​Medicare Improvements for Patients and Providers Act (MIPPA) Documents

2021 MIPPA Contract

Note: For 2022, 2023, and 2024, all D-SNPs received extension letters that extended the 2021 MIPPA contract for these contract years. The MIPPA contract year is the same as the calendar year. Please note that in addition to extension letters, a few new contracts were given for additional D-SNPs under organizations the Department already has other other D-SNP contracts with. These contracts are exactly the same as the 2021 MIPPA contract except for obvious changes such as the D-SNP name, address, etc.

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. The Department of Human Services (Department) utilizes the MIPPA Contract to improve care coordination between Medicare and Medicaid for better health outcomes and a more seamless experience for all Pennsylvania's dual eligibles that choose to enroll in D-SNPs within the state. 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 eight 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.