Dual Eligible Special Needs Plans (D-SNPs)

Working with Medicare Webinar | State Contracting with D-SNPs: Using D-SNPs to Integrate Care for Dually Eligible Individuals

12/15/2022

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:

Integrated Care Updates- August 2020

New ICRC Resources on Comprehensive Addiction and Recovery Act of 2016 (CARA) Related Restrictions on Medicare-Medicaid Plan (MMP) Enrollment
MACPAC Releases Updated Inventory of Integrated Care Models
Want to Know More about the Dually Eligible Individuals in Your State? Request a State Data Profile
August 2020 Enrollment in Medicare-Medicaid Plans
August 2020 Enrollment in PACE Organizations
New Resources on the ICRC Website
Key Upcoming Dates

Spotlight: New ICRC Tools Help States Identify Dually Eligible Individuals and Aligned Enrollees

ICRC has released two new resources to help states identify both individuals who are (or who will soon be) dually eligible and dually eligible individuals who are enrolled in Dual Eligible Special Needs Plans (D-SNPs) and Medicaid managed care plans owned by the same parent company (“affiliated” plans).

Proposed Addendum to the Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance

Public comments are requested on an addendum to the Part C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance. Commentors should use the template provided.

Contract Year 2021 Models for Applicable Integrated Plans: 'Letter about Your Right to Make a Fast Complaint' and 'Appeal Decision Letter'

This CMS memorandum describes the final Contract Year 2021 model notices for Dual Eligible Special Needs Plans that are applicable integrated plans, "Letter about Your Right to Make a Fast Complaint" and "Appeal Decision Letter", which are both available in English and Spanish language versions.

Integrated Care Updates - March 2020

March 2020 Update Content:

CMS Corona Virus (COVID-19) Partner Toolkit and Electronic Mailing List
Dual Eligible Special Needs Plans (D-SNPs) Entries and Departures
MedPAC March Report to the Congress: Issues Related to Integrated Care
Key 2020 Medicare Dates
March 2020 Enrollment in Medicare-Medicaid Plans
March 2020 Enrollment in PACE Organizations
New Resources on the ICRC Website

Reprioritization of PACE, Medicare Parts C and D Program, and Risk Adjustment Data Validation (RACV) Audit Activities

In response to the spread of COVID-19, the Centers for Medicare & Medicaid Services (CMS) has suspended non-emergency federal and state survey agency surveys. Consistent with that action, CMS is reprioritizing scheduled program audits for Medicare Advantage organizations, Part D sponsors, Medicare-Medicaid Plans, and PACE oganizations. Oversight will continue but will shift to prioritize the investigation and resolution of instances of noncompliance where the health and/or safety of beneficiaries is at risk and complaints allenging infection control concerns.

CMS Invites Comments on Proposed Rule for Medicare Advantage and Part D

On February 5, 2019, the Centers for Medicare & Medicaid Services (CMS) posted a new notice of proposed rulemaking for Medicare Advantage and Part D (see also the accompanying fact sheet). CMS also released the Advance Notice Part II and fact sheet). This e-alert includes notable provisions of the proposed rule and advanced notice.

Integrated Care Updates - January 2020

January 2020 Contents:

New ICRC Flow Charts Compare Existing and New Unified Appeals and Grievance Processes for Individuals Enrolled in Applicable Integrated D-SNPs
CMS Releases Additional Guidance on D-SNP Integration Requirements
CMS Releases the 2021 Medicare Advantage Advance Notice
MACPAC Considers Policy Options to Better Integrate Care for Dually Eligible Individuals
January 2020 Enrollment in Medicare-Medicaid Plans
January 2020 Enrollment in PACE Organizations
Key Upcoming Dates

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.