Sample Language for State Medicaid Agency Contracts (SMACs) 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.

 

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• Sample SMAC Language – Required Elements for All D-SNPs 

  This ICRC tool provides sample contract language for SMAC elements that must be in all D-SNP SMACs, regardless of the D-SNP’s level of integration. The SMAC elements described within this tool apply to coordination-only D-SNPs (CO D-SNPs) highly integrated D-SNPs (HIDE SNPs) and fully integrated D-SNPs (FIDE SNPs).

• Sample SMAC Language – Required Elements for Certain D-SNPs

  This ICRC tool provides sample contract language for SMAC elements that are required for certain types of D-SNPs. For example, CO D-SNPs are required to provide notifications to the state (or the state’s designee of hospital and skilled nursing facility admissions for a designated group of high-risk, full-benefit dually eligible individuals; HIDE SNPs and FIDE SNPs must cover certain Medicaid benefits, and applicable integrated plans (AIPs) must use integrated appeal and grievance processes.

• Sample SMAC Language – Optional Elements for All D-SNPs

  This ICRC tool provides sample contract language for SMAC elements that are not required, but that states may choose to incorporate into their SMACs with D-SNPs to further state goals related to care coordination, D-SNP eligibility and enrollment, reporting and information sharing, D-SNP materials, and enrollee advisory committees. The optional SMAC language provided in this tool could be used with any D-SNP of any integration level.

• Sample SMAC Language – Optional Elements for Certain D-SNPs

  This ICRC tool provides sample contract language for SMAC elements that are not required, but that states may choose to incorporate into their SMACs with D-SNPs to further state goals related to care coordination, D-SNP enrollment, reporting and information sharing, and D-SNP materials. The optional SMAC language provided in this tool is designed to be used with integrated D-SNPs that cover at least some Medicaid benefits, including (but not limited to) D-SNPs that operate with exclusively aligned enrollment.

• Sample SMAC Language – Cost Sharing Protections for D-SNP Enrollees

  This ICRC tool provides sample contract language that states can use to address the minimum required SMAC element described at 42 CFR 422.107(c)(4) - the cost-sharing protections covered under the D-SNP. The tool provides several different SMAC language examples to fit a variety of state circumstances.