Integrated SEP

[Crisfig]

Hi!

I am having trouble wrapping my head around the integrated SEP still. I have an idea of how it works, but when it comes time to do a D-SNP eligibility through a carrier for a client and in their portal it says they qualify for a plan I am still hesitant about knowing whether they can use the Integrated SEP or not.

The carriers are providing little information on this, and even when calling them they don't seem to know how to go about it.

How is everyone handling this new SEP?

 

[TwoCents]

So the person has to either be enrolled or be in the process of being enrolled into a Medicaid plan run by the DSNP carrier.

Beyond that CMS has put together a spreadsheet of all plans that the integrated SEP can be used on -- Scroll down to "2025 Integrated DSNPs"

D-SNPs: Integration & Unified Appeals & Grievance Requirements | CMS

OverviewThe Bipartisan Budget Act (BBA) of 2018 permanently authorized Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs), strengthened Medicare-Medicaid integration requirements, and directed the establishment of procedures to unify Medicare and Medicaid appeals and grievance...

www.cms.gov