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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.

This fact sheet provides basic information about people who are dually eligible for both Medicare and Medicaid, including information about how a person qualifies for both programs, the difference between “full-benefit” and “partial-benefit” dual eligibility, and certain characteristics of dually eligible individuals, like Medicare plan enrollment and use of certain kinds of health care services.

 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.