Medicare Advantage (MA) dual eligible special needs plans (D-SNPs) are MA plans tailored specifically to the needs of people who are dually eligible for Medicaid and Medicare. As of November 2024, more than six million dually eligible beneficiaries received their Medicare benefits and sometimes their Medicaid benefits through D-SNPs. Currently, D-SNPs are the primary vehicle for integrating care for dually eligible individuals, and the Commission regularly reviews proposed rulemaking affecting the MA program.
On December 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a notice of proposed rulemaking (NPRM) that would mandate coverage of certain weight loss drugs for obesity under MA and Medicaid, add integration requirements for certain D-SNPs, codify timelines for conducting health risk assessments and developing integrated care plans, and increase beneficiary awareness of certain cost-sharing assistance programs, among other things. Comments on the proposed rule are due January 27, 2025.
