Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
Dual Eligible Special Needs Plans (D-SNPs)
Dual Eligible Special Needs Plan (D-SNP) “Look-Alike” Transitions for Contract Year (CY) 2021
This memo provides information to Medicare Advantage organizations regarding the opportunity to transition enrollees in Dual Eligible Special Needs Plan (D-SNP) “look-alikes” for CY 2021.
Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter'
This CMS memorandum describes the final Contract Year 2021 model notices for Dual Eligible Special Needs Plans that are applicable integrated plans, "Letter about Your Right to Make a Fast Complaint" and "Appeal Decision Letter", which are both available in English and Spanish language versions.
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
Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RACV) Audit Activities
In response to the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has suspended non-emergency federal and state survey agency surveys. Consistent with that action, CMS is reprioritizing scheduled program audits for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans, and PACE oganizations. Oversight will continue but will shift to prioritize the investigation and resolution of instances of noncompliance where the health and/or safety of beneficiaries is at risk and complaints allenging infection control concerns.
CMS Invites Comments on Proposed Rule for Medicare Advantage and Part D
On February 5, 2019, the Centers for Medicare & Medicaid Services (CMS) posted a new notice of proposed rulemaking for Medicare Advantage and Part D (see also the accompanying fact sheet). CMS also released the Advance Notice Part II and fact sheet). This e-alert includes notable provisions of the proposed rule and advanced notice.
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
Additional Guidance on CY 2021 Medicare-Medicaid Integration Requirements for Dual Eligible Special Needs Plans (D-SNPs)
This HPMS memo provides additional guidance and clarification on four topics related to new integration standards for Dual Eligible Special Needs Plans: (1) distinctions between fully integrated D-SNPs (FIDE SNPs) and highly integrated (HIDE SNPs); (2) permissibility of carve-outs of behavioral health services and long term services and supports (LTSS) for FIDE SNPs and HIDE SNPs; (3) alignment of D-SNP and companion Medicaid plan service areas; and (4) compliance with integration requirements for D-SNPs that only enroll partial-benefit dually eligible individuals.
Appeals and Grievances: Comparisons of Existing and New Integrated Processes for Individuals Enrolled in Applicable Integrated Plans
Beginning in 2021, Dual Eligible Special Needs Plans (D-SNPs) with exclusively aligned enrollment must begin using integrated appeals and grievance processes. The flowcharts in this resource are designed to help states, health plans, and other stakeholders understand the differences between existing Medicare and Medicaid appeal and grievance processes and the new integrated appeal and grievance processes established at 42 CFR Part 422 Subpart M for fully and highly integrated D-SNPs with exclusively aligned enrollment.
Key Questions and Considerations for States Implementing New D-SNP Information-Sharing Requirements
12/16/2019
This webinar provides an update on new information-sharing requirements for Dual Eligible Special Needs Plans (D-SNPs) for 2021 and a review of key questions and considerations for states in working with D-SNPs to modify state contracts and develop a state-specific information-sharing approach.