Dual Eligible Special Needs Plans (D-SNPs)

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.

Integrated Care Updates - November 2019

November 2019 Contents:

Spotlight: Comments Requested on Proposed “Applicable Integrated Plan Coverage Decision Letter”

CMS requests comments from, states and other stakeholders on proposed new Plan Coverage Decision Letter for use in 2021 by Dual Eligible Special Needs Plans (D-SNPs) with unified Medicare and Medicaid appeals and grievance procedures. Comments are requested by December 17, 2019.

Key Questions and Considerations for States Implementing New D-SNP Information-Sharing Requirements

12/16/2019

This webinar provides an update on new information-sharing requirements for Dual Eligible Special Needs Plans (D-SNPs) for 2021 and a review of key questions and considerations for states in working with D-SNPs to modify state contracts and develop a state-specific information-sharing approach.

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.

CY 2021 Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for Dual Eligible Special Needs Plans (D-SNPs)

This memo to all Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) summarizes the new calendar year (CY) 2021 requirements for Medicare-Medicaid integration. These requirements were detailed in an April 2019 CMS final rule and must be incorporated into CY 2021 contracts with states that D-SNPs are required to submit to CMS by July 6, 2020.

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).

A New Approach to Integrating Care for Dually Eligible Beneficiaries: Idaho’s Medicare Medicaid Coordinated Plan (MMCP)

This blog post looks at Idaho's Dual Eligible Special Needs Plan (D-SNP)-based program’s structure and highlights early successes and lessons for other states. Idaho’s approach may be interesting to states that want to integrate care, but do not have Medicaid managed long-term services and supports (MLTSS) programs.

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

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.