Medicare SNP Members Must Verify Chronic Conditions to Retain Benefits
UHC announced that starting January 1, 2026, it will have new requirements for members of its Special Needs Plans (SNP) (Chronic (C-SNP), Dual-Eligible (D-SNP), and Institutional Equivalent (IE-SNP)) in accordance with new Centers for Medicare & Medicaid Services (CMS) regulations.
With this change, there are new and current SNP members who have a qualifying chronic condition documented to be able to receive Special Supplemental Benefits for the Chronically Ill (SSBCI), in which coverage of healthy food and/or utility expenditures is included. The requirement makes sure that Medicare Advantage plans verify and document the status of each eligible member on the following chronic conditions.
- Autoimmune disorders
- Cancer
- Cardiovascular disorders3
- Chronic alcohol use disorder and other substance use disorders (SUDs)
- Chronic and disabling mental health conditions
- Chronic gastrointestinal disease
- Chronic heart failure3
- Chronic hyperlipidemia
- Chronic hypertension
- Chronic kidney disease (CKD)
- Chronic lung disorders
- Conditions associated with cognitive impairment: Alzheimer’s disease, intellectual disability and developmental disabilities, traumatic brain injuries, disabling mental illness associated with cognitive impairment, and mild cognitive impairment
- Conditions with functional challenges that require similar services, including the following: spinal cord injuries, paralysis, limb loss, stroke, and arthritis
- Dementia
- Diabetes mellitus3
- HIV/AIDS
- Immunodeficiency and immunosuppressive disorders
- Myasthenia gravis/Myoneural disorders and Guillain-Barre syndrome/Inflammatory and toxic neuropathy
- Neurologic disorders
- Overweight, obesity, and metabolic syndrome
- Post-organ transplantation care
- Severe hematologic disorders
- Stroke
The list of eligible conditions may be found at CMS.gov.
Verification Process
C-SNPs and IE-SNPs: The eligibility will be established by using a chronic condition verification form in the registration of the plan and qualification to SSBCI.
D-SNP members: The confirmation will consist of a record attestation of a qualified diagnosis or attestation of the provider. UnitedHealthcare shall also call the office of a provider to verify eligibility in the event that the existence of the record does not prove the same.
The failure to do the verification within 60 days will lead to the loss of SSBCI benefits, although its members may apply to get it after the documentation.
SNPs are set to provide specific care to patients who have chronic or disabling conditions, dual eligibility, or institutional care needs.
To find help or to request additional clarification, medical professionals may contact the representatives of UnitedHealthcare 24/7 through chat on the Provider Portal.
