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.

The Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs Rule (CY 2023 Rule) codified a new pathway at 42 CFR 422.107(e) through which states can use state Medicaid agency contracts (SMACs) to require that D-SNPs with exclusively aligned enrollment (a) establish contracts that only include one or more D-SNPs within a state, and (b) integrate certain materials and notices for enrollees.