Dual Eligible SNP (D-SNP)
Dual Eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid.
D-SNPs are open to beneficiaries in all Medicaid eligibility categories, including:
- Qualified Medicare Beneficiary without other Medicaid (QMB only);
- Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB only);
- Qualifying Individual (QI);
- Other full benefit dual eligible (FBDE); and,
- Qualified Disabled and Working Individual (QDWI).
Although D-SNPs are available to beneficiaries in all Medicaid eligibility categories, D-SNPs may further restrict enrollment to beneficiaries that belong to certain Medicaid eligibility categories. CMS divides D-SNPs into the following five categories, according to the types of beneficiaries that the SNP enrolls:
- All-Dual D-SNPs
- Full-Benefit D-SNPs
- Medicare Zero-Cost-sharing D-SNPs
- Fully Integrated Dual Eligible (FIDE) SNPs
- Dual eligible subset D-SNPs
This webpage, along with Chapter 16b of the Medicare Managed Care Manual, provides more information on these D-SNP subtypes and the Medicaid eligibility categories they are permitted to enroll. A link to the State Resource Center below provides assistance to States that are seeking to contract with D-SNPs, pursuant to the Medicare Improvements for Patients and Providers Act (MIPPA) State contracting requirement for D-SNPs. In addition, we include a link to the Medicare-Medicaid Coordination Office website, which provides information on new CMS initiatives and demonstration projects designed to promote integrated care for dual eligible populations. We also describe D-SNP specific marketing requirements.
Fully Integrated Dual Eligible Special Needs Plans
Fully Integrated Dual Eligible (FIDE) SNPs were created by Congress in section 3205 of the Affordable Care Act (ACA). Designed to promote the full integration and coordination of Medicare and Medicare benefits for dual eligible beneficiaries by a single managed care organization, FIDE-SNPs are described in section 1853(a)(1)(B)(iv) of the Social Security Act and at 42 CFR §422.2. Please see section 20.2.5 of Chapter 16b of the Medicare Managed Care Manual for details.
State Resource Center
The link to the State Resource Center below provides more information on the requirements for all D-SNPs to contract with the States in which they operate, as well as information on the assistance CMS provides to States to facilitate the contracting process.
Medicare-Medicaid Coordination Office
Since the enactment of the ACA, CMS' efforts to improve SNP offerings have involved collaboration with the Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office), which was established pursuant to section 2602 of the ACA. The goal of the Medicare-Medicaid Coordination Office is to make sure dual eligible beneficiaries have full access to seamless, high quality health care and to make the system as cost-effective as possible. To do so, the Medicare-Medicaid Coordination Office works with the Medicaid and Medicare programs (including the MA SNP program), States and stakeholders to align and coordinate benefits between the two programs effectively and efficiently.
Like all Coordinated Care Plans (CCPs), SNPs must provide enrollees with an Annual Notice of Change (ANOC) and an Evidence of Coverage (EOC).
In addition to the aforementioned marketing requirements, D-SNPs must provide a comprehensive written statement to each prospective enrollee that describes:
- The benefits and cost sharing protections that the individual is entitled to under the State Medicaid program; and
- The specific benefits and cost-sharing protections that are covered by the plan.
The comprehensive written statement must be included with any description of benefits offered by the plan. Plans provide this required information in Section IV of the annually developed Summary of Benefits (SB). For more information, refer to section 70.2 of Chapter 16b of the Medicare Managed Care Manual. Please see the link to Chapter 3, (Medicare Marketing Guidelines) of the Medicare Managed Care Manual. The guidelines are updated annually.
- Page last Modified: 04/09/2013 3:30 PM
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