Policy Options to Enhance Medicare-Medicaid Integration for D-SNP Enrollees Nancy Archibald Senior Program Officer, Center for Health Care Strategies SNP.

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Presentation transcript:

Policy Options to Enhance Medicare-Medicaid Integration for D-SNP Enrollees Nancy Archibald Senior Program Officer, Center for Health Care Strategies SNP Alliance 13th Annual Leadership Forum November 2, 2017

About the Center for Health Care Strategies A non-profit policy center dedicated to improving the health of low-income Americans

Project Overview Funder: Assistant Secretary for Planning and Evaluation (ASPE) Start: October 2015/End: March 2017 Purpose: Identify policy options to advance D-SNPs as an integration platform by: Resolving misalignments in Medicare and Medicaid processes and procedures Encouraging both states and health plans to invest in D‑SNP-based integration models Facilitating collaboration between states and CMS

Project Methods Literature review Interviews with subject matter experts State case studies AZ, MA, MN, NJ, TN State officials, D-SNP leadership Meeting of state officials AZ, MA, MN, NJ, NM, PA, TN, TX, VA, WI October 2016

Policy Options to Improve Administrative Integration and Alignment* HHS could work with states to develop D‑SNP-specific network adequacy standards. HHS could promote greater integration of the Medicare Model of Care requirements with state Medicaid care management requirements. States could modify Medicaid managed care marketing criteria to align with Medicare Advantage practices. * Policy options gathered through a literature review, expert interviews, state case studies, and a meeting of state officials.

Policy Options to Improve Administrative Integration and Alignment Policy Options to Improve Administrative Integration and Alignment* (continued) States could conduct more beneficiary education and outreach activities. HHS could develop more integrated beneficiary and provider materials to be used by D‑SNPs. States could provide D‑SNPs with data on beneficiaries’ service utilization history. HHS could change the notification process around benefit denials for beneficiaries enrolled in aligned plans. * Policy options gathered through a literature review, expert interviews, state case studies, and a meeting of state officials.

Policy Options to Encourage Investment in D-SNPs* HHS could lift the temporary moratorium on new approvals for seamless conversion submitted by D‑SNPs. States could align their Medicaid annual open enrollment period with the Medicare Advantage open enrollment period. HHS could provide more guidance around the Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) and highly integrated D‑SNP designations. HHS could explore ways to make the frailty payment adjuster for FIDE SNPs available at the beneficiary level rather than the plan level. * Policy options gathered through a literature review, expert interviews, state case studies, and a meeting of state officials.

Other Takeaways* State commitment to integrated care Active state dialogue with CMS Priority issues for administrative alignment: care management and network standards Priority issue for increasing D‑SNP enrollment: seamless conversion Legislative, regulatory, or systems change may be needed Role of CMS technical assistance * Takeaways drawn from a literature review, expert interviews, state case studies, and a meeting of state officials.

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