State Contracting Strategies

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.

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:

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.