Unified Appeal and Grievance Processes for States with Applicable Integrated Plans (AIPs)
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Associated Project
Supporting States in Improving Care for Dually Eligible Individuals through the Integrated Care Resource Center
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare - Medicaid Coordination Office
CMS requires “applicable integrated plan” (AIP) dual eligible special needs plans (D-SNPs) to use unified plan-level appeal and grievance processes to resolve misalignments between Medicare and Medicaid plan-level processes and streamline experiences for plan enrollees. This technical assistance tool summarizes the federal unified appeal and grievance requirements for AIPs and provides information for state Medicaid agencies on requirements for state Medicaid agency contracts with D-SNPs and options for state oversight of these processes.
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