D-SNP Integration Requirements April 21, 2020 11:00 am 12:00 pm - - PowerPoint PPT Presentation
Count Down to 2021: Advancing New D-SNP Integration Requirements April 21, 2020 11:00 am 12:00 pm Eastern Time The Integrated Care Resource Center, an initiative of the Centers for Medicare & Medicaid Services Medicare -Medicaid
The Integrated Care Resource Center, an initiative of the Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office, provides technical assistance for states coordinated by Mathematica and the Center for Health Care Strategies.
Danielle Chelminsky Health Analyst Mathematica Erin Weir Lakhmani Senior Researcher Mathematica Nancy Archibald Senior Program Officer Center for Health Care Strategies
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WY WI
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WA VA VT UT TX TN SD SC RI PR PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL
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Both Financial Alignment Demonstration and Integrated D-SNPs Financial Alignment Demonstration Integrated D-SNP*
*These states have aligned D-SNP/MLTSS plans and/or FIDE SNPs as of 2020.
Note: 31 States currently have Programs of All-Inclusive Care for the Elderly (PACE). PACE is not included in this map.
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Integration/ Coordination Platform Enrollment States (2020) Feb 2011 Feb 2020 Financial Alignment Initiative Demonstrations 386,331 9 states
Capitated: CA, IL, MA, MI, NY, OH, RI, SC, TX
Dual-Special Needs Plans (D- SNPs)1 1,050,864 2,859,411 41 states, DC and PR
Two thirds of enrollment in 10 states: (FL, NY, PR, TX, PA, CA, TN, AZ, GA, AL)
Fully Integrated Dual Eligible (FIDE) SNPs 280,225 11 states
AZ, CA, FL, ID, MA, MN, NJ, NY, PA, TN, WI
Program of All-Inclusive Care for the Elderly (PACE) 22,489 48,934 31 states
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1All D-SNP enrollment includes FIDE SNP enrollment.
Sources: Centers for Medicare & Medicaid Services. SNP Comprehensive Report, September 2011 and Feb 2020: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics- Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html
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1Aligned enrollment refers to the number of full-benefit dually eligible individuals who are receive both Medicare and Medicaid coverage from the same plan, or from an
affiliated plan operated by the same company. Enrollment data for MMPs, PACE and FIDE SNPs are from July 2019 and were considered “Fully Integrated” in the FY2019 MMCO Report to Congress.
2 In the FY 2019 MMCO Report to Congress, “Integrated” enrollment consisted of enrollees in D-SNPs who received coverage for at least some Medicaid benefits through
the D-SNP or the D-SNP’s affiliated Medicaid managed care plan. Data as of July 2019, except for FL (as of May 2019) and CA (as of August and September 2019). The “Partially Integrated” category was not included in 2019 because classifications changed and those states that provided data were considered “Integrated” in 2019.
Plan Type Aligned Enrollment1 States
Medicare-Medicaid Plans (MMPs) 386,478 CA, IL, MA, MI, NY, OH, RI, SC, and TX PACE 46,291 31 states FIDE SNPs 196,816 AZ, CA, FL, MA, MN, ID, NJ, NY, TN and WI Non-FIDE SNP Integrated D- SNP/MLTSS Plans2 364,259 AZ, CA, FL, HI, MN, NM, OR, PA, TN, TX, VA Total Cost of Care Managed FFS 13,083 WA
SOURCES: CMS SNP Comprehensive Reports. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html; MMCO Report to Congress FY 2019 https://www.cms.gov/Medicare-Medicaid- Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/FY-2018-Report-to-Congress.pdf:; CMS Monthly Enrollment by Contract. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Contract.html; and State Medicaid officials.
