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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 2026 Materials

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.

Emergency Department (ED) Behavioral Health Services Utilization (ED BH)
Care Coordinator to Member Ratio (CCMR)
Cognitive Health Assessment (CHA)
Members With a Care Plan Completed Within 90 Days of Enrollment (ICP)
ECM-like Services (ECM)
Palliative Care (PAL)
Long-Term Care (LTC)
Note: Non-EAE D-SNPs are not required to report on the LTSS measures.
Healthcare Effectiveness Data and Information Set (HEDIS) Adults’ Access to Preventative/Ambulatory Health Services (AAP)
HEDIS Controlling High Blood Pressure (CBP)
HEDIS Glycemic Status Assessment for Patients With Diabetes (>9.0%) (GSD)
HEDIS Follow-Up After Emergency Department Visit for Mental Illness (FUM)
HEDIS Plan All-Cause Readmissions (PCR)
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

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

Utilization and Risk Adjusted Utilization

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

Care Coordination

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

Organizational Structure and Staffing

  • Care Coordinator to Member Ratio (CCMR)

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

  • Community-Based Adult Services (CBAS)
  • In-Home Supportive Services (IHSS)
  • Multipurpose Senior Services Program (MSSP)
  • Long-Term Care (LTC)

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

Alzheimer’s/Dementia Quality of Care

  • Cognitive Health Assessments (CHA)

Enhanced Care Management-like (ECM-like) Services

18.    ECM-like Services (ECM)

Palliative Care

19.    Palliative Care (PAL)