Institutional Special Needs Plans and Hospice Enrollment in Nursing Homes: A National Analysis

BACKGROUND Institutional Special Needs Plans (I-SNPs) in nursing homes could impact hospice use by residents with advanced illness. Little is known about their relationship. OBJECTIVE To determine whether I-SNP availability has been associated with changes in hospice utilization. DESIGN Federal data from 2011 and 2013 were extracted from the Minimum Data Set (MDS) and other sources. Multilevel models evaluated I-SNP-, resident-, and facility-related variables as predictors of hospice utilization. SETTING All US nursing homes in 2011 (N = 15 750) and 2013 (N = 15 732). PARTICIPANTS Nursing home residents enrolled in Medicare or in both Medicare and Medicaid. MEASUREMENTS Nursing home and resident data were obtained from Centers for Medicare and Medicaid Services sources: the MDS 3.0, Master Summary Beneficiary File, and Special Needs Plan Comprehensive Report. RESULTS The mean number of residents per nursing home was 210.9 (SD = 167.1) in 2011 and 217.2 (SD = 171.5) in 2013. The prevalence of I-SNP contracts in nursing homes increased between 2011 and 2013, from 55.2% (N = 8691) to 61.1% (N = 9605), respectively (P