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See slides 30-32 in the appendix for notes and data sources. 8
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Proportion of Full-Benefit Dually Eligible Individuals in Integrated Care Programs by State, 2019
Integrated D-SNPs MMPs FIDE SNPs Legacy Medi-Medi Demo Programs PACE Total Cost of Care FFS
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State Total # of FBDEs3 (Mar 2019) D-SNP1 FIDE SNP MMP PACE2
AK 16,927 AL 76,979 165 85,316 AR 22,474 289 67,135 AZ 85,626 12,178 169,542 CA 118,131 14,484 110,690 7,693 1,410,051 CO 17,929 4,437 82,962 CT 38,668 70,569 DC 11,882 22,346 DE 4,897 249 14,091 FL 368,732 2,177 397,219 GA 89,748 148,917 HI 24,085 35,140 IA 14,973 560 64,909 ID 7,638 27,894 IL 57,415 315,852 IN 38,816 441 138,527 KS 6,359 522 37,947 KY 28,683 92,766 LA 69,470 463 125,862 MA 58,657 26,590 4,690 282,385 MD 7,799 146 84,851 ME 14,277 51,468 MI 32,556 40,182 3,291 260,546 MN 5,094 40,791 122,051 MO 39,838 136,287
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1Not all D-SNP enrollees are in integrated arrangements, but their care must at least be coordinated with Medicaid. Six D-SNPs spanned across multiple states. For purposes of this
table, enrollment was split evenly across states. FIDE SNP enrollment is not included in the D-SNP count. The total D-SNP enrollment includes PR, which was not included in this table since there was no data on FBDEs available. 73 enrollees were in D-SNPs with under 11 enrollees and were included in the total.
2These enrollment numbers include Medicare enrollees only, and do not include Medicaid-only PACE enrollees, who represented about 19 percent of all PACE enrollees in July
2017, as shown in Tables 2 and 3 of the 2017 Medicaid Managed Care Enrollment Report, available at https://www.medicaid.gov/medicaid/managed- care/downloads/enrollment/2017-medicaid-managed-care-enrollment-report.pdf.
3Total FBDE data is from March 2019, the most recent data available. FBDEs includes QMB+, SLMB+ and Other FBDEs.
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State Total # of FBDEs (Mar 2019) D-SNP FIDE SNP MMP PACE
MS 27,882
MT 1,270 17,306 NC 65,336 249,570 ND 2,123 10,673 NE 7,679 180 35,737 NH 197 20,894 NJ
193,818 NM 28,285 1,064 65,338 NV 395 30,513 NY 285,424 60,348 755,820 OH 68,781 1,593 5,167 252,973 OK 7,884 75,365 491 93,952 OR 22,281 537 81,268 PA 123,181 30,611 1,540 375,676 PR 277,528 7,064 RI 4,247 36,854 SC 41,346 13,578 316 136,928 SD 18,016 431 12,309 TN 112,274 2,200 141,716 TX 231,247 260 378,653 UT 7,217 42,902 1,139 32,090 VA 42,839 128,695 VT 1,395 19,664 WA 59,107 132,607 WI 40,798 1,217 843 146,989 WV 7,493 537 45,431 WY 8,020
TOTAL
2,579,113 280,225 386,331 48,934 7,741,760
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D-SNP FIDE SNP MMP PACE Regular Medicare Advantage and Fee for Service (Full-Benefit Dually Eligible Individuals, Mar 2019)
Dual Eligible Enrollment by Plan Type Feb 2020
Notes: D-SNP total does not include FIDE SNP
Data from March 2019 is the most recent FBDE data available. D-SNP total includes 73 enrollees in plans with under 11 enrollees. D-SNP enrollment may include partial benefit dually eligible individuals. Sources: CMS Monthly Enrollment by Contract, Feb 2020: https://www.cms.gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Monthly- Enrollment-by-Contract.html CMS SNP Comprehensive Report, Feb 2020: https://www.cms.gov/Research-Statistics-Data-and- Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs- Plan-SNP-Data.html CMS Quarterly Enrollment Updates, Mar 2019: https://www.cms.gov/Medicare-Medicaid- Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- Office/Analytics.html
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WA VA VT UT TX TN SD SC RI PR PA OR OK OH ND NC NY NM NJ NH NV NE MT MO MS MN MI MA MD ME LA KY KS IA IN IL ID HI GA FL DC DE CT CO CA AR AZ AK AL
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26%-50% 11%-25% 1%-10% 0%/No D-SNPs 50%+
Notes: Six plans spanned across multiple states. For this map, the enrollment of these plans was divided evenly across states. Some state allow partial benefit duals in their D-SNPs, which are also captured in this map. Total FBDE data is from March 2019, the most recent data available.
