DSNPs must coordinate with Medicaid and meet specialized requirements. Which option best mirrors this statement?

• A. They must operate independently of Medicaid.
• B. They are not bound by CMS requirements.
• C. They coordinate only with private insurers.
• D. They must coordinate with Medicaid and meet specialized state and CMS requirements.

Answer: (D)

DSNPs are designed to serve beneficiaries who qualify for both Medicare and Medicaid, so the key idea is integration across programs and adherence to the rules that govern both. These plans must coordinate with the Medicaid program to align benefits, care management, provider networks, enrollment, and payments, while also following the specialized requirements established by CMS for DSNPs and any state-specific Medicaid policies. That combination—working with Medicaid and meeting both CMS and state requirements—best matches how DSNPs are supposed to operate.

Why the other ideas don’t fit: DSNPs cannot operate independently of Medicaid, since they are built to serve dual-eligible individuals and must align with Medicaid policies. They are not exempt from CMS requirements; in fact, they must follow CMS DSNP rules in addition to any state rules. Finally, coordinating only with private insurers ignores the critical Medicaid coordination that DSNPs must perform.