Providers and D-SNPs
The South Carolina Department of Health and Human Services acknowledges and partners with eight Dual Special Needs Programs (D-SNPS) designed to enhance coordination of benefits for individuals who are receiving Medicare and Healthy Connections Medicaid services.
The D-SNP serves as primary Medicare coverage for members followed by Healthy Connections Medicaid. D-SNPs are responsible for maintaining knowledge of SC State Plan for Medical Assistance but not responsible for providing Medicaid related services. Healthy Connections Medicaid services continue to be paid as Fee-for-Service (FFS) for members enrolled in a D-SNP. To learn more about the responbilities of D-SNPs, please visit www.cms.gov or review the Managed Medicare Plan Manual.
Click on the links below to learn more about each specific D-SNP.
Requirements and Payment Procedures
SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare-covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
Payment procedures for SNPs mirror the procedures that CMS uses to make payments to non-SNP MA plans. SNPs must prepare and submit bids like other MA plans, and are paid in the same manner as other MA plans based on the plan’s enrollment and risk adjustment payment methodology. All SNPs must abide by current CMS guidance on cost-sharing requirements.