*PR did not have data in Monthly Enrollment Snapshot
Sources: Centers for Medicare & Medicaid Services. SNP Comprehensive Report. February 2020. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html Center for Medicare & Medicaid Services. CMS Monthly Enrollment Snapshots, March 2019. Available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare- Medicaid-Coordination-Office/DataStatisticalResources/Data-and-Statistical-Resources.html.
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SOURCE: CMS SNP Comprehensive Reports. Available at: http://www.cms.gov/Research-Statistics-Data- and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html; 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000 200 250 300 350 400 450 500 550 600
Number of D-SNPs Number of D-SNP Enrollees
Years*
Total # of D-SNPs Total D-SNP Enrollment
*As of July of each year, Feb for 2020 Bipartisan Budget Act
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Number of Contracts: 271
CY 2019
New Contracts, 41
Continuing Contracts: 268
Departing Contracts, 3
CY 2020
Note: In the CMS MA system, contracts that include D-SNPs frequently offer plans in multiple states under the same contract number. To highlight the impact on states of new entries and departures, this slide counts these multi-state contracts as a separate contract in each state. A contract that covers four states, for example, is counted as four contracts. For more detailed, state-by-state D-SNP new entries and departures, see the ICRC TA tool: https://www.integratedcareresourcecenter.com/sites/default/files/ICRC%20- %20New%20and%20Departing%20D-SNPs%20in%20CY2020%20by%20State.pdf States with Departing Contracts: OH, PR, and NC States with New Contracts: AL, AR, AZ, CA, CO, FL, GA, IA, IN, KS, KY, LA, ME, MI, MO, NC, NE, NM, NY, OH, OK, PA, SC, TX, VA, WA, and WV Sources: CMS SNP Comprehensive Reports, Sept 2019 and Feb 2020: https://www.cms.gov/Research-Statistics- Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html
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Sources: CMS. “Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All- Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021.” Federal Register, April 16, 2019, pp.15710-15718 and 42 CFR 422.107(d)) p. 15828. Available at: https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf; Bipartisan Budget Act of 2018 (P.L. 115-123). Section 50311: Providing Continued Access to Medicare Advantage Special Needs Plans for Vulnerable Populations. Available at: https://www.congress.gov/115/bills/hr1892/BILLS-115hr1892enr.pdf
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Parameter State Determines Target Population Which group(s) of high-risk FBDE beneficiaries would benefit from targeted support after hospital or SNF admissions Entity Notified Which entities actually have care coordination resources in place to help manage transitions for the state’s selected group(s) Timeframe for Notification What timeframes will be required for the transmission of admission data between D-SNPs and other entities Notification Method Which methods should be used for SNF and hospital admission notifications
Additional details can be found in “Information Sharing to Improve Care Coordination for High-Risk Dual Eligible Special Needs Plan Enrollees: Key Questions for State Implementation.” ICRC, September 2019.
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to send admission notifications (though in some states, SNFs may receive such notifications from hospitals). However, a substantial number of SNF admissions may be captured through hospital-based notifications (when a hospital discharges an individual to a SNF).
