Special needs plans as pilot options

[cphi...@snpalliance.org]

Because special needs plans serve some of the most high cost and vulnerable populations - having access to such data would allow for much more seamless care coordination between settings and providers and improve patient outcomes.  Might Special Needs Plans be considered to participate in such a pilot?

[Amy Gleason]

Thanks for the question. My understanding is that Special Needs Plans are Medicare Advantage plans. The Data at the Point of Care project is for Original Medicare claims and does not have Medicare Advantage data. Please let me know if i am misunderstanding the question.

Sincerely,

Amy Gleason

[suk...@forcetherapeutics.com]

If the patient has an MA plan are these claims not available through the point of care project? Does CMS never receive claims from patients who have medicare advantage?

[Megan McFeely]

Thanks for reaching out! The DPC project is only focused on providing data from claims submitted to Original Medicare. 

You may want to check directly with your Medicare Advantage plan providers to see if they offer something similar - we are open sourcing the DPC code for reference.

Best,

Megan McFeely

DPC Community Manager

[suk...@forcetherapeutics.com]

Hi Megan, Thank you for the reply. Is this also true for claims through Blue Button project? Are only original Medicare claims available?

Thanks!

Suketu 

[Megan McFeely]

Hi Suketu,

More information about data provided through Blue Button is available here: https://www.medicare.gov/manage-your-health/medicares-blue-button-blue-button-20.

[Steven Stein]

Does the ISNP get access to the same 4 years of Medicare Part A, B and D info when it enrolls a long stay nursing home resident as what they would get through DPC?  I don’t think so.

[Data at the Point of Care (DPC) Community]

Hello,

DPC provides adjudicated FFS Medicare claims data for Part A, B, and D. This does not include Medicare Advantage data. 

A provider participating in an Institutional Special Needs Plan (I-SNP) could get access to this Medicare FFS claims data. However, an I-SNP itself would not be able to access data through the DPC pilot. At this time, CMS requires practitioners to attest that they have a treatment related purpose for requesting claims data. 

Please let us know if you have any other questions. 

Best,
The DPC Team