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    ​Medicare Improvements for Patients and Providers Act (MIPPA)

    The Department of Human Services (DHS) leverages MIPPA to improve care coordination between Medicare and Medicaid for better health outcomes and a more seamless experience for individuals who are eligible for both Medicare and Medicaid and choose to enroll in Dual-Eligible Special Needs Plans (D-SNPs).

    2025 MIPPA Contract

    View the 2025 Final MIPPA Contract

    Dual eligibles are individuals who are eligible for both Medicare and Medicaid. Dual Eligible Special Needs Plans (D-SNPs) are a type of Medicare managed care plan that can only enroll dual eligibles. The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 requires D-SNPs to obtain contracts with the State Medicaid Agency to improve the integration of Medicare and Medicaid benefits for dual eligibles. This includes those dual eligibles that choose a companion D-SNP offered by one of the managed care organizations (MCOs) operating in the Community HealthChoices (CHC) program.

    The federal Centers for Medicare & Medicaid Services (CMS) requires certain essential elements in a MIPPA Contract and allows states to add additional requirements. The Department's MIPPA Contract builds on prior contracts and strengthens provisions related to service coordination and data reporting. D-SNPs must:

    • Assist members with filing grievances and appeals with Medicaid.
    • Coordinate with the members' CHC and Behavioral Health MCOs.
    • Provide 48-hour notification of certain events to the CHC-MCO service coordination staff (i.e., hospital and skilled nursing facility admissions and discharges, ER visits, significant medication changes).
    • Continue to cover a member for six months if they lose Medicaid eligibility temporarily to allow time for them to regain it.
    • Conduct education about maintaining Medicaid eligibility and assist members in applying for Medicaid redeterminations.

    The MIPPA Contract also requires D-SNPs to report to the Department:

    • The D-SNP's Model of Care.
    • Quality indicators as reported to CMS or to the National Committee for Quality Assurance (NCQA), including measures such as follow-up care after a hospitalization for a mental illness, follow-up care for chronic conditions such as diabetes and high blood pressure, and whether members received certain screening tests.
    • The D-SNP's Opioid Strategy Plan.
    • A care coordination report that includes both a retrospective review of activities in the prior year and improvements planned for the current year.