Dual Special Needs Plans Contract and Policy Guide
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Return to Dual Special Needs Plans in California
Dual Special Needs Plans (D-SNPs) are Medicare Advantage (MA) plans that provide specialized care to beneficiaries dually eligible for Medicare and Medi-Cal, and offer care coordination and wrap-around services. All D-SNPs in California must have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency. These contracts, referred to as the "State Medicaid Agency Contract" (SMAC) or MIPPA contract, must meet a number of requirements, including Medicare-Medicaid integration requirements. DHCS is developing two SMAC templates for contract year 2023; the first for exclusively aligned enrollment (EAE) D-SNPs, and the second for non-EAE D-SNPs. DHCS maintains the authority to contract or not to contract with D-SNPs.
As part of the CalAIM initiative, DHCS is leveraging the lessons and success of the Cal MediConnect (CMC) Financial Alignment Initiative to launch EAE D-SNPs, effective January 1, 2023, in the seven counties where CMC was implemented: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Clara. EAE D-SNPs are D-SNPs where enrollment is limited to D-SNP members who are also enrolled in the affiliated Medi-Cal managed care plan.
Contract Year 2023 D-SNP Policy Guide
The CalAIM D-SNP Policy Guide is intended to serve as a resource for all D-SNPs in California, beginning in contract year 2023, by providing additional details to supplement the 2023 SMAC. The Policy Guide provisions that apply to all D-SNPs, and those that apply only to EAE D-SNPs, are indicated at the beginning of each section. The provisions of this Policy Guide will be part of the DHCS SMAC requirements for 2023. Updates will be published as guidance is added. This latest edition is current as of March 6, 2023.
Contract Year 2024 D-SNP Policy Guide
The CalAIM D-SNP Policy Guide is intended to serve as a resource for all D-SNPs in California, beginning in contract year 2024, by providing additional details to supplement the 2024 SMAC. The Policy Guide provisions that apply to all D-SNPs, and those that apply only to EAE D-SNPs, are indicated at the beginning of each section. The provisions of this Policy Guide will be part of the DHCS SMAC requirements for 2024. Updates will be published as guidance is added. This latest edition is current as of January 19, 2023.
For Contract Year 2024, DHCS will use the SMAC to require that all D-SNPs in California with EAE: (a) establish Medicare Advantage (MA) contracts (H contracts) that only include one or more D-SNPs within the state; and (b) integrate certain materials and notices for members. Please note that D-SNPs with EAE includes the state's Fully Integrated D-SNP, effective January 1, 2024. DHCS also notes that MA organizations implementing this policy should also include their non-EAE D-SNPs in the same H contract as their EAE D-SNP.
D-SNP State Medicaid Agency Contract (SMAC) Boilerplates
