Latest news with #I-SNP
The Hill
07-08-2025
- Health
- The Hill
Democrats press UnitedHealth Group over nursing home policies
Democratic Sens. Ron Wyden (Oreg.) and Elizabeth Warren (Mass.) are launching an investigation into UnitedHealth Group (UHG) over its actions reportedly steering seniors away from hospital visits for the sake of cutting costs. In a letter to UHG CEO Stephen J. Hemsley, Wyden and Warren cited reporting from outlets including The Guardian that said his company was paying nursing homes to reduce hospital transfers of sick patients. The senators wrote that UHG representatives told them bonus programs for nursing homes are offered to encourage 'adherence to certain quality measures.' One of these programs allows for nursing homes to receive bonuses if they reach certain levels of influenza and pneumococcal vaccination rates and cholesterol medication adherence rates, while also maintaining a hospital admission per thousand rate below a certain threshold. They also pointed to UHG institutional special needs plans, provided through its subsidiary Optum, which reportedly disincentivize 'medically-necessary hospitalizations and emergency room visits.' These plans also reportedly pressure nursing home residents to sign 'do not resuscitate' (DNR) and 'do not intubate' (DNI) orders. At the time of The Guardian's reporting in May, UHG denied it was preventing hospital transfers or pushing patients to sign DNRs and DNIs. 'Put simply, these allegations suggest that UHG appears to be prioritizing its bottom line at the expense of the health and safety of nursing home residents enrolled in UHG I-SNPs. Nursing home residents and their families should not live in fear of a for-profit health care company withholding care when it is most critical,' the lawmakers wrote. Though they expressed their support for evidence-based models that reduce 'unnecessary hospitalizations of nursing home residents,' Wyden and Warren noted a briefing with UHG representatives did not resolve their concerns surrounding these reports. The lawmakers requested information on UHG's I-SNP model, Optum's policies on transferring residents on I-SNP to the hospital as well as information on its bonus programs. 'Any attempt to take advantage of vulnerable nursing home residents is unacceptable, especially to pad a for-profit insurance company's revenues. It is vital that UHG respond to these alarming reports and provide prompt, detailed responses to our questions,' wrote Wyden and Warren.
Medical News Today
04-08-2025
- Health
- Medical News Today
What to know about Medicare Advantage Institutional Special Needs Plans (I-SNP)
Institutional special needs plans (I-SNP) are specialized Medicare Advantage plans for people who live in a care facility for at least 90 days or those who live in the community and require the care that facilities can Advantage (Part C) offers special needs plans (SNPs) that provide benefits and services specifically for people who have severe chronic conditions, certain healthcare needs, or who also qualify for Medicaid. There are three types of SNPs: Instituational SNP (I-SNP)Chronic Condition SNP (C-SNP)Dual Eligible SNP (D-SNP)What is an I-SNP?An I-SNP is a SNP where enrollment is limited to individuals with Medicare Advantage (Part C) plans who have had or are expected to need a level of care and services provided in:long-term care skilled nursing facilitiesnursing facilitiesintermediate care facility for individuals with intellectual disabilitiesinpatient psychiatric facilityIn order to qualify for an I-SNP, a person must require this care for at least 90 days. »Learn more: Medicare SNPsWhat do I-SNPs cover?All Medicare Advantage plans must offer the same coverage as Original Medicare (parts A and B). This means these plans cover inpatient care, outpatient care, hospice care, some home healthcare, and preventive care. While many Medicare Advantage plans offer prescription drug coverage (Part D), all SNP plans are required to include prescription drug coverage. SNPs may also include additional benefits, such as a care manager to assess a person's needs, provide supervision of their care, and advise on how best to manage health conditions. SNPs may offer coverage for dental, vision, and hearing. It is important to check the individual plan for additional benefits. Who is eligible for I-SNPs? In order for a person to join an SNP, they must meet these requirements: have both Medicare Part A and Part Blive within the plan's service areaIn order to be eligible for an I-SNP specifically, they must meet these requirements:living in the community but requiring the level of care a facility offersliving in or expected to live in a facility for at least 90 days, including: nursing homeintermediate care facilityskilled nursing facilityrehabilitation hospitallong-term care hospitalswing-bed hospitalpsychiatric hospitalother facility that offers similar long-term healthcare servicesWhat is the difference between an IE-SNP and an I-SNP?An I-SNP, known as an institutional-equivalent special needs plan (IE-SNP), is for people who require a level of care provided by facilities but are able to remain living within the may include people with chronic conditions who require extra help in accessing care, managing medications, or using appropriate levels of care. Chronic conditions that may require an IE-SNP include: congestive heart failurediabeteschronic obstructive pulmonary disorder (COPD)cardiovascular diseaseschronic kidney disease (CKD)depressiondementiaobesityany condition that impairs a person's functional statusIn order to qualify for an IE-SNP, a person will typically need an assessment by an impartial representative from their state. How is an I-SNP different from other SNPs? An I-SNP is just one type of SNP. Each plan has its own requirements and additional coverage options.C-SNPC-SNPs are specialized plans for individuals with one or more severe or disabling chronic conditions. People who qualify for C-SNPs must have a high risk of hospitalization or adverse health outcomes. Qualifying chronic conditions include:cancercertain autoimmune disorderschronic alcohol or substance dependencecardiovascular disordersdiabeteschronic heart failuredementiaend stage liver diseaseend stage renal disease (ESRD)HIV, including stage 3 HIVcertain chronic lung disordersstroke»Learn more: Medicare C-SNPD-SNPD-SNPs are plans specifically for people who are eligible for both Medicare and Medicaid. This is the only eligibility requirement for this type of plan. D-SNPs offer help to coordinate a person's Medicare and Medicaid benefits. »Learn more: Medicare D-SNPMedicare resourcesFor more resources to help guide you through the complex world of medical insurance, visit our Medicare are specialized Medicare Advantage plans that are designed for individuals with specific care needs or those who are eligible for both Medicare and Medicaid. I-SNPs are plans for people who are living or are expected to live in a care facility for at least 90 days. I-SNPs can also be used for people who still live in the community but require the level of care available in a facility.
