Medicare Advantage dual eligible special needs plans (D-SNPs) are designed to meet the specific needs of dually eligible beneficiaries, and must satisfy minimum requirements to coordinate Medicaid benefits for their enrollees. To operate within a state, D-SNPs are required to hold a state Medicaid agency contract (SMAC). While federal law sets minimum requirements for what a SMAC must include, states have the authority to include additional requirements in their SMACs to further integration.
In this session, staff presented key themes from our interviews with state Medicaid officials in five case study states, federal officials at the Centers for Medicare & Medicaid Services, and health plan representatives for D-SNPs operating in several of our case study states. These themes included: contracting considerations, SMAC authorities, data and reporting requirements, monitoring and oversight processes, and performance improvement and enforcement.