Dual Special Needs Plan Data Sharing of Hospital and Skilled Nursing Facility Admissions

Tuesday, January 12, 2021

Under the Bipartisan Budget Act of 2018, the Centers for Medicare & Medicaid Services (CMS) released a final rule on April 16, 2019, that requires Dual Eligible Special Needs Plans (D-SNPs) to share information with the Division for the hospital and skilled nursing facility admissions for all dually eligible recipient enrolled into a Dual Special Needs Plan with a Medicare Advantage Organization. 

Effective Jan. 1, 2021, under a new rule recently released by CMS, many D-SNPs will be required to notify the state Medicaid agencies they contract with (or the state's designee) when their enrollees are admitted to a hospital or skilled nursing facility (SNF). This requirement applies to any D-SNP that is not contracted, either directly or through an affiliated Medicaid managed care organization (MCO), to cover Medicaid behavioral health or long-term care benefits. 

The goal of the new rule is to ensure timely initiation of Medicaid care management activities around care transitions for at least one group of high-risk beneficiaries. This may, in turn, help lower readmission rates and more effectively support enrollees' return to the community. The new rule provides states with more opportunities to help ensure that beneficiaries receive care in the right settings at the right time.

NC Medicaid Third-Party Recovery: 919-527-7690