The Medicare Payment Advisory Commission (MedPAC) recently released its
June 2025 Report to Congress, which includes a focused chapter on Medicare beneficiaries in nursing homes. The chapter highlights key demographic trends and care needs and reviews initiatives by the Centers for Medicare and Medicaid Services (CMS) aimed at improving nursing home quality. The report touches on Accountable Care Organizations, but it also emphasizes the role and structures of Institutional Special Needs Plans (I-SNPs) and their impacts on nursing home quality.
Most importantly, MedPAC specifically discusses provider-sponsored I-SNPs – noting their growing role in the delivery of care within nursing homes. The report includes data points that distinguish provider-sponsored I-SNPs from other plan types, highlighting their potential to improve care coordination and outcomes through closer integration with facility operations.
Additional I-SNP highlights include:
- As of 2023, I-SNPs covered about 12% of Medicare nursing home residents, with enrollment growing.
- Access to I-SNPs remains limited, with only 33% of NH residents living in facilities that participate in I-SNPs.
- Of the 31 organizations offering I-SNPs, 23 are provider-sponsored. These plans typically have low enrollment and often operate I-SNPs as their sole Medicare Advantage offering.
- I-SNPs use capitated payments and incentive payments tied to quality and cost, discouraging unnecessary hospitalizations and encouraging in-place treatment.
- Although limited, research suggests that I-SNPs perform better on some quality measures than some MA plans, including reduced inpatient care use by enrollees.
In the report, MedPAC encourages CMS to strengthen data collection and reporting requirements for I-SNPs, particularly around quality metrics and beneficiary outcomes. It also recommends expanding access beyond affiliated facilities to reach more nursing home residents.
The full report is available on the
MedPAC website. Please contact AHCA’s Population Health Policy Analyst
Rohini Achal with questions.