New D-SNP Integration & Unified Appeals & Grievances Procedures for Contract Year 2021
|01/23/2020: The Integrated Care Resource Center (ICRC) has provided new appeals and grievance technical assistance tools|
01/17/2020 - Additional Guidance on CY2021 Medicare-Medicaid Integration Requirements for D-SNPs (01/17/2020) (PDF) was released.
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:
- NEW! Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for State Medicaid Agency Contracts with D-SNPs for Contract Year 2021, a CMCS Informational Bulletin that summarizes the requirements of the April 2019 final rule and highlights important information that states need to ensure that D-SNPs in their market meet the new integration and unified appeals and grievance requirements beginning in 2021.
- NEW! Additional Guidance on CY2021 Medicare-Medicaid Integration Requirements for D-SNPs (01/17/2020) (PDF)
- CY 2021 Medicare-Medicaid Integration & Unified Appeals & Grievance Requirements for D-SNPs Memorandum (10/07/2019) (PDF) (PDF).
- April 16, 2019 Final Rule (see 84 FR 15696 - 15744).
- The Integrated Care Resource Center (ICRC) provides technical assistance to states to help with implementation of these requirements through briefs, technical assistance tools, tip sheets, webinars, appeals and grievance technical assistance tools, and sample contract language.
More information about D-SNPs can be found on the Medicare D-SNPs page.