Highly integrated dual eligible special needs plan
Highly integrated dual eligible special needs plan means a dual eligible special needs plan offered by an MA organization that provides coverage of Medicaid benefits under a capitated contract that meets the following requirements (1) The capitated contract is between the State Medicaid agency and one of the following: (i) The MA organization. (ii) The MA organization's parent organization, or another entity that is owned and controlled by its parent organization. (iii) A local nonprofit public benefit corporation of which the MA organization, MA organization's parent organization, or another entity that is owned and controlled by its parent organization is a founding member where the local nonprofit public benefit corporation is responsible for the delivery of physical, behavioral, and dental health services. (2) The capitated contract requires coverage of the following benefits, to the extent Medicaid coverage of such benefits is available to individuals eligible to enroll in a highly integrated dual eligible special needs plan (HIDE SNP) in the State, except as approved by CMS under 422.107(g) or (h): (i) Long-term services and supports, including community-based long-term services and supports and some days of coverage of nursing facility services during the plan year; or (ii) Behavioral health services; and (3) For plan year 2025 and subsequent years, the capitated contract covers the entire service area for the dual eligible special needs plan.