Tsev Cov Chaw Muab Kev Pabcuam & Cov Neeg Koom Tes Daim Ntawv Cog Lus thiab Phau Ntawv Qhia Txog Cov Phiaj Xwm Tshwj Xeeb Ob Chav​​ 

Dual Special Needs Plans Contract and Policy Guide​​ 

Rov qab mus rau Integrated Care rau Dual Tsim Nyog tau txais txiaj ntsig​​ 
Rov qab mus rau Dual Special Needs Plans hauv California​​ 
Mus rau Daim Ntawv Cog Lus Xyoo 2026 Txoj Cai Qhia​​ 

Dual Special Needs Plans (D-SNPs) are Medicare Advantage (MA) plans that provide specialized care to beneficiaries dually eligible for Medicare and Medi-Cal, and offer care coordination and wrap-around services. All D-SNPs in California must have executed contracts with the Department of Health Care Services (DHCS), the state Medicaid agency. These contracts, referred to as the “State Medicaid Agency Contract” (SMAC) or MIPPA contract, must meet a number of requirements, including Medicare-Medicaid integration requirements. DHCS maintains the authority to contract or not to contract with D-SNPs.​​  

Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv tau tshaj tawm Daim Ntawv Qhia Txhua Lub Hom Phiaj (APL) 23-019 Kev Npaj Khomob nthuav dav rau Medicare Medi-Cal Plans los muab keeb kwm yav dhau los thiab txheeb xyuas cov subsets ntawm cov kev pabcuam kev noj qab haus huv tswj hwm los ntawm Lub Tsev Haujlwm uas yuav tsum tau xa daim ntawv thov rau Medi-Medi Plans, California cov npe tshwj xeeb rau EAE D-SNPs.
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Daim Ntawv Cog Lus Xyoo 2026 D-SNP Txoj Cai Qhia​​ 

Rau Daim Ntawv Cog Lus Xyoo 2026 Txoj Cai Qhia Ntawv Thov mus saib lub vev xaib D-SNP Txoj Cai Lij Choj Ua Ntej . Tsab ntawv no yog tam sim no thaum lub Cuaj Hlis 12, 2025.​​ 

Daim Ntawv Cog Lus Xyoo 2025 D-SNP Txoj Cai Qhia​​ 

Phau Ntawv Qhia Txoj Cai CalAIM D-SNP yog npaj los ua cov peev txheej rau txhua tus D-SNPs hauv California, pib xyoo ntawv cog lus 2025, los ntawm kev muab cov ntsiab lus ntxiv los ntxiv rau 2025 SMAC. Txoj Cai Qhia Txoj Cai uas siv rau tag nrho D-SNPs, thiab cov uas siv rau EAE D-SNPs nkaus xwb, tau qhia nyob rau hauv qhov pib ntawm txhua ntu. Cov kev cai ntawm Phau Ntawv Qhia Txoj Cai no yog ib feem ntawm DHCS SMAC cov cai rau xyoo 2025. Kev hloov tshiab yuav raug tshaj tawm raws li kev taw qhia ntxiv. Tsab ntawv no yog tam sim no txij lub Plaub Hlis 16, 2025. Nco tseg, yog tias koj txoj kev npaj khomob xav tau D-SNP Txoj Cai Qhia Txog tam sim no, thov email info@CalDuals.org.​​ 

*The unlocked versions of the 2025 Network Guidance for EAE D-SNPs Template and the 2025 D-SNP Medicare Network Template were sent to plans via the info@CalDuals.org inbox on September 6, 2024. For D-SNPs that need the templates to be re-sent, please email info@CalDuals.org.
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Daim Ntawv Cog Lus Xyoo 2024 D-SNP Txoj Cai Qhia​​ 

Phau Ntawv Qhia Txoj Cai CalAIM D-SNP yog npaj los ua cov peev txheej rau txhua tus D-SNPs hauv California, pib xyoo ntawv cog lus 2024, los ntawm kev muab cov ntsiab lus ntxiv los ntxiv rau 2024 SMAC. Txoj Cai Qhia Txoj Cai uas siv rau tag nrho D-SNPs, thiab cov uas siv rau EAE D-SNPs nkaus xwb, tau qhia nyob rau hauv qhov pib ntawm txhua ntu. Cov kev cai ntawm Phau Ntawv Qhia Txoj Cai no yog ib feem ntawm DHCS SMAC cov cai rau xyoo 2024. Kev hloov tshiab yuav raug tshaj tawm raws li kev taw qhia ntxiv. Tsab ntawv no yog tam sim no txij lub Kaum Ob Hlis 19, 2024.​​ 

*Yog tias koj xav tau lub xauv version ntawm ib qho ntawm cov qauv, thov email info@CalDuals.org
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For Contract Year 2024, DHCS will use the SMAC to require that all D-SNPs in California with EAE: (a) establish Medicare Advantage (MA) contracts (H contracts) that only include one or more D-SNPs within the state; and (b) integrate certain materials and notices for members. Please note that D-SNPs with EAE includes the state’s Fully Integrated D-SNP, effective January 1, 2024. DHCS also notes that MA organizations implementing this policy should also include their non-EAE D-SNPs in the same H contract as their EAE D-SNP.​​ 

Daim Ntawv Cog Lus Xyoo 2023 D-SNP Txoj Cai Qhia​​ 

The CalAIM D-SNP Policy Guide is intended to serve as a resource for all D-SNPs in California, beginning in contract year 2023, by providing additional details to supplement the 2023 SMAC. The Policy Guide provisions that apply to all D-SNPs, and those that apply only to EAE D-SNPs, are indicated at the beginning of each section. The provisions of this Policy Guide will be part of the DHCS SMAC requirements for 2023. Updates will be published as guidance is added. This latest edition is current as of November 17, 2023.​​ 

D-SNP State Medicaid Agency Contract (SMAC) Boilerplates​​