New York D-SNPs 2026 Model Material Released by CMS
Relevant to: State Medicare-Medicaid Plan Handbooks
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Click here to read the complete memo from CMS.
Introduction
The Centers for Medicare & Medicaid Services (CMS) has released the Final Contract Year 2026 Model Material for New York’s Applicable Integrated Plan Dual Eligible Special Needs Plans (AIP D-SNPs). This model material, developed with minimal updates, provides guidelines for the Summary of Benefits that must be available starting October 15, 2025. It is essential for plans operating in New York to adhere to this model to ensure consistency and compliance with CMS and state directives.
Key Dates and Deadlines
- Memorandum Date: June 24, 2025
- Summary of Benefits Availability: October 1, 2025
- Summary of Benefits Posting Deadline: October 15, 2025
PACE Compliance
This memo is relevant to PACE programs because of its implications on integrated care models and requirements for dual-eligible plans. While PACE organizations are not D-SNPs, understanding the regulatory environment around integrated plans like these can provide additional insights into compliance and regulatory dynamics that may indirectly impact PACE operations.
PACE organizations must ensure their materials, such as the Summary of Benefits, are compliant with both state and federal regulations. They should closely monitor any changes made by CMS to model materials for integrated plans, as these could suggest shifts in the focus or enforcement of compliance standards.
Moreover, even though PACE is a different program, it operates under the same broader Medicare and Medicaid regulatory framework. Therefore, advancements or changes in requirements for D-SNPs, as noted in this memo, may foreshadow or reflect potential areas of compliance enhancement needed in PACE programs as well.
Required Actions
1. Review and confirm receipt of the correct HPMS memorandum for New York AIP D-SNPs.
2. Ensure the Summary of Benefits is available and posted on plan websites by the required deadline, October 15, 2025.
3. Follow the regulatory guidance for the remaining required materials, as outlined in the State Medicaid Agency Contract and 45 CFR § 422.2267(e).
FAQs
- What are the requirements for the New York AIP D-SNPs model materials?
- When is the Summary of Benefits for New York AIP D-SNPs available?
- How should New York AIP D-SNPs handle State Medicaid Agency Contract requirements?
- Where can the model material for New York AIP D-SNPs be accessed?
