State Contracting with Dual Eligible Special Needs Plans

Integration models based on Dual Eligible Special Needs Plans (D-SNPs) are shaped by state contracting strategies. All D-SNPs must have a contract with the Medicaid agency in the states where they operate; however, states do not have to contract with D-SNPs. States can use this flexibility to shape their integrated care programs, and they can add requirements to their contracts with D-SNPs to create more advanced integration programs.

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• State Contracting with D-SNPs: Introduction to D-SNPs and D-SNP Contracting Basics

  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. (ICRC, December 2020)

• State Contracting with D-SNPs: Using D-SNPs to Integrate Care for Dually Eligible Individuals

  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. (ICRC, December 2020)

• Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans

  This technical assistance tool provides sample contract language that states can use in their D-SNP contracts to support plan compliance with new requirements – effective in 2021 – to increase the level of Medicare and Medicaid coordination and integration they provide. (ICRC, November 2019)

• State Contracting with Medicare Advantage D-SNPs: Issues and Options

  This tool describes how 13 states used their contracts with D-SNPs to coordinate care and services more effectively for Medicare-Medicaid beneficiaries. (ICRC, November 2016)

• Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Promoting Aligned Enrollment

  This tip sheet outlines tips for promoting aligned enrollment (i.e., enrollment of dually eligible beneficiaries in D-SNPs and Medicaid managed care plans offered by the same parent company in the same geographic area (aligned plans) as an integration tool. (ICRC, April 2018)

• Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Integrating Medicaid Managed Long-Term Services and Supports into D-SNP Models of Care

  This tip sheet outlines the benefits to states of requiring D-SNPs to develop a model of care that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits. (ICRC, June 2019)