
Goals
  • Increase beneficiaries’ ability to remain in their homes despite levels of frailty that would qualify them for nursing home care
  • Decrease Medicare spending by helping beneficiaries avoid unnecessary hospitalizations and emergency room (ER) visits
  • Reduce Medicaid spending by decreasing the number of at-risk Medicare beneficiaries who become institutionalized and then exhaust their resources and become eligible for Medicaid 
 
Scope
  • Five-year demonstration program
  • Up to five Medicare Advantage SNPs can participate
  • No more than 1,000 enrollees in each site 
 
Eligibility
  • Medicare beneficiaries 65+ with incomes below 150% of the federal poverty level who are not eligible for Medicaid
  • Participants must have two or more activities of daily living limitations (e.g., eating, bathing, toileting)
 
Need for Demonstration
  • Targets pre-duals (dually eligible individuals who receive both Medicaid and Medicare benefits)
  • Provides specific funding for critical LTSS (supplemental benefits offered by Medicare Advantage plans are not funded) 
  • Compares impact of LTSS between Medicare Fee-for-Service and Medicare Advantage populations

Outcome Measures
  • Improved beneficiary health and quality of life
  • Reduced hospitalizations and Medicaid nursing home admissions and lengths of stay
  • The number of beneficiaries who do not progress from near-dual to dual status
  • Caregiver satisfaction
 
Investment
  • Eligible beneficiaries would receive, on average, no more than $400 per month of community-based LTSS, which would be administered by selected Medicare Advantage plans
  • Budget neutral after three years; without evidence of savings, the demonstration would stop• Congressional Budget Office estimates that this demonstration would cost $21 million over 10 years
  • Congressional Budget Office estimates that this demonstration would cost $21 million over 10 years