Overview of Dual Eligible Special Needs Plans
Nevada has over 88,000 Dual Eligible recipients. With such a large population of dual-eligible recipients with high utilizations of Medicaid services, there are opportunities to better coordinate care through a D-SNP program with the goal of improving quality of care and the addition of more services.
Nevada has a Coordination Only Dual Eligible Special Needs Plan (CO D-SNP) which is an optional program within Medicare Advantage plans for individuals who are eligible for both Medicare and Medicaid coverage. This program is designed to coordinate care among Medicare and Medicaid to improve care more effectively while also lowering costs. In addition to care coordination, CO D-SNPs can also offer supplemental benefits not typically available under Medicare but offered through Medicaid programs.
Eligibility for D-SNP
A person must be eligible and enrolled in Medicare Part A and/or Part B and receiving Medicaid benefits or Medicaid assistance with Medicare premiums or cost sharing. There are different types of dual-eligible recipients. A Full Benefit Dual Eligible (FBDE) and Qualified Medicare Beneficiary Plus (QMB+) has access to all Medicaid services and Medicaid also pays for the Medicare premiums, co-insurance, and deductible. For a Qualified Medicare Beneficiary (QMB), Medicaid only pays an individual's Medicare premiums, co-insurance and deductible amounts up to Medicaid allowable amounts.
Nevada has chosen these three dual eligible categories to participate in DSNP:
- Full Benefit Dual Eligible (FBDE)
- Qualified Medicare Beneficiary (QMB)
- Qualified Medicare Beneficiary Plus (QMB+)
Recipients who enroll in a D-SNP who are Full Dual Eligible DO NOT lose any existing Medicaid benefits for their current benefit plan such as Personal Care Services and Non-Emergency Transportation.
Services Offered
Nevada Medicaid has chosen to make the following eight (8) services available for eligible D-SNP recipients.
- Dental
- Vision
- Hearing Aids
- Non-emergency transportation to and from medical visits, including pharmacy
- Personal Emergency Response Systems (PERS)
- Nursing Hotline
- Telemedicine
- Meal Services after a hospital stay
Nevada Plans
Nevada currently has a State Medicaid Agency Contract (SMAC) with nine (9) (soon to be ten(10)) Medicare Advantage Plans. Each plan must provide the eight services listed above; however, there may be additional services offered to a CO D-SNP member as detailed on the right by each plan.
Upcoming D-SNP changes
Nevada was awarded a grant through Arnold Venture Foundation to improve its D-SNP program and the integration of Medicaid and Medicare dual eligible services. As part of the grant activities, the Division is receiving Technical Assistance from Mercer to strengthen Nevada’s State Medicaid Agency Contract (SMAC). In addition, Mercer also evaluated options for improvements towards advancing integration of Medicaid and Medicare services for this population. Based on the research, Mercer developed the following report:
DHCFP welcomes feedback on areas to consider for future plan years. Below is an estimated timeline of events.
- Stakeholder engagement sessions- June through August of 2023
- Procurement Activities- January 2024 through December 2024
- Notification of Awardees- early January 2025 for Plan Year 2026