This week, our In Focus section provides an overview of new requirements and opportunities for states and Medicare Advantage (MA) Dual Eligible Special Needs Plans (D-SNPs) to increase Medicare and Medicaid coordination in plan year 2021. Specifically, states and health plans will need to partner for compliance with calendar year (CY) 2021 Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) data sharing requirements for D-SNPs that are not designated as a fully integrated D-SNP (FIDE SNP) or a highly integrated D-SNP (HIDE SNP). CY 2021 State Medicaid Agency Contracts (SMACs) with these D-SNPs must document the notification process for sharing hospital and skilled nursing facility (SNF) admissions for at least one group of high-risk enrollees.
States are given flexibility to:
- Identify group(s) of high-risk full-benefit dual eligible individuals
- Outline the manner of notification
- Designate what entity receives the notification
States are not limited in setting the size of the group of high-risk individuals for which D-SNPs must share this data. It may be a subgroup or could include all full benefit dual eligible individuals.
States and health plans have an opportunity to work together and engage stakeholders to identify entities to receive the hospital and SNF admission data and support care transitions for high-risk dual eligible individuals. Designated entities to receive the admission information may be Medicaid health plans, fee-for-service providers or care managers.
Health Management Associates is working with states, plans, and other stakeholders to establish and inform these processes and support integrated care for Medicare-Medicaid dually eligible individuals. CY 2021 SMACs are due to the Centers for Medicare and Medicaid Services (CMS) by July 6, 2021.
Supporting slides for states, health plans, and other stakeholders may be accessed here.
For more information, please contact Sarah Barth, principal, HMA.
 Link to slide deck identifying key characteristics of FIDE SNP and HIDE SNPs provided at end of article.
 October 7, 2019 Medicare-Medicaid Coordination Office Memorandum to Dual Eligible Special Needs Plans, CY 2021 Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for Dual Eligible Special Needs Plans (D-SNPs)
 States, or their designee may receive the data.
 Over 12 million people nationwide are dually eligible for Medicare and Medicaid. Some qualify for full Medicaid benefits, referred to as full benefit dually eligible (FBDE) individuals. Others solely qualify for assistance with payment of Medicare premiums, and in some cases, Medicare cost sharing, referred to as partial benefit dually eligible individuals.
Related blog posts:
- D-SNP 2021 Integration Requirements: Opportunities for Plans, States to Partner on Medicare-Medicaid Integration
- Evolving Integrated Managed Care Models for Medicare-Medicaid Dual Eligible Beneficiaries: Key Considerations for Health Plans
- New Opportunities and Requirements for Integrated Managed Care Models for Medicare-Medicaid Dually Eligible Individuals Served by Health Plans