Care Coordination in Dual Eligible Special Needs Plans (D-SNPs)

All D-SNPs must at least coordinate the Medicaid benefits of their enrollees, and all D-SNPs must also have a Model of Care that is approved by the National Committee for Quality Assurance (NCQA). The Model of Care provides a basic framework under which the D-SNP will meet the needs of the population(s) it enrolls, as well as a foundation for promoting quality, care management, and care coordination processes. When executing State Medicaid Agency Contracts (SMACs) with D-SNPs, states can require D-SNPs to comply with state-specific care coordination requirements and/or incorporate state-specific information into the D-SNPs’ Models of Care.

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• Leveraging D-SNP Models of Care to Enhance Enrollee Care Coordination

  This webinar will discuss strategies states can use to improve care coordination for D-SNP enrollees. It provides an overview of federal D-SNP care coordination and Model of Care (MOC) requirements, describes state options for incorporating care coordination requirements into state Medicaid agency contracts (SMACs) with D-SNPs, and/or requiring D-SNPs to incorporate state-specific information into MOCs, and discusses key considerations for states when implementing state-specific care coordination requirements. (ICRC, April 2023)

• Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Integrating Medicaid Managed Long-Term Services and Supports into D-SNP Models of Care

  This tip sheet outlines the benefits to states of requiring D-SNPs to develop a model of care that describes not just how Medicare services will be provided, but also how the plan will provide and/or coordinate Medicaid benefits. (ICRC, June 2019)

• State Options and Considerations for Sharing Medicaid Enrollment and Service Use Information with D-SNPs

  This technical assistance brief summarizes four options that states can use, individually or concurrently, to provide information to D-SNPs on their dually eligible members' Medicaid plan enrollment and/or service use. (ICRC, December 2019)

• ICRC Resources on Information-Sharing Requirements for D-SNPs

  By sharing information about hospital and skilled nursing facility admissions for designated groups of high-risk, full-benefit dually eligible individuals with states or states' designees, D-SNPs can support improved coordination during important care transitions.  ICRC has developed several resources to help states develop meaningful information-sharing requirements for D-SNPs.