Funder: Centers for Medicare & Medicaid Services
Author: Alexandra Kruse and Nancy Archibald, Center for Health Care Strategies; and Rebecca Lester, Mathematica
August 2019 | Brief
Many states contract with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to provide Medicare services to individuals dually eligible for Medicare and Medicaid, but they do not require these D-SNPs to provide coverage of Medicaid long-term services and supports or behavioral health benefits. Starting in 2021, under a recently released rule from the Centers for Medicare & Medicaid Services, these D-SNPs will now be required to notify the state or state’s designee when enrollees experience Medicare-covered hospital or skilled nursing facility admissions.
This brief examines approaches used by three states — Oregon, Pennsylvania, and Tennessee — to develop and implement information-sharing processes for their D-SNPs that support care transitions. It also includes examples of contract language and strategies to encourage plan collaboration around information sharing. It can help states, D-SNPs, and other stakeholders assess how to meet the new D-SNP contracting requirements and improve care for dually eligible individuals.
This brief 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 Policy Research and the Center for Health Care Strategies.