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January 25, 2022

Medicare Program Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs: Summary of Proposed Changes to Dual Eligible Special Needs Plans and to Other Special Needs Plans

This Bulletin is brought to you by AHLA’s Payers, Plans, and Managed Care Practice Group.
  • January 25, 2022

CMS proposes and solicits comments around three new requirements in the Proposed Rule that apply to D-SNPs and/or all other SNPs that may be instituted:

  • As part of CY 2023, to solicit direct input on experiences of beneficiaries enrolled in both Medicare and Medicaid (dually eligible enrollees), Medicare Advantage Organizations (MAOs) offering D-SNPs must establish and maintain enrollee advisory committees in each state. (Enrollee Input on D-SNP Operations)
  • To begin in 2024 or 2025, building on CMS’ experience with CMS Innovation Center model tests and other programs, all SNPs must include standardized questions on food security, access to transportation, and housing stability as part of their health risk assessments. (Social Determinants of Health and Special Needs Plan Health Risk Assessments)
  • For CY 2025 and subsequent years, CMS proposes several changes to definitions of Fully Integrated Dual Eligible (FIDE) SNPs and Highly Integrated Dual Eligible (HIDE) SNPs to aid in differentiation among D-SNP types, improvements in integrations, and transparency for beneficiaries. (Refining Definitions for Fully Integrated Dual Eligible (FIDE) SNPs and Highly Integrated Dual Eligible (HIDE) SNPs)

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