Indiana AIP D-SNPs: 2026 Model Materials Release
Relevant to: Marketing Guidance
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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Introduction
Indiana’s Dual-Eligible Special Needs Plans, or D-SNPs, are preparing for the 2026 contract year with new model materials developed by CMS and the state. This includes the Summary of Benefits, a Provider and Pharmacy Directory, and a List of Covered Drugs, all set for release by October 15, 2025. These materials aim to ensure enrollees have easy access to crucial information and comply with regulatory requirements.
Key Dates and Deadlines
- Model Materials Release Date: June 17, 2025
- Summary of Benefits (SB) Availability Date: October 1, 2025
- Final Deadline for Summary of Benefits (SB), Provider Directory, and Drug Formulary: October 15, 2025
PACE Compliance
This memo is relevant to PACE programs as it outlines the requirements for the release and availability of integrated D-SNP model materials in Indiana. It emphasizes compliance with the State Medicaid Agency Contracts and the importance of adhering to set deadlines and procedures for the Summary of Benefits, Provider and Pharmacy Directory, List of Covered Drugs, and Member ID Card.
For PACE compliance, Indiana AIP D-SNPs must adhere to the following guidelines:
- Summary of Benefits (SB) must be made available by October 15, 2025, with the option for early release on October 1, 2025. The document must also be published on plan websites by the deadline, ensuring widespread accessibility.
- The Provider and Pharmacy Directory should be distributed to current enrollees by no later than October 15, 2025. This directory must also be made available to prospective enrollees and published on plan websites by this date for enhanced accessibility.
- The List of Covered Drugs (Formulary) must reach current enrollees by October 15, 2025, and should be accessible to prospective enrollees and available on the plan websites by this deadline.
The plans are encouraged to collaborate with CMS and state marketing reviewers to ensure timely submissions and adherence to requirements outlined in both the regulatory guidance at 45 CFR § 422.2267(e) and the State Medicaid Agency Contracts.
Required Actions
1. Ensure all model materials for Contract Year 2026, including Summary of Benefits, Provider and Pharmacy Directory, and List of Covered Drugs, are prepared and ready for distribution to current enrollees by October 15, 2025. The materials should also be posted on plan websites by this date.
2. Work closely with CMS and state marketing reviewers to ensure timely submission and approval of all required CY 2026 materials.
3. Follow regulatory guidance outlined in 45 CFR § 422.2267(e) and any additional guidance provided by the state in the State Medicaid Agency Contract for the creation and distribution of the materials.
FAQs
- “What are the model materials for the Indiana AIP D-SNPs for Contract Year 2026?”
- “When must the Summary of Benefits, Provider and Pharmacy Directory, and List of Covered Drugs be available for Indiana AIP D-SNPs?”
- “Why are plans encouraged to work closely with CMS and state marketing reviewers?”
