Oversight and Monitoring of Dual Eligible Special Needs Plans

State oversight and monitoring of Dual Eligible Special Needs Plans (D-SNPs) can help to ensure that these plans operate in a way that promotes integration and coordination of care for dually eligible individuals.

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• Improving Quality and Performance in D-SNPs: Monitoring and Oversight Tips for States

  This webinar describes the Medicare resources available to states to monitor D-SNP performance and provide tips for states on incorporating D-SNPs into Medicaid quality improvement activities. (ICRC, November 2023)

• Tips for States on Incorporating D-SNPs into Medicaid Quality Improvement Activities

  This tip sheet describes the Medicare resources available to states to monitor Dual Eligible Special Needs Plan (D-SNP) performance, explains how states can leverage those resources for Medicaid managed care quality oversight and improvement, and provides tips for states on incorporating D-SNPs into Medicaid quality improvement activities. (ICRC, October 2023)

• How States Can Monitor Dual Eligible Special Needs Plan (D-SNP) Performance: A Guide to Using CMS Data Resources

  This resource shows how states can use CMS data to create tables, graphs, and figures and interpret their meaning in order to assess D-SNP performance. (ICRC, January 2018)

• Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Using Medicare Program Audit Reports to Improve Managed Care Organization Oversight

  This tip sheet describes how states can use the results of Medicare program audits to identify performance issues impacting dually eligible beneficiaries’ receipt of care coordination, long-term services and supports, durable medical equipment, and other services, and incorporate that information into their audit and oversight activities. (ICRC, June 2018)

• D-SNP Performance Monitoring and Oversight: State Experiences and CMS Resources

  This webinar covers resources and strategies available to states to begin or improve their oversight of Dual Eligible Special Needs Plans (D-SNPs). Presenters provide an overview of CMS’ publicly available D-SNP performance monitoring resources and share approaches used by Oregon and Tennessee to incorporate performance monitoring and oversight requirements into D-SNP contracts. (ICRC, April 2019)

• How States Can Use Medicare Advantage Star Ratings to Assess D-SNP Quality and Performance

  This technical assistance tool explains the five-star quality rating system that CMS uses to evaluate the performance of Medicare Advantage health plans and how states can use star ratings data for integrated care program oversight. (ICRC, October 2019)