To improve the integration of Medicare and Medicaid benefits for dual eligibles, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires Dual Eligible Special Needs Plans (D-SNPs) to obtain contracts with the State Medicaid Agency. The MIPPA Contract allows DHS to improve coordination between Medicare and Medicaid for better health outcomes and a more seamless experience for all dual eligibles that enroll in D-SNPs, including those who choose a companion D-SNP in the Community HealthChoices (CHC) program.
The Centers for Medicare & Medicaid Services (CMS) require eight essential elements in a MIPPA Contract and allow states to add additional requirements. In crafting this MIPPA Contract, DHS did extensive research on MIPPA contracts in other states and examined best practices across the country.
The 2017 MIPPA Contract builds on the prior contract and strengthens provisions related to service coordination and data reporting. In an effort to minimize the administrative burden on D-SNPs, DHS has focused its reporting requirements on data that CMS already requires D-SNPs to submit.
Here are some key points from the 2017 MIPPA Contract:
• Beginning January 1, 2018, CHC-MCOs will be required to have companion D-SNPs that match the regions
and service areas of their CHC-MCOs, to ensure that all CHC members have the option of
integrating their Medicare and Medicaid benefits.
• Companion D-SNPs will be required to work with the CHC Independent Enrollment Broker so it can better
counsel participants on their options for integrated Medicare benefits.
• An MCO must provide a single point of contact for a member who chooses both its CHC-MCO and its
• Non-companion D-SNPs (those not aligned with a CHC-MCO) are also eligible for MIPPA contracts and
may serve any combination of dual eligibles permitted by CMS.
You may access the final 2017 MIPPA Contract by clicking on the following link (click here). Questions related to the MIPPA Contract may be sent to the MIPPA mailbox, at RA-MIPPA@pa.gov.