Helping states develop integrated programs for individuals who are dually eligible for Medicare and Medicaid
This Centers for Medicare & Medicaid Services (CMS) Health Plan Management System (HPMS) memorandum reminds Medicare plans of their obligation to educate network providers, suppliers, and pharmacies about, and ensure compliance with, QMB billing rules. It also provides information regarding Centers for Medicare & Medicaid Services (CMS) resources that are available to plans to identify Qualified Medicare Beneficiary (QMB) status.
This memorandum outlines lessons learned from a series of strategic conversations the Centers for Medicare & Medicaid Services held with Medicare Advantage organizations in December 2023 and January 2024 regarding calendar year 2023 implementation of Dual Eligible Special Needs Plan enrollee advisory committees.
This memorandum provides states with guidance on the process for working with the Centers for Medicare & Medicaid Services (CMS) to establish Dual Eligible Special Needs Plans (D-SNP)-only contracts and develop integrated materials.
ICRC has developed a basic fact sheet on individuals who are dually eligible for Medicare and Medicaid.
This analysis examines trends in enrollment and eligibility for Medicare-Medicaid enrollees.
Please see the attached memorandum entitled "Contract Year (CY) 2021 Notices for Applicable Integrated Plans: “Coverage Decision Letter”, “Letter about Your Right to Make a Fast Complaint” and “Appeal Decision Letter”" from Sharon Donovan, Director, Program Alignment Group, Medicare-Medicaid Coordination Office. The memorandum describes the notices available for D-SNPs that are applicable integrated plans.
This technical assistance tool provides tables describing both general and special election periods relevant to the enrollment of dually eligible indiviuals in drug management programs into Medicare Advantage plans, including Medicare--Medicaid Plans operating in demonstrations under the Financial Alignment Initiative.
Related Resources:
This memo provides information to Medicare Advantage organizations regarding the opportunity to transition enrollees in Dual Eligible Special Needs Plan (D-SNP) “look-alikes” for CY 2021.
This CMS memorandum describes the final Contract Year 2021 model notices for Dual Eligible Special Needs Plans that are applicable integrated plans, "Letter about Your Right to Make a Fast Complaint" and "Appeal Decision Letter", which are both available in English and Spanish language versions.