Dual Eligible Special Needs Plans. (D-SNPs) Requirements
Dual Eligible Special Needs Plans. (D-SNPs) Requirements
EXHIBIT 1. A. SCOPE OF WORK 2020, Nov Contractor submits Notice of Intent to Apply (NOIA) to CMS for CY 2022 2021, Jan-Feb Contractor submits the following to CMS: • MA and Part D application • Initial SNP application • Model of Care 2021, May CMS/NCQA issues MOC renewal terms of one, two, or three years 2021, Jun Contractor submits the following to CMS for 2022: • Plan Benefit Package (PBP) • Completed Bid Pricing Tool (PBT) to CMS for the upcoming year Both should be consistent with State requirements 2021, July Contractor submits its State Medicaid Agency Contract (SMAC) to CMS for CY 2022. Contract must include the following. New Provisions (due to be implemented CY 2021): • Provision of Medicaid LTSS and/or Medicaid behavioral health benefits either directly with the legal entity providing the D-SNP, with the parent organization of the D-SNP, or with a subsidiary owned and controlled by the parent organization of the D-SNP; OR • Process to share information with the State or the State’s designee (such as a Medicaid managed care organization or Medicaid care manager), on hospital and SNF admissions of high-risk individuals who are enrolled in the D-SNP. In addition to the minimum requirements per 42 CFR 422.107: • The D-SNP’s responsibility, including financial obligations, to provide or arrange for Medicaid benefits. • The categories of dually eligible beneficiaries eligible to be enrolled under the SNP (e.g., full benefit, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), etc.). • The Medicaid benefits covered under the SNP. • The cost sharing protections covered under the SNP. • The requirements to identify and share information on Medicaid provider participation. • The procedural requirements for the verification of enrollees’ eligibility for both Medicare and Medicaid. • The service area covered by the SNP. The contract period for the SNP. 2021, Sept CMS issues SNP approval/denial notices
Dual Eligible Special Needs Plans. (D-SNPs) Requirements 2021, Apr 1 Hoosier Care Connect contracts implemented 2022, April 1 Hoosier Care Connect Contractor D-SNPs implemented
