Tip Sheet

Integrating Dual Eligible Special Needs Plan Materials to Promote Enrollee Understanding of and Access to Benefits

Integrating Dual Eligible Special Needs Plan Materials to Promote Enrollee Understanding of and Access to Benefits

Dual Eligible Special Needs Plans (D-SNPs) that operate with exclusively aligned enrollment and cover Medicaid benefits through the D-SNP or an affiliated Medicaid managed care plan – classified as applicable integrated plans (AIPs) – can provide their enrollees with a single set of fully integrated materials that describe both the Medicare and Medicaid benefits covered by the D-SNP (and its affiliated Medicaid plan, when applicable). 

Tips for States with Dual Eligible Special Needs Plans Affected by 42 CFR §422.514(h) Federal Regulations

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.

Tips for States on Working with Dual Eligible Special Needs Plans to Improve Coordination of Physical and Behavioral Health Services for Dually Eligible Individuals

This tip sheet details strategies states can use in their State Medicaid Agency Contracts (SMACs) with Dual Eligible Special Needs Plans (D-SNPs) to promote integration and coordination of behavioral health benefits among enrolled dually eligible individuals. This tip sheet also highlights how a few D-SNPs have gone beyond the SMAC requirements to further promote behavioral health integration.

Tips for States on Incorporating D-SNPs into Medicaid Quality Improvement Activities

This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities.

 

Tips to Help States Select Medicaid Managed Care Authorities as They Design Integrated Care Initiatives for Dually Eligible Individuals

This tip sheet summarizes key considerations for states trying to decide which pathway to use to advance Medicare-Medicaid integration, and which Medicaid managed care authority(ies) might best support that pathway. Although the tip sheet presents two pathways for states to consider, ultimately, a state may develop an integrated care model that falls somewhere in between these options. The Centers for Medicare & Medicaid Services (CMS) and ICRC can help each state identify a strategy that best meets its needs.