Resources

As of February 2025, several legislative developments have impacted dual-eligible providers in the United States. Here are some of the most recent and relevant pieces of legislation:

1. Delivering Unified Access to Lifesaving Services Act of 2024 (DUALS Act of 2024):

• • Link: DUALS Act of 2024
  • Description: Introduced in the Senate on March 14, 2024, this bill aims to provide states with support to establish integrated care programs for individuals who are dually eligible for Medicare and Medicaid. The legislation seeks to enhance care coordination and improve health outcomes for dual-eligible individuals.
  • Key Strength: Facilitates the creation of state-level integrated care programs, promoting a more unified approach to serving dual-eligible populations.

2. Contract Year 2025 Medicare Advantage and Part D Final Rule:

• • Link: CMS Fact Sheet
  • Description: Published by the Centers for Medicare & Medicaid Services (CMS) in April 2024, this rule includes provisions that affect Dual Eligible Special Needs Plans (D-SNPs). Notably, it limits out-of-network cost-sharing for Medicare Advantage D-SNP preferred provider organizations (PPOs) for specific services beginning in 2026. The rule aims to reduce cost-shifting to Medicaid, increase payments to safety net providers, expand dually eligible enrollees’ access to providers, and protect them from unaffordable costs.
  • Key Strength: Enhances financial protections for dual-eligible beneficiaries and incentivizes providers to participate in D-SNPs.

3. Dual Eligible Special Needs Plans (D-SNPs) Regulations:

• • Link: CMS D-SNP Information
  • Description: CMS provides detailed regulations and guidelines for D-SNPs, which are Medicare Advantage plans tailored for dual-eligible individuals. These plans integrate Medicare and Medicaid benefits, offering additional services beyond Original Medicare.
  • Key Strength: Offers comprehensive information on the structure, requirements, and benefits of D-SNPs, aiding providers in understanding and complying with federal regulations.

4. The Landscape of Medicare and Medicaid Coverage Arrangements for Dual-Eligible Individuals Across States:

• • Link: KFF Report
  • Description: This report by the Kaiser Family Foundation, published in October 2024, examines the various coverage arrangements for dual-eligible individuals across different states. It provides insights into how dual-eligible individuals access care and the implications for providers.
  • Key Strength: Offers a comprehensive analysis of state-specific variations in dual-eligible coverage, assisting providers in navigating the diverse regulatory environments.

5. Dual-Eligible Special Needs Plans: Frequently Asked Questions:

• • Link: Justice in Aging FAQ
  • Description: This document addresses common questions about health care options for dual-eligible individuals, providing clarity on D-SNPs and other related programs.
  • Key Strength: Serves as a valuable resource for providers seeking to understand the nuances of D-SNPs and their impact on dual-eligible beneficiaries.

These legislative developments and resources are crucial for dual-eligible providers to stay informed about policy changes and to ensure compliance with federal regulations.