Count Down to 2021: Advancing New D-SNP Integration Requirements April 21, 2020 11:00 am – 12:00 pm Eastern Time The Integrated Care Resource Center, an initiative of the Centers for Medicare & Medicaid Services’ Medicare -Medicaid Coordination Office, provides technical assistance for states coordinated by Mathematica and the Center for Health Care Strategies.
Speakers Danielle Chelminsky Health Analyst Mathematica Erin Weir Lakhmani Senior Researcher Mathematica Nancy Archibald Senior Program Officer Center for Health Care Strategies 3
Agenda • D-SNP Enrollment Landscape in 2020 • New D-SNP Integration Requirements for 2021 and Resources for States and D-SNPs • Emerging State Approaches to Information Sharing • Designing and Implementing Information Sharing Approaches: Potential Challenges • Discussion 3
D-SNP Enrollment Landscape in 2020 4
States at the Forefront of Integration in 2020 ME WA VT MT ND NY NH MN OR WI ID SD MA MI PA WY RI IA OH NE IN IL CT NV VA WV CA UT CO KY MO NJ KS NC TN DE SC OK AR AZ MD NM GA AL MS DC TX LA FL HI AK KEY PR Integrated D-SNP* Financial Alignment Demonstration Both Financial Alignment Demonstration and Integrated D-SNPs *These states have aligned D-SNP/MLTSS plans and/or FIDE SNPs as of 2020. Note: 31 States currently have Programs of All-Inclusive Care for the Elderly (PACE). PACE is not 5 5 included in this map.
Growth in Integrated/Coordinated Care Enrollment Enrollment Integration/ States (2020) Coordination Platform Feb 2011 Feb 2020 9 states Financial Alignment Initiative 0 386,331 Demonstrations Capitated: CA, IL, MA, MI, NY, OH, RI, SC, TX 41 states, DC and PR Dual-Special Needs Plans (D- 1,050,864 2,859,411 SNPs) 1 Two thirds of enrollment in 10 states: (FL, NY, PR, TX, PA, CA, TN, AZ, GA, AL) 11 states Fully Integrated Dual 0 280,225 Eligible (FIDE) SNPs AZ, CA, FL, ID, MA, MN, NJ, NY, PA, TN, WI Program of All-Inclusive Care 22,489 48,934 31 states for the Elderly (PACE) 1 All D-SNP enrollment includes FIDE SNP enrollment. Sources : Centers for Medicare & Medicaid Services. SNP Comprehensive Report , September 2011 and Feb 2020: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics- Trends-and-Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html 6 6
Aligned Enrollment in Integrated Plans, 2019 Plan Type Aligned States Enrollment 1 Medicare-Medicaid Plans 386,478 CA, IL, MA, MI, NY, (MMPs) OH, RI, SC, and TX 46,291 PACE 31 states FIDE SNPs 196,816 AZ, CA, FL, MA, MN, ID, NJ, NY, TN and WI Non-FIDE SNP Integrated D- 364,259 AZ, CA, FL, HI, MN, SNP/MLTSS Plans 2 NM, OR, PA, TN, TX, VA Total Cost of Care Managed 13,083 WA FFS 1 Aligned enrollment refers to the number of full-benefit dually eligible individuals who are receive both Medicare and Medicaid coverage from the same plan, or from an affiliated plan operated by the same company. Enrollment data for MMPs, PACE and FIDE SNPs are from July 2019 and were considere d “Fully Integrated” in the FY2019 MMCO Report to Congress. 2 In the FY 2019 MMCO Report to Congress, “Integrated” enrollment consisted of enrollees in D -SNPs who received coverage for at least some Medicaid benefits through the D-SNP or the D- SNP’s affiliated Medicaid managed care plan. Data as of July 2019, except for FL (as of May 2019) and CA (as of August and September 2019). The “Partially Integrated” category was not included in 2019 because classifications changed and those states that provided data wer e considered “Integrated” in 2019. SOURCES: CMS SNP Comprehensive Reports. Available at: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html; MMCO Report to Congress FY 2019 https://www.cms.gov/Medicare-Medicaid- Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/FY-2018-Report-to-Congress.pdf:; CMS Monthly Enrollment by Contract. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- 7 Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Contract.html; and State Medicaid officials.
