Dual Eligible Special Needs Plans (D-SNPs)

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.

Appeals and Grievances: Comparisons of Existing and New Integrated Processes for Individuals Enrolled in Applicable Integrated Plans

Beginning in 2021, Dual Eligible Special Needs Plans (D-SNPs) with exclusively aligned enrollment must begin using integrated appeals and grievance processes. The flowcharts in this resource are designed to help states, health plans, and other stakeholders understand the differences between existing Medicare and Medicaid appeal and grievance processes and the new integrated appeal and grievance processes established at 42 CFR Part 422 Subpart M for fully and highly integrated D-SNPs with exclusively aligned enrollment.

Care Coordination in Integrated Care Programs Serving Dually Eligible Beneficiaries – Health Plan Standards, Challenges and Evolving Approaches

This MACPAC report reviews and analyzes care coordination requirements in the managed care organization contracts of nine states participating in demonstrations under the Financial Alignment Initiative, 10 states that contract with Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and eight states that contract with Dual Eligible Special Needs Plans (D-SNPs) that are required to have companion plans that provide Medicaid managed longterm services and supports (MLTSS plans). 

Integrated Care Updates - August 2019

August 2019 Contents:

  • New ICRC Brief on Implementation of D-SNP Information Sharing Requirements
  • CMS Releases New Proposed Rule on Durable Medical Equipment
  • CMS Report on State Balancing of Medicaid Long-Term Services and Supports
  • MACPAC Releases Compendium of State Fee-for-Service DME Polices
  • August 2019 Enrollment in Medicare-Medicaid Plans
  • August 2019 Enrollment in PACE Organizations
  • New Resources on the ICRC Website
  • Key Upcoming Dates