Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
Published
CMS requires D-SNPs that qualify as AIPs—meaning they operate with exclusively aligned enrollment and cover certain Medicaid benefits through the D-SNP or the D-SNP’s affiliated Medicaid managed care plan—to use unified appeal and grievance processes. These integrated processes are designed to resolve misalignments between Medicare and Medicaid plan-level processes and streamline experiences for plans.
This technical assistance tool summarizes the federal unified appeal and grievance requirements for states that contract with AIPs. It also provides information for these states on (1) requiring AIPs to use the unified appeal and grievance processes via their state Medicaid agency contracts, (2) requiring AIPs to use shorter appeal and grievance timeframes and/or more protective requirements than those included in federal rules, (3) requiring AIPs to use state-specific language in certain unified appeal and grievance letters, (4) conducting state-specific training for plans, (5) overseeing D-SNP compliance with state-specific unified appeal and grievance requirements, and (6) using appeal and grievance data to monitor and improve D-SNP performance.