Funder: Centers for Medicare & Medicaid Services
Author: Alexandra Kruse, Center for Health Care Strategies
September 2019 | Technical Assistance Tool
Starting January 1, 2021, under a new rule recently released by the Centers for Medicare & Medicaid Services, many Dual Eligible Special Needs Plans (D-SNPs) will be required to notify the state Medicaid agencies they contract with (or the state’s designee) when their enrollees are admitted to a hospital or skilled nursing facility. This requirement applies to any D-SNP that is not contracted — either directly or through an affiliated Medicaid managed care organization — to cover either Medicaid behavioral health or long-term care benefits. The goal of the new rule is to ensure timely initiation of Medicaid care management activities around care transitions for at least one group of high-risk beneficiaries. This may, in turn, help lower readmission rates and more effectively support enrollees’ return to the community. The new rule provides states with more opportunities to help ensure that beneficiaries receive care in the right settings at the right time.
To implement the new rule, states will need to work with D-SNPs subject to the notification requirement to develop a process for sharing and using admissions data. States will need to determine a high-risk population for which the data should be shared and to whom admission notifications should go. To determine the latter, states should consider which entities will be in a position to act on the data to support the state-defined group of high-risk D-SNP enrollees. 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.
This resource is a product of the Integrated Care Resource Center, a national initiative of the Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office, which is coordinated by Mathematica and the Center for Health Care Strategies.