Aligned Enrollment in Integrated Plans by State, 2019 Proportion of Full-Benefit Dually Eligible Individuals in Integrated Care Programs by State, 2019 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Integrated D-SNPs MMPs FIDE SNPs Legacy Medi-Medi Demo Programs PACE Total Cost of Care FFS 8 See slides 30-32 in the appendix for notes and data sources. 8
Total D-SNP, FIDE SNP, MMP, and PACE Enrollment by State, Feb 2020 Total # of FBDEs 3 State D-SNP 1 FIDE SNP MMP PACE 2 (Mar 2019) AK 16,927 AL 76,979 165 85,316 AR 22,474 289 67,135 AZ 85,626 12,178 169,542 CA 118,131 14,484 110,690 7,693 1,410,051 CO 17,929 4,437 82,962 CT 38,668 70,569 DC 11,882 22,346 DE 4,897 249 14,091 FL 368,732 2,177 397,219 GA 89,748 148,917 HI 24,085 35,140 IA 14,973 560 64,909 ID 7,638 27,894 IL 57,415 315,852 IN 38,816 441 138,527 KS 6,359 522 37,947 KY 28,683 92,766 LA 69,470 463 125,862 MA 58,657 26,590 4,690 282,385 MD 7,799 146 84,851 ME 14,277 51,468 MI 32,556 40,182 3,291 260,546 MN 5,094 40,791 122,051 MO 39,838 136,287 1 Not all D-SNP enrollees are in integrated arrangements, but their care must at least be coordinated with Medicaid. Six D-SNPs spanned across multiple states. For purposes of this table, enrollment was split evenly across states. FIDE SNP enrollment is not included in the D-SNP count. The total D-SNP enrollment includes PR, which was not included in this table since there was no data on FBDEs available. 73 enrollees were in D-SNPs with under 11 enrollees and were included in the total. 2 These enrollment numbers include Medicare enrollees only, and do not include Medicaid-only PACE enrollees, who represented about 19 percent of all PACE enrollees in July 2017, as shown in Tables 2 and 3 of the 2017 Medicaid Managed Care Enrollment Report, available at https://www.medicaid.gov/medicaid/managed- care/downloads/enrollment/2017-medicaid-managed-care-enrollment-report.pdf. 3 Total FBDE data is from March 2019, the most recent data available. FBDEs includes QMB+, SLMB+ and Other FBDEs. 9 9
Total D-SNP, FIDE SNP, MMP, and PACE Enrollment by State, Feb 2020 Total # of FBDEs (Mar State D-SNP FIDE SNP MMP PACE 2019) MS 27,882 - 76,706 MT 1,270 17,306 NC 65,336 249,570 ND 2,123 10,673 NE 7,679 180 35,737 NH 197 20,894 NJ - 52,101 193,818 NM 28,285 1,064 65,338 NV 395 30,513 NY 285,424 60,348 755,820 OH 68,781 1,593 5,167 252,973 OK 7,884 75,365 491 93,952 OR 22,281 537 81,268 PA 123,181 30,611 1,540 375,676 PR 277,528 7,064 RI 4,247 36,854 SC 41,346 13,578 316 136,928 SD 18,016 431 12,309 TN 112,274 2,200 141,716 TX 231,247 260 378,653 UT 7,217 42,902 1,139 32,090 VA 42,839 128,695 VT 1,395 19,664 WA 59,107 132,607 WI 40,798 1,217 843 146,989 WV 7,493 537 45,431 WY 8,020 TOTAL 2,579,113 280,225 386,331 48,934 7,741,760 10 10
National D-SNP, FIDE SNP, MMP, and PACE Enrollment, Feb 2020 Dual Eligible Enrollment by Plan Type Notes : D-SNP total does not include FIDE SNP enrollment. No FBDE data were available for PR. Feb 2020 Data from March 2019 is the most recent FBDE data available. D-SNP total includes 73 enrollees in plans with under 11 enrollees. D-SNP enrollment may include partial benefit dually eligible individuals. Regular Sources: CMS Monthly Enrollment by Contract, Feb Medicare 2020: https://www.cms.gov/Research-Statistics- D-SNP Data-and-Systems/Statistics-Trends-and- Advantage and Reports/MCRAdvPartDEnrolData/Monthly- Fee for Service Enrollment-by-Contract.html (Full-Benefit CMS SNP Comprehensive Report, Feb 2020: https://www.cms.gov/Research-Statistics-Data-and- Dually Eligible Systems/Statistics-Trends-and- Individuals, Mar Reports/MCRAdvPartDEnrolData/Special-Needs- 2019) Plan-SNP-Data.html CMS Quarterly Enrollment Updates, Mar 2019: https://www.cms.gov/Medicare-Medicaid- FIDE SNP Coordination/Medicare-and-Medicaid- Coordination/Medicare-Medicaid-Coordination- MMP Office/Analytics.html PACE 11 11
Percentage of Full Benefit Dually Eligibles Served by D-SNPs, by State, February 2020 ME WA VT AK MT ND NY NH MN OR WI ID SD MA MI PA WY RI IA OH NE IN IL CT NV WV VA CA UT CO KY MO NJ KS NC TN DE SC OK AR MD AZ KEY NM GA AL MS DC 0%/No D-SNPs TX 1%-10% LA FL 11%-25% 26%-50% HI 50%+ PR *PR did not have data in Monthly Enrollment Snapshot Notes : Six plans spanned across multiple states. For this map, the enrollment of these plans was divided evenly across states. Some state allow partial benefit duals in their D-SNPs, which are also captured in this map. Total FBDE data is from March 2019, the most recent data available. Sources: Centers for Medicare & Medicaid Services. SNP Comprehensive Report. February 2020. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- Reports/MCRAdvPartDEnrolData/Special-Needs-Plan-SNP-Data.html Center for Medicare & Medicaid Services. CMS Monthly Enrollment Snapshots , March 2019. Available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare- 12 12 Medicaid-Coordination-Office/DataStatisticalResources/Data-and-Statistical-Resources.html.
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