Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
To operate in a state, a Dual Eligible Special Needs Plan(D-SNP) must hold a contract with the state Medicaid agency. Those state Medicaid agency contracts (SMACs) must all have at least certain minimum elements, and states can also add additional requirements that aim to further coordination or integration of Medicare and Medicaid benefits for D-SNP enrollees.
This technical assistance tool is the last in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.
This tool provides optional SMAC sample language applicable to certain types of D-SNPs, such as applicable integrated plans (AIPs).
This technical assistance tool is the first in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements
and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.
This technical assistance tool is the second in a series of four tools that provide sample State Medicaid Agency
Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.
This technical assistance tool is the third in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.
This tool provides optional SMAC sample language applicable to all types of D-SNPs.
This memorandum provides states with guidance on the process for working with the Centers for Medicare & Medicaid Services (CMS) to establish Dual Eligible Special Needs Plans (D-SNP)-only contracts and develop integrated materials.
This webinar explains the potential benefits for states of selectively contracting with D-SNPs, key building blocks for selective contracting, considerations for states when deciding to selectively contract with D-SNPs, and steps that states can take when implementing selective contracting.
Learning Objectives: By the end of this presentation, attendees should be able to:
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.
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.
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.