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​​​​​​​​​​​​​​​​​​​​​​​​​​D-SNP Quality and Data Reporting​​​

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Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage Plan that are only available for people dually eligible for Medicare and Medi-Cal. Each D-SNP must have a contract with the Department of Health Care Services (DHCS) that specifies state-specific care coordination and quality reporting requirements, among other requirements.

California's state-specific reporting requirements for Exclusively Aligned Enrollment (EAE) D-SNPs, non-EAE D-SNPs, and SCAN’s Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP) are part of a larger quality strategy within DHCS. This includes the Comprehensive Quality Strategy, the Long-Term Services and Supports (LTSS) dashboard, and the Master Plan for Aging.

D-SNPs have robust reporting requirements for both Medicare and Medi-Cal. CMS requires several types of quality reporting for Medicare Advantage Plans including D-SNPs. DHCS also monitors the quality of care and health equity provided to members in Medi-Cal through various reporting requirements, as detailed in the 2022 DHCS Comprehensive Quality Strategy and Medi-Cal contracts.

DHCS state-specific quality and reporting requirements for EAE D-SNPs, non-EAE D-SNPs, and SCAN’s FIDE SNP are described in the 2025 D-SNP Policy Guide and 2025 D-SNP Reporting Requirements Technical Specifications.

Key Resources for D-SNPs

Contract Year 2025 Materials

​Contract Year 2024 Materials

​Contract Year 2023 Materials​​

Additional Resources 

2025 State Specific Quality and Reporting Requirements

Below is a list of state-specific quality and reporting requirements for D-SNPs in 2025.​

  1. Emergency Department (ED) Behav​ioral Health Services Utilization (ED BH)
  2. Care Coordinator to Member Ratio (CCMR)
  3. Cognitive Health Assessment (CHA)
  4. Members With a Care Plan Completed Within 90 Days of Enrollment (ICP)
  5. ECM-like Services (ECM)
  6. Palliative Care (PAL)
  7. Long-Term Care (LTC)
    1. Note: Non-EAE D-SNPs are not required to report on the LTSS measures.
  8. Healthcare Effectiveness Data and Information Set (HEDIS) Adults' Access to Preventative/Ambulatory Health Services (AAP)
  9. HEDIS Controlling High Blood Pressure (CBP)
  10. HEDIS Glycemic Status Assessment for Patients With Diabetes (>9.0%) (GSD)
  11. HEDIS Follow-Up After Emergency Department Visit for Mental Illness (FUM)
  12. HEDIS Plan All-Cause Readmissions (PCR)
    1. Note: 2025 state-specific D-SNP reporting for HEDIS AAP, CBP, GSD, FUM, and PCR are only required for D-SNPs without a state-specific D-SNP only H Contract.

2024 State Specific Quality and Reporting Requirements

Below is a list of state-specific quality and reporting requirements for D-SNPs in 2024.

Access/Availability of Care

1. Healthcare Effectiveness Data and Information Set (HEDIS) Adults' Access to Preventative/Ambulatory Health Services (AAP)

Effectiveness of Care

  1. HEDIS Controlling High Blood Pressure (CBP)
  2. HEDIS Glycemic Status Assessment for Patients With Diabetes (>9.0%) (GSD, formerly HBD-H9)
  3. HEDIS Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Utilization and Risk Adjusted Utilization

  1. HEDIS Plan All-Cause Readmissions (PCR)
  2. Emergency Department (ED) Behavioral Health Services Utilization (ED BH)

Care Coordination

  1. Members with a Health Risk Assessment (HRA) completed within 90 days of enrollment (HRA1)
  2. Members with an Annual Reassessment (HRA2)
  3. Members with a Care Plan Completed within 90 Days of Enrollment (ICP1)
  4. Members with a Current Care Plan (Created or Updated in the Last Year) (ICP2)
  5. Members with Documented Discussions of Care Goals (GOC)

Organizational Structure and Staffing

  1. Care Coordinator to Member Ratio (CCMR)

Medi-Cal Long-Term Services and Supports (LTSS)

  1. Community-Based Adult Services (CBAS)
  2. In-Home Supportive Services (IHSS)
  3. Multipurpose Senior Services Program (MSSP)
  4. Long-Term Care (LTC)

Note: Non-EAE D-SNPs are not required to report on the LTSS measures.

Alzheimer's/Dementia Quality of Care

  1. Cognitive Health Assessments (CHA)

Enhanced Care Management-like (ECM-like) Services

18.    ECM-like Services (ECM)

Palliative Care

19.    Palliative Care (PAL)​

Last modified date: 2/11/2026 3:30 PM