Gabay sa Kontrata at Patakaran ng Dual Special Needs Plans
Bumalik sa Pinagsanib na Pangangalaga para sa Dalawang Kwalipikadong Benepisyaryo
Bumalik sa Dual Special Needs Plans sa California
Pumunta sa Gabay sa Patakaran sa Taon ng Kontrata 2027
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.
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 Medi-Medi Plans, the California-specific names for EAE D-SNPs.
Taon ng Kontrata 2026 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 2026, by providing additional details to supplement the 2026 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 2026. Updates will be published as guidance is added. This edition is current as of February 27, 2026 . Note, if your health plan needs the most recent D-SNP Policy Guide, please email info@CalDuals.org.
Gabay sa Patakaran ng D-SNP (2026)
Supplemental Materials
2026 Network Guidance for EAE D-SNPs Taxonomy Crosswalk
* Ang mga naka-unlock na bersyon ng 2026 Network Guidance para sa EAE D-SNPs Template at ang 2026 D-SNP Medicare Network Template ay ipinadala sa mga plano sa pamamagitan ng info@CalDuals.org inbox sa Setyembre 12, 2025. Para sa mga D-SNP na nangangailangan ng muling pagpapadala ng mga template, mangyaring mag-email sa info@CalDuals.org.
Taon ng Kontrata 2025 D-SNP Policy Guide
Ang Gabay sa Patakaran ng Calaim D-SNP ay inilaan upang magsilbing isang mapagkukunan para sa lahat ng mga D-SNP sa California, simula sa taon ng kontrata 2025, sa pamamagitan ng pagbibigay ng karagdagang mga detalye upang madagdagan ang 2025 SMAC. Ang mga probisyon ng Gabay sa Patakaran na nalalapat sa lahat ng mga D-SNP, at ang mga nalalapat lamang sa mga EAE D-SNP, ay ipinahiwatig sa simula ng bawat seksyon. Ang mga probisyon ng Gabay sa Patakaran na ito ay bahagi ng mga kinakailangan ng DHCS SMAC para sa 2025. Ang mga update ay ilalathala habang idinagdag ang patnubay. Ang edisyon na ito ay kasalukuyang hanggang Abril 16, 2025. Tandaan, kung kailangan ng iyong plano sa kalusugan ang pinakabagong Gabay sa Patakaran ng D-SNP, mangyaring mag-email sa info@CalDuals.org.
Gabay sa Patakaran ng D-SNP (2025)
Supplemental Materials
2025 Network Guidance for EAE D-SNPs – Taxonomy Crosswalk (January 2024)
*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.
Taon ng Kontrata 2024 Gabay sa Patakaran ng D-SNP
Ang CalAIM D-SNP Policy Guide ay nilayon na magsilbi bilang isang mapagkukunan para sa lahat ng D-SNP sa California, simula sa taong kontrata 2024, sa pamamagitan ng pagbibigay ng mga karagdagang detalye upang madagdagan ang 2024 SMAC. Ang mga probisyon ng Gabay sa Patakaran na nalalapat sa lahat ng D-SNP, at yaong nalalapat lamang sa mga EAE D-SNP, ay ipinahiwatig sa simula ng bawat seksyon. Ang mga probisyon ng Gabay sa Patakaran na ito ay bahagi ng mga kinakailangan ng DHCS SMAC para sa 2024. Ipa-publish ang mga update habang idinagdag ang gabay. Ang edisyong ito ay kasalukuyan noong Disyembre 19, 2024.
Gabay sa Patakaran ng D-SNP (2024)
Supplemental Materials
2024 Network Guidance for EAE D-SNPs – Template 11.28.2023
2024 Network Guidance for EAE D-SNPs – Taxonomy Crosswalk (January 2023)
2024 D-SNP Medicare Network – Template 11.23.2023
D-SNP Quality and Data Reporting
*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.
Taon ng Kontrata 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.
Gabay sa Patakaran ng D-SNP (2023)
Memorandums
AEVS Instructions
Interoperability Memo
Supplemental Materials
2023 Network Guidance for EAE D-SNPs – Taxonomy Crosswalk (March 2022)
2023 Network Guidance for EAE D-SNPs – Template 3.6.2023
2023 Integrated Appeals and Grievances – Requirement Comparison Table
D-SNP Quality and Data Reporting
D-SNP Palliative Care Policies
D-SNP State Medicaid Agency Contract (SMAC) Boilerplates
2026 Boilerplate EAE
2026 Boilerplate Hindi EAE
2025 Boilerplate EAE
2025 Boilerplate Non-EAE
2024 Boilerplate EAE
2024 Boilerplate Non-EAE
Exhibit H
2023 Boilerplate EAE
2023 Boilerplate Non-EAE
2022 Boilerplate CCI Non-CMC
2022 Boilerplate CCI-CMC
2022 Boilerplate Non-CCI
D-SNP State Medicaid Agency Contract Boilerplate, Non-CCI County – Contract Year 2021
D-SNP State Medicaid Agency Contract Boilerplate, CCI County – Contract Year 2021