Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This technical assistance tool highlights key dates in (1) the CMS bid and contracting process for Medicare Advantage (MA) plans (including D-SNPs), (2) the processes used to develop material templates for MA plans (including integrated material templates for applicable integrated plans), and (3) the Medicare Advantage enrollment process.
In April 2024, CMS released new rules at 42 CFR §422.514(h) for D-SNPs with affiliated Medicaid managed care organizations (MCOs). This ICRC tip sheet provides (1) an overview of those new requirements, which take effect in 2027 and 2030, and a summary of rule exceptions, (2) illustrative examples and options for D-SNP compliance with each rule provision, and (3) action steps for states in working with D-SNPs to ensure compliance with these new rules.
States can allow or require D-SNPs that meet certain requirements to use default enrollment to align Medicare and Medicaid coverage for dually eligible individuals. Under default enrollment, D-SNPs may automatically enroll individuals who are enrolled in a comprehensive Medicaid managed care organization offered by the same parent organization as the D-SNP when those individuals first become eligible for Medicare Parts A and B (at the same time) due to age or disability.
During this webinar, ICRC staff provide an overview of the Medicare enrollment process used by dual eligible special needs plans (D-SNPs) and describe key steps and considerations for states that choose to align Medicaid coverage with D-SNP enrollment. We expect this webinar to be of interest to states with integrated D-SNPs that must achieve exclusively aligned enrollment by 2030, per the rules at 42 CFR 422.514(h)(2), as well as states that are otherwise interested in requiring D-SNPs to operate with exclusively aligned enrollment in the future.
"Exclusively aligned enrollment" (EAE) occurs when a state restricts enrollment in a Medicare Advantage dual eligible special needs plan (D-SNP) to full-benefit dually eligible individuals who receive Medicaid benefits from the D-SNP or an affiliated Medicaid managed care plan offered by the same parent organization as the D-SNP. This technical assistance brief is part of ICRC's series of tools on EAE.
Aligned Medicare and Medicaid provider networks can improve the care experience of D-SNP enrollees by eliminating the need to navigate separate Medicare and Medicaid provider networks to access care. During this ICRC state-only call, ICRC staff briefly described federal provider network adequacy requirements for D-SNPs.
This webinar builds on the foundational information presented in our last Working with Medicare webinar. It provides an overview of D-SNP contracting strategies and considerations for states with integrated D-SNPs. It is the second in a series of three webinars.
This webinar will be especially helpful to state Medicaid agency staff who (1) are new to working with dually eligible individuals or (2) wish to better understand the different types of dual eligibility and the ways in which different groups of dually eligible individuals experience coverage and care.
Learning Objectives: By the end of this presentation, attendees should be able to:
This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023 implementation of Dual Eligible Special Needs Plan enrollee advisory committees.