Dual Eligible Special Needs Plans (D-SNPs)

Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans

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.

CY 2021 Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for Dual Eligible Special Needs Plans (D-SNPs)

This memo to all Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) summarizes the new calendar year (CY) 2021 requirements for Medicare-Medicaid integration. These requirements were detailed in an April 2019 CMS final rule and must be incorporated into CY 2021 contracts with states that D-SNPs are required to submit to CMS by July 6, 2020.  

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches

This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and eight states that contract with Dual Eligible Special Needs Plans (D-SNPs) that are required to have companion plans that provide Medicaid managed longterm services and supports (MLTSS plans). 

A New Approach to Integrating Care for Dually Eligible Beneficiaries: Idaho’s Medicare Medicaid Coordinated Plan (MMCP)

This blog post looks at Idaho's Dual Eligible Special Needs Plan (D-SNP)-based program’s structure and highlights early successes and lessons for other states. Idaho’s approach may be interesting to states that want to integrate care, but do not have Medicaid managed long-term services and supports (MLTSS) programs.

Comments Sought on Proposed Process to Verify that D-SNP Contracts Meet New Information-Sharing Requirements for Contract Year 2021

On September 12, 2019, the Centers for Medicare & Medicaid Services (CMS) released the draft Contract Year 2021 Medicare Advantage-Prescription Drug Application for a 60-day public comment period. The draft MA-PD application shows how CMS proposes to collect information from Dual Eligible Special Needs Plans (D-SNPs) to verify that the plans will meet the new Medicaid integration requirements from the Bipartisan Budget Act of 2018 as codified in the April 2019 final rule (CMS-4185-F).

New ICRC Resource | Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

This technical assistance tool describes key issues states will want to address as they work with D-SNPs and other parties to design and implement information-sharing requirements. The tool includes model D-SNP contract language states can adapt for inclusion in their D-SNP contracts. Because D-SNPs must submit their 2021 contracts to CMS by early July 2020, all states should begin to consider the new information sharing requirements now in order to have sufficient time to develop new contract language and processes for 2021.

Integrated Care Updates - August 2019

August 2019 Contents:

  • New ICRC Brief on Implementation of D-SNP Information Sharing Requirements
  • CMS Releases New Proposed Rule on Durable Medical Equipment
  • CMS Report on State Balancing of Medicaid Long-Term Services and Supports
  • MACPAC Releases Compendium of State Fee-for-Service DME Polices
  • August 2019 Enrollment in Medicare-Medicaid Plans
  • August 2019 Enrollment in PACE Organizations
  • New Resources on the ICRC Website
  • Key Upcoming Dates

Integrated Care Updates - June 2019

June 2019 Contents:

  • MedPAC June Report to Congress Reviews D-SNPs and Discusses Policy Options for Improved
    Integration with Medicaid
  • ASPE Releases Two Reports on Dual Eligibility
  • ACL Releases a New Alzheimer’s and Dementia Program Cooperative Agreement Grant Opportunity
  • June 2019 Enrollment in Medicare-Medicaid Plans
  • June 2019 Enrollment in PACE Organizations
  • New Resources on the ICRC Website
  • Key Upcoming Dates

Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

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.

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