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:

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

Page Last Modified:
01/27/2020 02:12 PM