Dual eligible special needs plan definition

Dual eligible special needs plan means a special needs plan that enrolls beneficiaries entitled to both Medicare and Medicaid.

Dual eligible special needs plan. (Dual Eligible SNP)” means the Medicare Part C and other health plan services provided to MA Health Plan Members under a SNP as defined and pursuant to an MA Agreement, as defined in 42 C.F.R. § 422.2. Highly Integrated Dual Eligible Special Needs Plan

Dual eligible special needs plan means a special needs plan that enrolls beneficiaries

Examples of Dual eligible special needs plan in a sentence

• The Contractor—if currently operating a statewide Dual Eligible Special Needs Plan (D- SNP)—shall cease operating a D-SNP within the State beginning 1/1/2025 unless the Contractor’s parent company will also operate a managed Long-term Services and Supports Plan (MLTSS) in the State.

• One Care Plans and SCO Plans in Massachusetts must meet Massachusetts state and federal requirements to qualify as an Exclusively Aligned Fully Integrated Dual Eligible Special Needs Plan (Exclusively Aligned FIDE SNP), a specialized type of Medicare Advantage Plan that meets criteria for the highest level of integration for serving Dual Eligible individuals.

• The Contractor shall operate a SCO Plan that meets the requirements of a Medicare Advantage Fully Integrated Dual Eligible Special Needs Plan (FIDE SNP), and shall provide Exclusively Aligned Enrollment for Dual Eligible individuals as follows: Eligible individuals choosing to participate in SCO shall enroll for both their Medicare and their MassHealth coverage through a single SCO Plan, and Dual Eligible individuals may not be enrolled in a SCO Plan for only their Medicare or their MassHealth coverage.

• Association of Dual Eligible Special Needs Plan Enrollment with Beneficiary-Reported Experiences with Care.

• An enrollment process that allows a Medicare Advantage (MA) organization, following approval by the state and CMS, to enroll – unless the Member chooses otherwise – a Member of an affiliated MassHealth health plan into its Medicare Dual Eligible Special Needs Plan (D-SNP) when that Member becomes newly eligible for Medicare.

• Default Enrollment - An enrollment process that allows a Medicare Advantage (MA) organization, following approval by the state and CMS, to enroll – unless the Member chooses otherwise – a Member of an affiliated MassHealth health plan into its Medicare Dual Eligible Special Needs Plan (D-SNP) when that Member becomes newly eligible for Medicare.

• Read the Evidence of Coverage for the full list of benefits.• UHC Dual Complete VA-Y001 (HMO-POS D-SNP) is a Dual Eligible Special Needs Plan (D-SNP) with a Medicare contract and a contract with the Virginia Medicaid program.

• What are Managed Long-Term Services and Supports (MLTSS)?A Dual Eligible Special Needs Plan (D-SNP) is a typeof Medicare Advantage health plan.

• The CONTRACTOR shall, by January 1, 2025, have a Dual Eligible Special Needs Plan (D‑SNP) agreement in good standing with CMS, and agree to the terms and conditions set forth by HCA in the State Medicaid Agency Contract.

• Procurement RequirementsSection 3.1 Exclusively Aligned Fully Integrated Dual Eligible Special Needs PlansOne Care Plans and SCO Plans in Massachusetts must meet Massachusetts state and federal requirements to qualify as an Exclusively Aligned Fully Integrated Dual Eligible Special Needs Plan (Exclusively Aligned FIDE SNP), a specialized type of Medicare Advantage Plan that meets criteria for the highest level of integration for serving Dual Eligible individuals.

More Definitions of Dual eligible special needs plan

Dual eligible special needs plan or “D-SNP” means a type of health benefits plan offered by a Centers for Medicare and

Dual eligible special needs plan or “FIDE SNP” means a D-SNP (1) that provides Dual-Eligible Beneficiaries access to Medicare and Medicaid benefits under a single entity that holds both a Medicare Advantage contract with CMS and a Medicaid managed care organization contract under section 1903(m) of the Social Security Act with SDOH; (2) whose capitated contract with SDOH provides coverage, consistent with SDOH policy, of specified primary care, acute care, behavioral health, and long-term services and supports, and provides coverage of nursing facility services for a period of at least 180 days during the plan year; (3) that coordinates the delivery of covered Medicare and Medicaid services using aligned care management and specialty care network methods for high-risk beneficiaries; and (4) that employs policies and procedures approved by CMS and SDOH to coordinate or integrate beneficiary communication materials, enrollment, communications, grievance and appeals, and quality improvement; and (5) has received CMS designation as a FIDE SNP.