Dual Eligible Special Needs Plans (D-SNPs)

State Options and Considerations for Sharing Medicaid Enrollment and Service Use Information with D-SNPs

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.

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.

Promoting Information Sharing by Dual Eligible Special Needs Plans to Improve Care Transitions: State Options and Considerations

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.

Medicare 201: Actions States Can Take to Improve Quality and Coordination of Care for Dually Eligible Individuals

03/25/2021

This is part two a two-part Integrated Care Resource Center (ICRC) Working with Medicare webinar on Medicare 201 held on March 25, 2021.

This webinar provides an overview of integrated care pathways, how states can work with D-SNPs to design supplemental benefits offerings, and steps that states can take to improve coordination of care for dually eligible populations. The webinar is especially helpful to state staff who are new to or seek a refresher on Medicare.

Medicare 101: An Introduction to Medicare Benefits and the Roles of Medicare and Medicaid in Serving Dually Eligible Individuals

03/22/2021

This is part one of a two-part Integrated Care Resource Center (ICRC) Working with Medicare webinar on Medicare 101, held on March 22, 2021.

This webinar provides an overview of Medicare benefits, how Medicare and Medicaid benefits overlap and interact for dually eligible individuals, and steps that states can take to improve care for vulnerable dually eligible populations. The webinar is especially helpful to state staff who are new to or seek a refresher on Medicare.

Integrated Appeal and Grievance Processes for Integrated D-SNPs with “Exclusively Aligned Enrollment”

On April 16, 2019, CMS released a final rule that implements provisions of the 2018 Bipartisan Budget Act (BBA) requiring greater D-SNP integration, including integrated plan-level appeal and grievance processes for certain “applicable integrated plans.” This fact sheet is intended to help states with applicable integrated plans understand the new integrated appeal and grievance processes, the types of D-SNPs that are required to use them, and steps that states can take to help ensure effective implementation of the new processes in 2021.

Working with Medicare Webinar | State Contracting with D-SNPs: Introduction to D-SNPs and D-SNP Contracting Basics

12/14/2020

This is part one of a two part series that provides an overview of state strategies for contracting with D-SNPs to improve care coordination and Medicare-Medicaid alignment for dually eligible enrollees. The webinars are especially helpful to state staff who are new to or seek a refresher on D-SNP contracting and working with Medicare plans.

Webinar 1: Introduction to D-SNPs and D-SNP Contracting Basics

Learning Objectives: By the end of this presentation, attendees should be able to describe:

Working with Medicare Webinar | State Contracting with D-SNPs: Using D-SNPs to Integrate Care for Dually Eligible Individuals

12/17/2020

This is part two of a two part series that provides an overview of state strategies for contracting with D-SNPs to improve care coordination and Medicare-Medicaid alignment for dually eligible enrollees. The webinars are especially helpful to state staff who are new to or seek a refresher on D-SNP contracting and working with Medicare plans.

Webinar 2: Using D-SNPs to Integrate Care for Dually Eligible Individuals

Learning Objectives: By the end of this presentation, attendees should be able to describe:

Integrated Care Updates- August 2020

Integrated Care Updates- August 2020

  •  New ICRC Resources on Comprehensive Addiction and Recovery Act of 2016 (CARA) Related Restrictions on Medicare-Medicaid Plan (MMP) Enrollment
  • MACPAC Releases Updated Inventory of Integrated Care Models
  • Want to Know More about the Dually Eligible Individuals in Your State? Request a State Data Profile
  • August 2020 Enrollment in Medicare-Medicaid Plans
  • August 2020 Enrollment in PACE Organizations
  • New Resources on the ICRC Website
  • Key Upcoming Dates