Dual Special Needs Plan definition

Dual Special Needs Plan and “DSNP” means a specific type of Medicare Advantage Plan for those individuals who have special needs as defined in 42 CFR § 422.2 and meet the eligibility requirements set forth in 42 CFR § 422.52.

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Dual Special Needs Plan and “DSNP” each means a specific type of Medicare Advantage Plan for those individuals who are dual eligible as defined in 42 CFR § 422.2 and meet the eligibility requirements set forth in 42 CFR § 422.52.

Dual Special Needs Plan and “DSNP” each means a specific type of Medicare Advantage Plan for those individuals who have special needsare dual eligible as defined in 42 CFR § 422.2 and meet the eligibility requirements set forth in 42 CFR § 422.52.

Examples of Dual Special Needs Plan in a sentence

Contractors in Coordinated Care Initiative counties (Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa ▇▇▇▇▇ counties) must have a Dual Special Needs Plan (D-SNP) available to dual eligible Members for contract year 2024 and must provide documentation of the Centers for Medicare & Medicaid approval of the D-SNP by December 2, 2023.
MA Health Plan holds an agreement with CMS to provide a Dual Special Needs Plan covered under this SMAC (or another organization under the same parent company) and receives direct capitation from HCA to provide coverage of the Medicaid benefits described in the Integrated Managed Care (IMC) Contract including BH Services listed in Exhibit 5.
Contractor shall actively support Full Benefit Dual Eligible (FBDE) Member enrollment decisions by providing information about opportunities to align and coordinate Medicaid benefits with Contractor’s Affiliated or Contracted Medicare Advantage or Dual Special Needs Plan.
Once the Department provides an electronic data file list of participating Medicaid providers, the D-SNP will identify in the D-SNP’s provider directory those health care providers that are participating in both the State Plan and the D- SNP’s network for Dual Eligible members who are enrolled in a Dual Special Needs Plan in the Dual Special Needs Plan’s provider directory.
Once the Department provides an electronic data file list of participating Medicaid providers, the MA Health Plan will identify those health care providers that are participating in both the State Plan and the MA Health Plan’s network for Dual Eligible Members who are enrolled in a Dual Special Needs Plan in the Dual Special Needs Plan’s provider directory.
This includes ensuring newly Medicare eligible members receive information about the affiliated Medicare Advantage or Dual Special Needs Plan at least sixty (60) days prior to the Medicare effective date.
Finally, the MA Health Plan shall identify for the Department on Appendix A, which categories of Dual Eligible individuals are eligible to enroll in the Dual Special Needs Plan.
MA Health Plan holds an agreement with CMS to provide a Dual Special Needs Plan covered under this SMAC (or another organization under same parent company) and receives direct capitation from HCA to provide coverage of the Medicaid benefits described in the Integrated Managed Care (IMC) Contract including BH Services listed in Exhibit 5.

More Definitions of Dual Special Needs Plan

Dual Special Needs Plan means a specialized Medicare Advantage plan for special needs individuals who are entitled to medical assistance under a State plan under title XIX of the Act that coordinates the delivery of Medicare and Medicaid services for individuals who are eligible for such services. Exclusively Aligned Enrollment means State policy limits a D-SNP’s membership to individuals whose Medicaid benefits are covered under a Medicaid managed care organization contract under section 1903(m) of the Act between the applicable State and: the dual eligible special needs plan's (D-SNP's) MA organization, the D-SNP's parent organization, or another entity that is owned and controlled by the D-SNP's parent organization.