Headline
Using Medicare resources can enable states to support Medicaid managed care quality oversight and improvement, including quality monitoring of Dual Eligible Special Needs Plans (D-SNPs).
Context
State Medicaid agencies face barriers to obtaining quality oversight information on Medicare Advantage D-SNPs, which states can contract with to deliver Medicaid services for dually eligible individuals. These barriers are related to the siloed administrative infrastructure of the Medicaid and Medicare programs. This tool describes opportunities, strategies, and tips for state policymakers to improve quality improvement monitoring of D-SNPs.
About this Tool
This tool can support state policymakers in:
- Learning about Medicare Advantage (MA) data resources available through the Centers for Medicare & Medicaid Services, which states can access to monitor D-SNP performance;
- Understanding how MA data resources can bolster states’ Medicaid managed care quality oversight efforts;
- Integrating D-SNPs into Medicaid quality improvement activities, with a focus on developing goals, objectives, and Medicaid quality measures specific to D-SNPs;
- Developing requirements for D-SNPs to implement or be involved in Medicaid quality assessment and performance improvement programs; and
- Streamlining Medicaid quality review for D-SNPs by using Medicare data resources.
Takeaways
State policymakers can use this tool to integrate D-SNPs into Medicaid quality improvement strategies, and to focus on improvements in quality of care for dually eligible individuals.