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“For all plan enrollees enrolled in [Medicaid health home/HCBS waiver/behavioral health MCO/MLTSS plan—Use state specific terms, include all that apply], [D-SNP name] shall provide timely notification of all admissions to a hospital or skilled nursing facility to the enrollee’s [Medicaid health home/HCBS waiver case manager/behavioral health MCO/MLTSS plan—Use state-specific terms, include all that apply] as applicable to the
(HIT) or Health Insurance Exchange (HIE) or, where notification via HIT or HIE is not provided, via direct communication from [D-SNP name] within [x hours/days] of [D-SNP name] receiving information of such admission. [State Medicaid Agency] will provide [D- SNP name] information on plan enrollees enrolled in [Medicaid health home/HCBS waiver/behavioral health MCO/MLTSS plan—Use state specific terms, include all that apply] via [daily file exchange/access to Medicaid eligibility portal/other specified exchange—Use state specific terms, include all that apply].”
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reliable data to their D-SNPs about which high-risk FBDEs are in their target population (e.g., HCBS waiver enrollees or FBDEs enrolled in an unaligned Medicaid managed care plan).
complete and up-to-date information to facilitate timely sharing of data between health plans.
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challenging in the current environment.
are available to designated receiving entities.
the receiving entity must be able to process and distribute data from D- SNPs.
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are not included in Figure 1. This graph only presents enrollment of full-benefit dually eligible individuals in integrated care programs – it does not include enrollment of partial-benefit dually eligible individuals in integrated care programs, nor does it include enrollment of Medicaid-only beneficiaries in PACE programs.
Congress, which is available at https://www.cms.gov/files/document/mmco-report-congress.pdf. The graph on page 8 of that report presents integrated care enrollment data at the national level in “fully integrated” and “integrated” programs. The authors of the Report to Congress considered the following to be “fully integrated” enrollment in 2019: enrollment in PACE, in MMPs that operate as part of state CMS Financial Alignment Initiative demonstrations, in legacy Medi-Medi demonstrations (in Massachusetts, Minnesota, and Wisconsin), and in FIDE SNPs.
receiving both Medicare and Medicaid coverage from the entity offering the FIDE SNP. FIDE SNP enrollment excludes enrollment in legacy Medi-Medi demonstrations (in Massachusetts and Minnesota) because the FIDE SNP enrollment in those states is accounted for separately.
Medicaid coverage from an entity outside of the D-SNP’s parent company (for example, through fee-for-service Medicaid or through a Medicaid managed care plan operated by a different parent company than the enrollee’s D-SNP).
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coverage for at least some Medicaid benefits through the D-SNP or the D-SNP’s affiliated Medicaid managed care
used the total number of full-benefit dually eligible individuals from the March 2019 MMCO Dual Eligible Enrollment Snapshot Report (available at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and- Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Data-and-Statistical- Resources) as the denominator and state-level enrollment data (from the data sources listed below) as the numerator.
states, which were not included in this graph: Alabama, Arkansas, Delaware, Iowa, Indiana, Kansas, Louisiana, Maryland, North Carolina, North Dakota, Nebraska, New Mexico, New York, Oklahoma, Wisconsin, and Wyoming. The District of Columbia and Puerto Rico were excluded from the analysis.
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32 MMP and PACE Enrollment: Data for all states were extracted from the CMS Medicare Advantage Enrollment by Contract Report, July 2019, available at https://www.cms.gov/index.php/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Contract-Items/Enrollment-by-Contract-2019-07 Enrollment in Legacy Medi-Medi Demonstrations and FIDE SNPs:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan- SNP-Data-Items/SNP-Comprehensive-Report-2019-07.
from May 2019. Enrollment in Integrated D-SNPs:
agency in each state and are from July 2019.
and-Systems/Statistics-Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data-Items/SNP-Comprehensive-Report- 2019-07 Enrollment in Washington’s Total Cost of Care FFS program: Washington enrollment data were provided by CMS MMCO. Total Number of Full-Benefit Dually Eligible Individuals by State (used to calculate the proportion of full-benefit dually eligible individuals enrolled in integrated care programs): Medicare-Medicaid Dual Eligible Enrollment Snapshots, March 2019: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/DataStatisticalResources/Data-and-Statistical-Resources
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SOURCE: CMS SNP Comprehensive Reports, 2008 - 2020. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html 20 40 60 80 100 120 140 160 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000
Number of Plans
Enrollment
I-SNP Enrollment and Number of Plans, 2008 - 2020
*As of March of each year. 2019 and 2020: as of February.
