State Contracting Strategies

Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans (D-SNPs): Optional Language Applicable to Certain D-SNPs

This technical assistance tool is the last in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.

This tool provides optional SMAC sample language applicable to certain types of D-SNPs, such as applicable integrated plans (AIPs).

Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans (D-SNPs): Requirements for All D-SNPs

This technical assistance tool is the first in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements
and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.

Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans (D-SNPs): Requirements for Certain Types of D-SNPs

This technical assistance tool is the second in a series of four tools that provide sample State Medicaid Agency
Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.

Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans (D-SNPs): Optional Language Applicable to All D-SNPs

This technical assistance tool is the third in a series of four tools that provide sample State Medicaid Agency Contract (SMAC) language that states can use in contracts with D-SNPs to meet federal requirements and advance state goals regarding care coordination, eligibility and enrollment, data reporting, marketing and enrollee communications, or other requirements regarding D-SNP activities.

This tool provides optional SMAC sample language applicable to all types of D-SNPs.

Guidance for States Seeking to Leverage New Opportunities for Integrated Care Programs

This memorandum provides states with guidance on the process for working with the Centers for Medicare & Medicaid Services (CMS) to establish Dual Eligible Special Needs Plans (D-SNP)-only contracts and develop integrated materials.

Selectively Contracting with Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) to Promote Alignment with Medicaid Managed Care Plans

02/23/2023

This webinar explains the potential benefits for states of selectively contracting with D-SNPs, key building blocks for selective contracting, considerations for states when deciding to selectively contract with D-SNPs, and steps that states can take when implementing selective contracting.

Learning Objectives: By the end of this presentation, attendees should be able to:

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.

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.