How States Can Monitor Dual Eligible Special Needs Plan Performance: A Guide to Using CMS Data Resources

ICRC Technical Assistance Tool Brief
Publisher: Washington, DC: U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Medicare-Medicaid Coordination Office
Jan 30, 2018
Danielle Chelminsky

Key Findings:

  • Help states effectively interpret and use the various CMS data resources on the Medicare-Medicaid enrollees (dual eligible) population in their state.
  • Help states locate, sort and manipulate relevant data to develop user-friendly and accessible tables, graphs and figures.
  • Help states decision makers monitor D-SNP performance based on enrollment, quality measures, audits and compliance actions and payment information to compare D-SNPs within their state and to D-SNPs in other states.
The Centers for Medicare & Medicaid Services regularly reports data on health plan enrollment, quality, and compliance that states can use to monitor the performance of the Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) they contract with to serve Medicare-Medicaid enrollees. This technical assistance tool shows how states can use these data to create tables, graphs, and figures and interpret their meaning in order to assess D-SNP performance. Using data effectively can help state decision makers and external stakeholders better understand D-SNPs and how they serve Medicare-Medicaid enrollees in their states.