C-SNPs are SNPs that restrict enrollment to Medicare eligible individuals who have one or more severe or disabling chronic conditions. The chronic care SNPs available in MN are limited to the following chronic conditions:'

• Cardiovascular disorders
  • Cardiac arrythmias
  • Coronary artery disease
  • Peripheral vascular disease
  • Chronic venous thromboembolic disorder
• Chronic heart failure
• Diabetes

How is eligibility determined for a C-SNP?

To determine eligibility for a special needs beneficiary to enroll in a C-SNP, CMS requires that the C-SNP contact the applicant's existing provider to verify the enrollee has the qualifying conditions. C-SNPs must reconfirm a beneficiary's eligibility at least annually.

MA organizations may request CMS approval to use a Pre-enrollment Qualification Assessment Tool in its process for verifying that a beneficiary is eligible to enroll in a particular C-SNP. CSNPs that enroll applicants based on the information collected using a CMS-approved Pre-enrollment Qualification Assessment Tool must obtain confirmation of the qualifying chronic condition(s) from the existing provider during the first month of enrollment. The organization must inform each enrollee that he/she will be disenrolled from the plan by the end of the second month if eligibility cannot be verified during the first month of enrollment.

The beneficiary can stay enrolled in a Medicare chronic care SNP or Medicare institutional only SNP if the beneficiary continues to meet the condition(s) served by the plan. If they are losing their plan because they no longer meet the plan's conditions, they are eligible for a Special Enrollment Period to join another plan.
 

Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to Medicare Advantage (MA) eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility (ICF) for the developmentally disabled, or an inpatient psychiatric facility A plan that enrolls eligible individuals who continuously reside or are expected to continuously reside for 90 days or longer in a long-term care (LTC) facility.

• These facilities may include a skilled nursing facility (SNF), nursing facility (NF), (SNF/NF), an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID), an inpatient psychiatric facility, and/or facilities approved by CMS that furnishes similar long-term, health care services that are covered under Medicare Part A, Medicare Part B, or Medical Assistance; and whose residents have similar needs and health care status to the other named facility types. An institutional Special Needs Plan must have a contractual arrangement with (or own and operate) the specific LTC facility(ies).

How is eligibility determined for an I-SNP?

An I-SNP can enroll an individual prior to having at least 90 days of institutional level care if the I-SNP completes a CMS-approved needs assessment showing that the individual’s condition makes it likely that either the length of stay or the need for an institutional level-of-care will be at least 90 days.
I-SNPs will enroll MA eligible individuals living in the community, and not in an institution, if they meet both of the following eligibility requirements:

• The I-SNP must determine that an institutional level-of-care is needed based on the use of a MNCHOICES assessment tool. The assessment tool used for persons living in the community must be the same as that used for individuals residing in an institution.
• In States and Territories without a specific tool, SNPs must use the same level-of-care determination methodology used in the respective State or Territory in which the SNP is authorized to operate. 
  • The I-SNP must arrange to have the level-of-care assessment administered by an independent, impartial party with the requisite professional knowledge to accurately identify institutional level-of-care needs. 

The beneficiary can stay enrolled in a Medicare chronic care SNP or Medicare institutional only SNP if the beneficiary continues to meet the condition(s) served by the plan. If they are losing their plan because they no longer meet the plan's conditions, they are eligible for a Special Enrollment Period to join another plan.

What happens if an individual changes residence?

If an I-SNP enrollee changes residence, the SNP must document that it is prepared to implement a CMS-approved Model of Care (MOC) at the enrollee’s new residence in another institution, or in another setting that provides an institutional level of care, as long as the enrollee still resides within the I-SNP’s service area. If the MA organization operating the I-SNP did not submit MOCs for the type of residence in which the enrollee is relocating, such as an LTC facility, the MA organization is required to give the beneficiary the option to disenroll.
 

In 2025, there are four different types of Special Needs Plans.

• FIDE SNP: Fully Integrated D-SNP
  • What it is: FIDE SNPs must cover at least Medical Assistance primary and acute care services and long-term services and supports (LTSS), including at least 180 days of nursing facility coverage during the plan year. FIDE SNPs must also coordinate Medicare and Medical Assistance benefits
  • FIDE SNPs must cover primary and acute care benefits and LTSS, and FIDE SNPs must begin covering behavioral health benefits in 2025
• HIDE SNP: Highly Integrated D-SNP
  • What it is: A Highly Integrated Dual Special Needs Plan (HIDE-SNP) is an integrated care plan that combines the benefits of Medicare and Medical Assistance from a managed care organization (MCO) into a more unified care plan. Although less integrated than FIDE-SNPs, HIDE-SNPs still incorporate both behavioral health and Managed Long-Term Services and Supports (MLTSS) benefits into the plan.
• CO D-SNP: Coordination-Only D-SNP
  • What it is: Does not qualify as FIDE or HIDE SNP. At a minimum must coordinate with Medical Assistance benefits. Must notify the state Medical Assistance office of hospital/SNF admissions for at least one group of for at least one group of high-risk full benefit dually eligible beneficiaries.  Must screen members for housing, transportation and food security during required health risk assessment.
• Applicable Integrated Plans (AIPs)
  • What it is: Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) that operate with exclusively aligned enrollment and cover at least some Medical Assistance benefits (through the D-SNP or an affiliated Medical Assistance managed care plan operated by the same parent organization as the D-SNP). AIPs must implement unified plan-level appeal and grievance processes.