Associated Press
04-03-2025
- Health
- Associated Press
CareSource and ElderServe Health seek affiliation to strengthen long-term care for older adults and adults with disabilities in New York
DAYTON, Ohio and NEW YORK, March 04, 2025 (GLOBE NEWSWIRE) -- CareSource, a nationally recognized nonprofit managed care organization, today announced that it will seek an affiliation with ElderServe Health, Inc., dba RiverSpring Health Plans (ElderServe Health) through a change-of-control transaction. Subject to state regulatory approval, RiverSpring Living will end its affiliation with ElderServe Health, which will join CareSource's family of brands. CareSource will strengthen ElderServe Health's ability to provide high-quality long-term support services, with both organizations bringing their shared members-first approach to more New Yorkers, while RiverSpring Living will focus on residential, supportive and assisted living. 'As demographics continue to shift, the need for long-term services and support will triple by 2050,' said Erhardt Preitauer, president and CEO, CareSource. 'We are passionate about transforming care for individuals with complex health needs, enabling them to live healthier, fuller lives. Growing our family of brands allows us to deepen our collective impact by improving quality of life and health outcomes for some of the most vulnerable populations in our country.' ElderServe Health provides long-term care services to more than 20,000 older adults and adults with disabilities in New York City and Westchester, Nassau and Suffolk counties. The organization serves a frail and elderly or disabled, predominantly dual-eligible membership enrolled in one of the following programs: New York State Medicaid Managed Long Term Care Program, Medicare Advantage Institutional Special Needs Plan (I-SNP) or Medicaid Advantage Plus / Medicare Advantage Dual Eligible Special Needs Program (D-SNP MAP). 'CareSource's innovation and managed care expertise will support ElderServe Health's commitment to high-quality care and strong community connections,' said Scott Markovich, EVP, markets and products, CareSource. 'We are excited to join forces with a like-minded, mission-driven organization to further improve care and services for New Yorkers.' Approximately 3.5 million New Yorkers are aged 65 or over, making it the most rapidly growing segment of the state's population, and more than half will require long-term care during their lifetime. Additionally, over a million New Yorkers with disabilities, chronic illnesses or other functional complications are anticipated to need long-term care services. The CareSource and ElderServe Health affiliation is designed to help fill these critical, long-term care needs for New York's growing population of older adults and adults with disabilities. 'CareSource's mission-driven commitment is exemplary, and they are ideally suited to acquire control of ElderServe Health,' said David V. Pomeranz, President & CEO of RiverSpring Living. 'RiverSpring Living will continue to prioritize residential, supportive and assisted living at our Riverdale campus.' ElderServe Health headquarters and employees will remain in New York. There is no anticipated disruption to member coverage as ElderServe Health becomes part of the CareSource family of brands. 'For our members, this transition should be seamless – they will continue to receive care management from the same trusted team and have the same access to the services that matter most,' said Susan Aldrich, executive vice president, ElderServe Health. 'Our new partnership will further enhance the quality of care and provide even more resources, ensuring that we are always meeting the evolving needs of our members.' About CareSource CareSource is a nonprofit, nationally recognized managed care organization with over two million members. CareSource administers one of the largest Medicaid managed care plans in the U.S. The organization offers health insurance, including Medicaid, Health Insurance Marketplace and Medicare products. As a mission-driven organization, CareSource is transforming health care with innovative programs that address the social determinants of health, health equity, prevention and access to care. For more information, visit us at or follow us on X, formerly known as Twitter, LinkedIn or Facebook. ElderServe Health, Inc., dba RiverSpring Health Plans is a mission driven, not-for-profit managed care organization serving the New York metropolitan area, with over 20,000 members, all of whom are frail and elderly or disabled. Its team has decades of experience managing care by paying attention to individuals, their environments and their health issues. We are about the whole person. ElderServe Health offers Medicaid managed long-term care, Medicare-only and integrated Medicaid-Medicare plans. In all plans, clinical staff work with members to develop care plans, assure that they are effective and that they change to meet evolving needs. Our goal is helping our members be as healthy and independent as possible.
