Letter # 21-04 (rev.) - Implementation of an Integrated Medicare-Medicaid D-SNP Program Effective February 1, 2022

Purpose

This document supplements and updates Medicaid Director Letter # 21-04, issued on September 3, 2021. The purpose of this Medicaid Director Letter is to inform all stakeholders that, effective February 1, 2022, DHCF will expand its “Dual Choice Program” by consolidating the delivery of all covered D.C. Medicaid benefits through the enrollee’s selected D-SNP, subject to the following limitations:

Dual choice enrollees who are also enrolled in the 1915(c) Persons with Intellectual and Developmental Disabilities (IDD) or Individual and Family Support (IFS) waivers, or residing in an intermediate care facility (ICF) may enroll or remain enrolled in a D-SNP, but for Medicare benefits only. Delivery and payment for D.C. Medicaid benefits for these enrollees will continue on a fee-for-service basis by DHCF. Similarly, there will not be any changes to the authorization processes for ICF or IDD and IFS waiver benefits.

For any enrollee, community-based behavioral health services (e.g., MHRS and ASARS) are also excluded from the Medicaid coverage under the D-SNP. Medicaid coverage for these services will be authorized and reimbursed through the same processes by which they are now.