Dual Eligible Special Needs Plans (D-SNPs) Requirements. The Contractor—if currently operating a statewide Dual Eligible Special Needs Plan (D- SNP)—shall cease operating a D-SNP within the State beginning 1/1/2025 unless the Contractor’s parent company will also operate a managed Long-term Services and Supports Plan (MLTSS) in the State. If the Contractor will not operate a MLTSS plan in the State, the Contractor, at their option, can operate their current statewide D-SNP for the duration of CY2024 at a capped enrollment not to exceed the members who were enrolled in that D-SNP for CY2023. This capped enrollment shall not include any members enrolled for CY2024 open enrollment.
Dual Eligible Special Needs Plans (D-SNPs) Requirements. The Contractor shall have Centers for Medicare & Medicaid Services (CMS) approval to operate a statewide Dual Eligible Special Needs Plan (D-SNP) by April 1, 2022. The Contractor seeking D-SNP status for the first time shall be aware of the following general timeline as it intersects with the Hoosier Care Connect program. CMS continues to develop this timeline therefore it is subject to change without notice to the State. CMS will provide more specific due dates as it gets closer to the time period in the general timeline described below. The Contractor is responsible for monitoring CMS information regarding dates of submission for D-SNP related documentation. The Remainder Of This Page Has Deliberately Been Left Blank EXHIBIT 1 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, Apr 1 Hoosier Care Connect contracts implemented 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 pr...
