William Dede, MPP, health policy associate, Special Needs Plan Alliance, will lead a session on CY21 integration requirements for FIDE-, HIDE-, and D-SNPs during RISE’s upcoming live-streamed virtual event on Oct. 27-28.

The Special Needs Plan Leadership Summit will provide regulatory and legislation updates, audit protocols, operational best practices, and marketing and communication strategies for Special Need Plans (SNPs) seeking to improve outcomes for hard-to-reach and at-risk populations.

Dede’s session will focus on Centers for Medicare & Medicaid Services (CMS) requirements and flexibilities that encourage states and health plans to develop or enhance integrated care programs for their dually eligible beneficiaries (individuals eligible for both Medicare and Medicaid benefits). Those plans include Medicare Advantage dual-eligible plans (D-SNPs), and those classified as integrated (FIDE-SNPs), and highly integrated (HIDE-SNPs).

Dede, pictured right, will also explain why integration of Medicare and Medicaid benefits matters to states, plans, and beneficiaries and he’ll explore integration requirements contained in the 2020 CMS Medicare Advantage Final Rule.

The overarching goal of CMS, he said, is to integrate care for individuals dually eligible for Medicare and Medicaid. D-SNPs are the largest and most versatile ways to achieve this. Integrating Medicare and Medicaid services under one managed care plan will reduce difficulties for beneficiaries with complex care needs, while improving health outcomes and reducing costs, he explained.

“When those who are dually eligible are asked to navigate two different health systems, which is what occurs when they’re not enrolled in an integrated plan, confusion abounds. This can lead to duplication of care, cost overruns for states and CMS, and more importantly, mismanaged care for the beneficiary. We have seen health outcomes improve for individuals enrolled in the D-SNP model, in addition to documented cost savings,” he said.

The session will also address “look-alike” plans, Medicare Advantage plans that offer dual-eligibles supplemental benefits that aren’t available when they enroll in Original Medicare. However, these look-alike plans don’t integrate with Medicaid. CMS this year has taken a step to restrict these look-alike plans by capping the enrollment of dual eligible members to 80 percent of total enrollment. “Generally, the long-term thinking is that CMS will move that threshold down over time. And though 80 percent seems like a high threshold, it shows CMS is going to start moving forward on restricting look-alike plans. The SNP Alliance supported this action taken by CMS.”

One day, Dede said, the goal is to have dual-eligible beneficiaries under the umbrella of one health plan that covers both their Medicare and Medicaid.

Dede will also discuss integration requirement delays due to COVID-19 and obstacles attendees may face. “Due to the difficulty states are experiencing, especially the related to the impact of COVID-19, states often do not have the resources available to develop expertise in Medicare and integrated models, and therefore advance more integrated plans for beneficiaries.”

COVID-19 has also had a significant impact on dual eligibles, who are high risk and especially vulnerable to serious complications and illness. “A lot of Special Needs Plan Alliance members have been doing amazing work to care for their members and adjust their operations to meet the needs of these new circumstances. We have members providing services they have not provided before, whether its telehealth services or delivering meals to their members. Fortunately, CMS provided telehealth flexibilities to allow health plans to provide telehealth services that normally are not covered or payable,” he said.

For vulnerable populations, who are older, have difficulty accessing transportation, and may be afraid to visit a doctor in person because of the pandemic, telehealth has been integral to ensuring these patients continue to receive necessary care.

The Special Needs Plan Leadership Summit will take place Oct. 27-28. Dede is scheduled to speak at the live-streamed event at 2:15 p.m. Tuesday, Oct. 27. Click here to see the full agenda, speakers, and to register for the conference.