D-SNPs: Integration & Unified Appeals & Grievance Requirements

SPOTLIGHT & RELEASES

03/10/2022: CMS released Integration Status for Contract Year 2022 D-SNPs (rev. 01/05/2022). More information can be found below under "Integration."

Overview

The Bipartisan Budget Act (BBA) of 2018 permanently authorized Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), strengthened Medicare-Medicaid integration requirements, and directed the establishment of procedures to unify Medicare and Medicaid appeals and grievance procedures to the extent feasible for D-SNPs beginning in 2021. On April 16, 2019, CMS finalized rules to implement these new statutory provisions.

All D-SNPs must have executed contracts with state Medicaid agencies, referred to as the "State Medicaid Agency Contract" (SMAC) or MIPPA contract, that meet a number of requirements, including Medicare-Medicaid integration requirements and, for some D-SNPs, unified appeals and grievance processes.

Additional Information for D-SNPs and States

Integration

Unified Appeals and Grievances

More information about D-SNPs can be found on the Medicare D-SNPs page.


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Page Last Modified:
03/10/2022 12:43 PM