Integrated Appeals and Grievances: A Roadmap for D-SNPs

Sarah Swank, Counsel, Nixon Peabody LLP. Justin Frazer, Director, Regulatory Compliance, Mazars USA LLP.

February 2, 2021

  • Per CMS requirements, by 2021, D-SNPS must be prepared to deliver to its beneficiaries a fully integrated (Medicaid and Medicare) appeals and grievance model

  • At the time of this presentation, State agencies have already proposed various models of integration to CMS that D-SNPs will be required to implement, operationalize, and monitor to assure that mandated benchmarks meet the revised regulatory standards

  • Most integrated models will be similar in scope and delivery; therefore, methods and controls for D-SNPs to update their operational models, member notifications, corporate policies, member materials as well as assurances of compliance will be recommended

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