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Optimizing Contracts with Medicare Advantage Dual Eligible Special Needs Plans: State Medicaid Agency Contracts

This session provided background on Medicare Advantage dual eligible special needs plans (D-SNPs) and the state Medicaid agency contracts (SMACs) they must hold to operate within a state. The presentation included a brief overview of D-SNPs and their role in providing integrated care to people who are eligible for Medicaid and Medicare, including the varying levels of integration required by federal rulemaking. The presentation highlighted contracting strategies that states may use in their SMACs to further integrate care above federal requirements.

Staff also presented results from a contract review of SMACs that identified how states are leveraging their contracts to require greater integration in coverage alignment, care coordination, member materials and experience, data sharing, as well as requiring D-SNPs to work toward reducing health disparities and improving quality. This review will support upcoming interviews with state and federal officials and health plan representatives to better understand federal and state challenges to optimizing SMACs, how states make use of data and reporting requirements, state monitoring and oversight, and state requirements that have contributed the most to integrating care.