D-SNP Quality and Data Reporting
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Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage Plan that are only available for people dually eligible for Medicare and Medi-Cal. Each D-SNP must have a contract with the Department of Health Care Services (DHCS) that specifies state-specific care coordination and quality reporting requirements, among other requirements.
California's state-specific reporting requirements for Exclusively Aligned Enrollment (EAE) and non-EAE D-SNPs are part of a larger quality strategy within DHCS. This includes the Comprehensive Quality Strategy, the Long-Term Services and Supports (LTSS) dashboard, and the Master Plan for Aging.
D-SNPs have robust reporting requirements for both Medicare and Medi-Cal. CMS requires several types of quality reporting for Medicare Advantage Plans including D-SNPs. DHCS also monitors the quality of care and health equity provided to members in Medi-Cal through various reporting requirements, as detailed in the 2022 DHCS Comprehensive Quality Strategy and Medi-Cal contracts. Some of the state-specific quality measures for D-SNPs mirror the CMS Medicare Advantage measures, although the state requires reporting at the D-SNP Plan level instead of the broader Medicare Advantage contract level.
DHCS state-specific quality and reporting requirements for EAE and non-EAE D-SNPs are described in the 2023 D-SNP Policy Guide and 2023 D-SNP Reporting Requirements Technical Specifications.
Key Resources for D-SNPs
State Specific Quality and Reporting Requirements
Below is a list of state-specific quality and reporting requirements for D-SNPs.
Access/Availability of Care
I. Healthcare Effectiveness Data and Information Set (HEDIS) Adults' Access to Preventative/Ambulatory Health Services (AAP)
Effectiveness of Care
II. HEDIS Controlling High Blood Pressure (CBP)
III. HEDIS Poor HbA1c Control (>9.0%) (HBD-H9)
IV. HEDIS Follow-Up After Emergency Department Visit for Mental Illness (FUM)
Utilization and Risk Adjusted Utilization
V. HEDIS Plan All-Cause Readmissions (PCR)
Care Coordination
VI. Members with a Health Risk Assessment (HRA) completed within 90 days of enrollment (Core 2.1)
VII. Members with an annual reassessment (Core 2.3)
VIII. Members with a care plan completed within 90 days of enrollment (Core 3.2)
IX. Members with an Individualized Care Plan (ICP) Completed (CA 1.5)
X. Members with Documented Discussions of Care Goals (CA 1.6)
Organizational Structure and Staffing
XI. Care coordinator to member ratio (Core 5.1)
XII. Care coordinator training for supporting self-direction (CA 3.2)
Medi-Cal Long-Term Services and Supports (LTSS)
XIII. Community-Based Adult Services (CBAS)
XIV. In-Home Supportive Services (IHSS)
XV. Multipurpose Senior Services Program (MSSP)
XVI. Long-Term Care (LTC)
Note: Non-EAE D-SNPs are not required to report on the LTSS measures.
Alzheimer's/Dementia Quality of Care
XVII. Mild Cognitive Impairment Measure
Additional Resources
