Dual Special Needs Plans Contract and Policy Guide
Return to Integrated Care for Dual Eligible Beneficiaries
Return to Dual Special Needs Plans in California
Go to Contract Year 2025 Policy Guide
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 is developing two SMAC templates for contract year 2023; the first for exclusively aligned enrollment (EAE) D-SNPs, and the second for non-EAE D-SNPs. DHCS maintains the authority to contract or not to contract with D-SNPs.
The Department of Managed Health Care has issued an All Plan Letter (APL) 23-019 Health Plan Expansion for Medicare Medi-Cal Plans to provide background and identify the subsets of health care service plans regulated by the Department that are required to submit a filing for Medicare Medi-Cal Plans (MMPs), the California-specific names for EAE D-SNPs.
Contract Year 2023 D-SNP Policy Guide
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.
Contract Year 2024 D-SNP Policy Guide
The CalAIM D-SNP Policy Guide is intended to serve as a resource for all D-SNPs in California, beginning in contract year 2024, by providing additional details to supplement the 2024 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 are part of the DHCS SMAC requirements for 2024. Updates will be published as guidance is added. This edition is current as of January 23, 2024.
*If you need an unlocked version of any of the templates, please email info@CalDuals.org
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.
D-SNP State Medicaid Agency Contract (SMAC) Boilerplates
