Nursing Facility Resources
Nursing Facility Payment Incentive Updates
- Nursing Facility Incentive Update March 1, 2026 (PDF)
- Nursing Facility VBP April 2025 (PDF)
- Nursing Facility Incentive Extention March 2025 (PDF)
- Nursing Facility Retro Rate Adjustment Q3-Q4 2024 (PDF)
- Nursing Facility Payment Incentive Update January 2, 2025 (PDF)
- NF QIP Update December, 2024 (PDF)
- QIP 2023 Updates (PDF)
Nursing Facility Payment Incentive Resources
Understanding Duals Alignment
Important Notice: Upcoming Changes to Benefit Alignment for Dually Eligible Members
The Centers for Medicare and Medicaid Services (CMS) has finalized federal regulations that will change how Medicare and Medicaid coverage is aligned for dually eligible individuals. These changes are intended to improve care coordination by promoting enrollment with Managed Care Organizations (MCOs) that offer fully integrated Dual Eligible Special Needs Plans (D-SNPs), providing both Medicare and Medicaid coverage.
What's Changing
Beginning in 2027, individuals newly enrolling in a D-SNP will be required to enroll with the same MCO for both Medicare and Medicaid coverage. Members already enrolled in a D-SNP may continue their current coverage during the transition period. By 2030, all individuals dually eligible for Medicare and Medicaid will be required to receive both benefits through the same MCO.
How May Dual Alignment Impact Nursing Facilities?
- Resident Enrollment Changes: Some participants may transition to aligned health plans as the requirements are implemented.
- Network and Administrative Updates: Facilities should review network participation and monitor for changes to eligibility verification, authorizations, claims, and payment processes.
- Care Coordination and Management: Facilities may work with new care managers and care coordination teams as participants transition to aligned coverage.
- Resident and Family Education: Facilities may receive questions about health plan changes and should be prepared to direct participants and families to the appropriate plan resources for assistance.
The CMS regulation in its entirety and CMS FAQs regarding this update can be found at the links below:
How This May Impact Members
Visit our member Understanding DSNP webpage to learn about how these changes may affect members. Help members learn what a Dual-Eligible Special Needs Plan (D-SNP) and the importance of these regulation changes.
Wellcare Provider Phone Number
Dual Special Needs Plans (D-SNPs): 1-844-796-6811 (TTY:711)
All other Medicare Advantage plans: 1-800-977-7522 (TTY:711)
If participants or their representatives are not yet members and interested in more information regarding Wellcare plans they can visit our Wellcare website. They can also contact us via our non-member line at 1-844-480-0680 (TTY: 711).