New federal rules released in April 2019 require that Dual Eligible Special Needs Plans (D-SNPs) must, at a minimum, coordinate the delivery of Medicare and Medicaid benefits. The final rule includes new regulatory language effective January 1, 2020 and provides examples of ways that D-SNPs should coordinate their members’ Medicare and Medicaid services. This technical assistance brief discusses issues and options for states to support D-SNPs in meeting this requirement.
As of 2021, the contracts that Dual Eligible Special Needs Plans (D-SNPs) have with state Medicaid agencies must include not just the elements specified by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008, but also new language detailing the requirements issued by CMS in April 2019 to increase the level of Medicare and Medicaid coordination and integration provided by these plans. This technical assistance tool provides sample contract language that states can use in their D-SNP contract to comply with these requirements. Use of this language in the contract does not guarantee that CMS will approve the D-SNP to operate.
This technical assistance tool offers key questions and considerations that states can review as they begin working with Dual Eligible Special Needs Plans (D-SNPs) and other parties to design and implement information-sharing requirements.
This brief examines the approaches used by three states – Oregon, Pennsylvania, and Tennessee – to develop and implement information-sharing processes for their Dual Eligible Special Needs Plans (D-SNPs) that support care transitions. The brief includes examples of contract language and strategies to encourage plan collaboration and problem solving around information sharing. It can help states, D-SNPs, and other stakeholders assess how to meet the new D-SNP contracting requirements and improve the care of dually eligible individuals.
