Information-Sharing Requirements for Dual Eligible Special Needs Plans

Beginning in 2021, many Dual Eligible Special Needs Plans (D-SNPs) will need to begin sharing information on enrollees’ Medicare-covered hospital and skilled nursing facility admissions with states or states’ designees. The goal of this requirement is to improve coordination of Medicare and Medicaid services during transitions between care settings. States have an important role in supporting D-SNPs to meet the new requirements.

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• 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 to develop and implement information-sharing processes for their D-SNPs that support care transitions. (ICRC, August 2019)

• Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation

  This technical assistance tool offers key questions and considerations that states can review as they begin working with D-SNPs and other parties to design and implement information-sharing requirements. (ICRC, September 2019)

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

  This technical assistance brief describes 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)

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

  This webinar provides an update on new D-SNP information-sharing requirements 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. (ICRC, December 2019).

• Sample Language for State Medicaid Agency Contracts with Dual Eligible Special Needs Plans

  To operate in a state, a Dual Eligible Special Needs Plan(D-SNP) must hold a contract with the state Medicaid agency.  Those state Medicaid agency contracts (SMACs) must all have at least certain minimum elements, and states can also add additional requirements that aim to further coordination or integration of Medicare and Medicaid benefits for D-SNP enrollees.  ICRC has developed four tools for states that provide sample contract language for the minimum required SMAC elements, as well as optional elements that states can add to SMACs with D-SNPs to further state goals related to care coordination, D-SNP enrollment, reporting and information sharing, and D-SNP materials. (ICRC, January 2024)