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How do I fill this out?

To fill out this form, start by reviewing the required attestations and criteria for D-SNPs. Next, gather the necessary documentation including your state Medicaid agency contract. Finally, complete the submission via the Health Plan Management System (HPMS) by the specified deadline.

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How to fill out the Medicare Advantage Dual Eligible Special Needs Plans?

  1. 1

    Review the requirements and guidelines for D-SNPs.

  2. 2

    Prepare the necessary documentation including attestations.

  3. 3

    Ensure all documents are completed accurately.

  4. 4

    Submit the documentation through the HPMS.

  5. 5

    Monitor for confirmation of submission and compliance.

Who needs the Medicare Advantage Dual Eligible Special Needs Plans?

  1. 1

    Medicare Advantage Organizations aiming to expand D-SNP offerings.

  2. 2

    State Medicaid Agencies reviewing compliance for D-SNP contracts.

  3. 3

    Healthcare Providers working with D-SNP beneficiaries needing guidance.

  4. 4

    Compliance Officers ensuring adherence to Medicare guidelines.

  5. 5

    Policy Makers in the healthcare sector seeking to understand D-SNP requirements.

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What are the instructions for submitting this form?

To submit the D-SNP state Medicaid agency contract, utilize the Health Plan Management System (HPMS). All documents must be uploaded electronically by the submission deadline. Ensure that all materials, including attestations and required matrices, are accurate and complete to prevent any processing delays.

What are the important dates for this form in 2024 and 2025?

The submission deadline for state Medicaid agency contracts for 2024 D-SNPs is crucial for compliance. Organizations must ensure submissions align with the CMS deadlines. For further review and adjustments, keep in mind the timelines outlined for the upcoming contract year.

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What is the purpose of this form?

The purpose of this form is to facilitate the submission of contracts for D-SNPs in line with CMS requirements. This ensures that Medicare Advantage organizations are properly aligned with state Medicaid agencies, promoting better care integration for dual eligible beneficiaries. By adhering to this form, organizations can maintain compliance and avoid potential disruptions in providing services.

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Tell me about this form and its components and fields line-by-line.

This form contains various components required for submission related to D-SNP contracts.
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  • 1. Attestations: Sections where organizations provide assurances regarding their D-SNP operations.
  • 2. State Medicaid Agency Contract: Documentation outlining the agreement between organizations and state Medicaid agencies.
  • 3. D-SNP Requirements Matrix: A detailed account of the essential criteria for D-SNPs.
  • 4. SNP Contract Status Review Matrix: A tool to evaluate the contract status of special needs plans.
  • 5. Submission Confirmation: Acknowledgment from CMS of successful contract submission.

What happens if I fail to submit this form?

Failure to submit this form may result in non-compliance with CMS requirements, jeopardizing the operation of your D-SNP. Organizations may face delays in the approval of their contracts, affecting access to essential services for beneficiaries. It's crucial to ensure timely and accurate submissions to avoid these complications.

  • Non-Compliance: Potential sanctions and operational hurdles due to lack of proper submissions.
  • Delay in Operational Approval: Lag in the initiation of D-SNP services for eligible beneficiaries.
  • Impact on Beneficiaries: Disruption of care for dual eligible individuals relying on timely D-SNP services.

How do I know when to use this form?

This form should be used by organizations looking to establish or renew their D-SNP contracts with state Medicaid agencies. You'll need to fill it out when preparing for the upcoming contract year and ensure compliance with CMS regulations. Additionally, refer to this form whenever there are updates or changes to contract requirements.
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  • 1. Establishing New D-SNP Contracts: To create a compliant framework for new D-SNP offerings.
  • 2. Renewing Existing Contracts: To maintain continuity in services provided under D-SNP agreements.
  • 3. Documenting Compliance: To demonstrate adherence to CMS and state Medicaid agency standards.
  • 4. Preparing for Contract Year Submissions: To ensure timely and accurate processing of submissions each year.
  • 5. Integrating Benefits: To ensure proper alignment of Medicare and Medicaid benefits for dual eligible individuals.

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What should I do after completing the form?

Once your form is complete, submit it via the HPMS as instructed and keep a copy for your records.

Are there any specific deadlines for submission?

Yes, it's important to refer to the deadlines specified in the instructions for correct submission timing.

Do I need to upload any additional documents?

Yes, make sure to upload all necessary documents as specified in the submission guidelines.

How do I know if my submission was successful?

You will receive a confirmation notification via HPMS once your submission is successfully recorded.

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