Nevada Department of Health and Human Services, Division of Health Care Financing and Policy

Nevada Medicaid took an important step towards integrating Medicare and Medicaid services for their dual-eligible population when it began contracting with Dual Eligible Special Needs Plans (D-SNPs) in January 2021. The state’s project under the Advancing Medicare and Medicaid Integration initiative will focus on strengthening state oversight and enhancing D-SNPs to advance Medicare and Medicaid integration and improve the delivery and quality of services for dual-eligible individuals.

Project Goals

With support from Arnold Ventures, Nevada’s Department of Health and Human Services is working on a on a two-part project to improve integration and oversight of D-SNPs. During the first phase, Nevada and its technical assistance partner will identify opportunities for strengthening and integrating D-SNP contracts; during the second phase, Nevada will implement the recommended changes to the D-SNP program and contract requirements.

Project Approach

To achieve project goals, Nevada and partners are undertaking a 14-month effort that includes the following activities:

• Conducting an in-depth assessment of Nevada’s current landscape: This will include assessing the State Medicaid Agency Contracts (SMACs) with the D-SNPs and procurement process to identify low-burden opportunities to improve care coordination for dual-eligible individuals and enhance beneficiary experience, and how the state can improve state oversight of D-SNP operations. These efforts will include conducting targeted interviews with key stakeholders such as dual-eligible individuals and their caregivers, beneficiary advocacy organizations, providers, plans, and community-based organizations; and analyzing dual-eligible individuals’ enrollment, chronic conditions, and service utilization.

• Implementing SMAC oversight and contracting strategies: Nevada and partners will use the assessment and landscape analyses to inform the development and implementation of additional D-SNP SMAC standards and state oversight procedures. In addition, the team will develop quality metrics, reporting templates, and other mechanisms to support the state’s efforts to ensure D-SNP compliance.

Support for Other States

Many states are in the same position as Nevada — they know they want to improve care for their dual-eligible populations by providing fully-integrated programs, but face resource gaps that prevent them from moving forward. Arnold Ventures launched the Advancing Medicare & Medicaid Integration initiative to support states and help fill those resource gaps. Learn more about funding opportunities.