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Note: United HealthCare I-SNP enrollment includes Care Improvement Plus, Oxford Health Plans, and Sierra Health and Life. New plans are considered plans that entered the marketplace in 2018, 2019, or 2020. SOURCE: CMS SNP Comprehensive Report, Feb 2018, 2019 and 2020. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html
40 60 80 100 120 140 2018 2019 2020
Total Number of I-SNPs, 2018 - 2020
United Plans Non-United New Plans Non-United Existing plans
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2,000 4,000 6,000 8,000 10,000 12,000
Enrollment
Enrollment by Company in New Non-United I-SNPs*
All other Plans** LIBERTY (NC) AMERICAN (TN) NHC ADVANTAGE (TN) PRUITT (SC) LONGEVITY (NY) GOOD SAMARITAN (NE) PROVIDER PARTNERS (IL) SIMPRA (AL) ISNP VENTURES (MD) GEORGIA HEALTH (GA)
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SOURCE: CMS SNP Comprehensive Report, Feb 2018, 2019 and 2020. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html
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State Number of I-SNP Plans Total I-SNP Enrollment
New York 18 19,915 Florida 18 6,818 Georgia 5 5,259 North Carolina 8 4,718 Pennsylvania 6 4,499 Ohio 7 4,367 New Jersey 5 4,270 Connecticut 3 3,908 Delaware 3 3,797 Colorado 4 3,590 Alabama 2 3,412 California 5 3,230 Arizona 3 3,213 Virginia 9 2,598 Maryland 7 2,546 Wisconsin 4 2,524 Indiana 1 2,473 Illinois 7 2,285 Missouri 4 1,901 Rhode Island 4 1,841 Oregon 6 1,750 Texas 5 1,572 Tennessee 4 1,380 Washington 3 1,269 SOURCE: CMS SNP Comprehensive Report, Sept 2019. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html
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State Number of I-SNP Plans Total I-SNP Enrollment
Idaho 1 1,145 Nevada 1 762 Nebraska 2 637 South Carolina 1 482 West Virginia 1 482 Oklahoma 2 438 Kansas 3 380 South Dakota 2 329 Mississippi 2 326 Kentucky 2 321 Maine 1 293 New Hampshire 2 293 North Dakota 2 236 Minnesota 4 152 Michigan 2 151 Washington, D.C. 1 62 Massachusetts 1 17 Arkansas 1
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175 99,765
1 Thirteen plans spanned across multiple states. In this table, we divided the number of enrollees in those
plans evenly across the states and added the plan to each state’s total number of I-SNP Plans. The total includes 39 enrollees in plans with fewer than 11 enrollees.
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– File name and location of resource – What it contains – Why it is useful – Description – Things to keep in mind – How to use the data – Other Resources and Excel tips
Sources: D. Chelminsky. “How States Can Better Understand their Medicare-Medicaid Enrollees: A Guide to Using CMS Data Resources.” Integrated Care Resource Center, November 2018. Available at: https://www.integratedcareresourcecenter.com/sites/default/files/CMS_Data_Resources_Nov_2018.pdf;
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Source: CMS Monthly Enrollment Snapshots, June 2018. Available at: https://www.cms.gov/Medicare-Medicaid- Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Data-and- Statistical-Resources.html
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Chronic Condition categories in MMLEADS include Alzheimer’s disease, kidney disease, diabetes, mental health disorders, intellectual disabilities, and substance use disorders.
