D-SNPs: Integration & Unified Appeals & Grievance Requirements

SPOTLIGHT & RELEASES

02/22/2021: CMS released a revised version of the Integration Status for Contract Year 2021 D-SNPs (rev. 02/22/2021). More information can be found below under "Integration."
12/09/2020: CMS released a revised version of the Integration Status for Contract Year 2021 D-SNPs (found below under "Integration"), and provided the CY 2021 Part C Reporting Updates for Applicable Integrated Plans and the Unified Appeals and Grievance Procedures and revised Coverage Decision Letter and associated OMB-Approved Memorandum (both found below under "Unified Appeals and Grievances").
12/03/2020CMS released the Addendum to the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance. More information can be found below under "Unified Appeals and Grievances."

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.

Page Last Modified:
02/26/2021 06:39 AM