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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.

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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. Use of this language in the contract does not guarantee that CMS will approve the D-SNP to operate.

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Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

This technical assistance tool offers key questions and considerations that states can review as they begin working with Dual Eligible Special Needs Plans (D-SNPs) and other parties to design and implement information-sharing requirements.

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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.

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Latest Resources

Study Hall Call | May 2022

Exclusively Aligned Enrollment 101: Considerations for States Interested in Leveraging D-SNPs to Integrate Medicare and Medicaid Benefits

Technical Assistance Tool | April 2022

Monthly Enrollment in Medicare-Medicaid Plans by Plan and by State, April 2021 to April 2022

Technical Assistance Tool | April 2022

Program of All Inclusive Care for the Elderly (PACE) Total Enrollment by State and by Organization

Technical Assistance Tool | April 2022

New and Departing Dual Eligible Special Needs Plans (D-SNPs) in Calendar Year 2022, by State

Tip Sheet, Other Resource | April 2022

Dually Eligible Individuals: The Basics

Key Upcoming Dates

May 26, 2022 | Key Medicare Advantage dates

CY 2023 D-SNP module released for D-SNPs to upload required State Medicaid Agency Contracts (SMACs) and Contract Matrices in HPMS. D-SNPs must upload CY2023 SMACs into HPMS by July 5

Early June - Late August 2022 | Key Medicare Advantage dates

Completion of CMS’s CY 2023 bid review and approval, to include pricing, PBPs, and formularies. Deadline for MAOs/Part D sponsors to submit attestations, contracts, initial actuarial certifications, and final actuarial certifications.

June 1, 2022 | Key Medicare Advantage dates

Submission period begins for plans to submit CY 2023 marketing materials to CMS for review via the HPMS Marketing Module.

June 2022 | Key Medicare Advantage dates

MA organizations with D-SNP look-alike plans notify CMS of their transitions via HPMS.

June 2022 | Key Medicare Advantage dates

CMS conducts provider network adequacy reviews for MA plans, including D-SNPs.

State Options and Considerations for Sharing Medicaid Enrollment and Service Use Information with D-SNPs

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

Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

Promoting Information Sharing by Dual Eligible Special Needs Plans to Improve Care Transitions: State Options and Considerations

Latest Resources

Key Upcoming Dates