Source: MMCO Statistical & Analytic Reports, MMLEADS PUF (2006-2012). Available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare- and-Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/Analytics.html
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Demographic categories in MMLEADS include age, race, gender, and ESRD status.
Source: MMCO Statistical & Analytic Reports, All State/County-Level Profiles (2012 Data). Available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare- and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Analytics.html
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Source: Medicaid managed care enrollment report, 2017: https://www.medicaid.gov/medicaid/managed-care/enrollment/index.html
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sources
learning more about the demographics, chronic conditions, service utilization, and managed care enrollment trends of their dually eligible beneficiary populations
If your state is interested in technical assistance, state agency staff are welcome to submit the State Data Profile Request Form
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FIDE SNP HIDE SNP
Must have a contract with the state Medicaid agency that meets the requirements of a managed care organization as defined in section 1903(m) of the Act. Yes No May provide coverage of Medicaid services to full-benefit dually eligible enrollees via a Prepaid Inpatient Health Plan (PIHP) or a prepaid ambulatory health plan (PAHP). No Yes Must provide coverage of applicable Medicaid benefits to full- benefit dually eligible enrollees through the same entity that contracts with CMS to operate as an MA plan. Yes No1 Must have a capitated contract with the state Medicaid agency to provide coverage of LTSS to full-benefit dually eligible enrollees, consistent with state policy. Yes No, if the capitated contract
services. Must have a capitated contract with the state Medicaid agency to provide coverage of behavioral health services to full-benefit dually eligible enrollees, consistent with state policy.
behavioral health coverage by the state Medicaid agency is permitted. No, if the capitated contract
Must have a capitated contract with the state Medicaid agency to provide coverage of a minimum of 180 days of nursing facility services to full-benefit dually eligible enrollees during the plan year. Yes No
Source: Medicare-Medicaid Coordination Office. “Additional Guidance on CY 2021 Medicare-Medicaid Integration Requirements for Dual Eligible Special Needs Plans (D-SNPs).” 2020. Available at: https://www.cms.gov/files/document/cy2021dsnpsmedicaremedicaidintegrationrequirements.pdf
1 The state Medicaid contract may be with: (1) the MA organization offering the D-SNP; (2) the MA organization’s parent organization; or
(3) another entity owned and controlled by the MA organization’s parent organization.
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Tool, November 2019: https://www.integratedcareresourcecenter.com/resource/sample-language- state-medicaid-agency-contracts-dual-eligible-special-needs-plans
Applicable Integrated Plans. ICRC TA Tool, January 2020: https://www.integratedcareresourcecenter.com/resource/appeals-and-grievances-comparisons- existing-and-new-integrated-processes-individuals
D-SNPs. ICRC TA Tool, December 2019: https://www.integratedcareresourcecenter.com/resource/state-
https://www.integratedcareresourcecenter.com/webinar/key-questions-and-considerations- states-implementing-new-d-snp-information-sharing
Enrollees: Key Questions for State Implementation. ICRC TA Tool, September 2019: https://www.integratedcareresourcecenter.com/resource/information-sharing-improve-care- coordination-high-risk-dual-eligible-special-needs-plan
State Options and Considerations. ICRC Brief, August 2019: https://www.integratedcareresourcecenter.com/sites/default/files/ICRC_InfoSharing_HospitalSNF.pdf
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for Dual Eligible Special Needs Plans (D-SNPs).” HPMS Memo. January 17, 2020. Available at: https://www.cms.gov/files/document/cy2021dsnpsmedicaremedicaidintegrationrequire ments.pdf
Requirements for Dual Eligible Special Needs Plans (D-SNPs).” HPMS Memo. October 7,
and-Medicaid-Coordination/Medicare-Medicaid-Coordination- Office/Downloads/DSNPsIntegrationUnifiedAppealsGrievancesMemorandumCY2021100 72019.pdf
https://www.govinfo.gov/content/pkg/FR-2019-04-16/pdf/2019-06822.pdf
https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination-Office/D-SNPs