Tips to Improve Medicare-Medicaid Integration Using D-SNPs: Designing an Integrated Summary of Benefits Document

Publisher: Washington, DC: Integrated Care Resource Center
Jun 26, 2018
Erin Weir Lakhmani and Alexandra Kruse

Key Findings:

  • Benefits of Integrated Summary of Benefits Documents include more beneficiary engagement, improved comprehension, and better retention of information.
  • The two main approaches states can use to achieve integration of D-SNP SB documents include collaborating with CMS to design an integrated SB template or using contractual requirements to ensure that D-SNPs provide clear, straightforward Medicaid information in their Summary of Benefits documents.
  • Key Steps in developing integrated SB documents include: reviewing CMS guidelines and sample summary of benefits documents, collecting feedback from key stakeholders, and incorporating requirements into D-SNP and Medicaid managed care contracts.

States are increasingly contracting with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) to better integrate Medicare and Medicaid benefits for dually eligible enrollees in order to increase care coordination and improve beneficiaries’ experience of care. D-SNPs whose enrollees are also enrolled in aligned Medicaid managed care (MMC) or managed long-term services and supports (MLTSS) plans can receive their Medicare and Medicaid benefits in a seamless, coordinated manner. In these arrangements, member materials that describe both Medicare and Medicaid benefits in an integrated, understandable way are an important component in improving the beneficiary experience. States can start to improve member materials by using contractual requirements to ensure that Medicare and Medicaid benefit information for aligned plans is incorporated into a single, streamlined Summary of Benefits (SB) document.