The Centers for Medicare and Medicaid Services (CMS) has issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs, including provisions designed to improve the integration of Medicare and Medicaid programs for individuals enrolled in dual eligible special needs plans (D-SNPs).
In the preamble of the Proposed Rule, CMS indicates that dually eligible individuals have an array of choices for how to receive their Medicare coverage, including fully integrated dual eligible special needs plans (FIDE SNPs) and highly integrated dual eligible special needs plans (HIDE SNPs). While CMS has defined these terms through rulemaking, there remains nuance and variation that make it difficult for members of the public to understand what may be unique about a certain type of plan or what a beneficiary can expect from a plan. CMS is proposing changes in certain definitions to help differentiate among various types of plans, clarify options for beneficiaries and improve integration
CMS is also proposing to require, for 2025 and subsequent years, that all FIDE SNPs have exclusively aligned enrollment (i.e., limit enrollment to individuals in the affiliated Medicaid MCO) and cover Medicaid home health, durable medical equipment, and behavioral health services through a capitated contract with the state Medicaid agency. CMS is proposing to require that each HIDE SNP’s capitated contract with the state apply to the entire service area for the D-SNP for plan year 2025 and subsequent years.