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.

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.

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.

Update on State Contracting with D-SNPs: The Basics and Meeting New Federal Requirements for 2021

Working with Medicare
07/09/2019

This webinar provides an overview of state strategies for contracting with D-SNPs to improve care coordination and Medicare-Medicaid alignment for dually eligible enrollees. Special attention is given to new federal D-SNP integration standards for 2021 contract year, and how states can help plans to meet these requirements.

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

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.

Integrated Care Updates - March 2020

March 2020 Update Content:

  • CMS Corona Virus (COVID-19) Partner Toolkit and Electronic Mailing List
  • Dual Eligible Special Needs Plans (D-SNPs) Entries and Departures
  • MedPAC March Report to the Congress: Issues Related to Integrated Care
  • Key 2020 Medicare Dates
  • March 2020 Enrollment in Medicare-Medicaid Plans
  • March 2020 Enrollment in PACE Organizations
  • New Resources on the ICRC Website

Integrated Care Updates - January 2020

January 2020 Contents:

  • New ICRC Flow Charts Compare Existing and New Unified Appeals and Grievance Processes for Individuals Enrolled in Applicable Integrated D-SNPs
  • CMS Releases Additional Guidance on D-SNP Integration Requirements
  • CMS Releases the 2021 Medicare Advantage Advance Notice
  • MACPAC Considers Policy Options to Better Integrate Care for Dually Eligible Individuals
  • January 2020 Enrollment in Medicare-Medicaid Plans 
  • January 2020 Enrollment in PACE Organizations 
  • Key Upcoming Dates

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