SLMB Only definition

SLMB Only means a SLMB does not qualify for any additional Medicaid benefits.

SLMB Only. The member’s benefits are limited to payment of the member’s Medicare Part B premium only. Specified Low-Income Medicare Beneficiary Plus (SLMB+): The member’s benefits include payment of the member’s Medicare Part B premium in addition to Traditional Medicaid benefits throughout each month of eligibility, including deductibles, co-insurance and co-pays (except for Part D). Qualifying Individual (QI): The member’s benefit is payment of the member’s Medicare Part B premium. The Eligibility Verification System (EVS) identifies this coverage as Qualified Individual. Qualified Disabled Working Individual (QDWI): The member’s benefit is payment of the member’s Medicare Part A premium. The EVS identifies this coverage as Qualified Medicare Beneficiary. Other Full-Benefit Dually Eligible (FBDE): The member is eligible for Medicaid either categorically or through optional coverage groups but is not enrolled for QMB or SLMB. An FBDE is eligible for Medicaid payment of Medicare premiums, deductibles, co-insurance and co-pays (except for Part D). Category Medicare Part A Premiums Medicare Part B Premiums Medicare Cost Sharing (Except Part D) Other Medicaid Benefits Part A Part B FBDE X X X X X SLMB+ X X X X SLMB X QI X QDWI X EXHIBIT 1 ACKNOWLEDGEMENT OF AWARENESS, SERVICES TO BE PROVIDED

SLMB Only is an individual (i) who is entitled to Medicare Part A benefits; (ii) who has annual income that exceeds 100% FPL but is less than 120% FPL; and (iii) whose resources do not exceed twice the SSI limit. Under the Medicaid State Plan, a SLMB is eligible for financial assistance from the Agency in connection with certain Medicare benefits, including payment of Medicare Part B premiums.

Examples of SLMB Only in a sentence

• Specified Low-Income Medicare Beneficiaries (SLMBs) without other Medicaid (SLMB Only) – These individuals are entitled to Medicare Part A, have countable income of greater than 100% FPL, but less than 120% FPL, resources within the federally defined limits, and are not otherwise eligible for Medicaid.

• The categories of dual eligible members for D-SNPs include the following: QDWIs, QMB Only, QMB Plus, QI, SLMB Only, SLMB Plus, and Other FBDEs. Dual Eligible Special Needs Plan (D-SNPs).

• Specified Low-Income Medicare Beneficiaries (SLMBs) without other Medicaid (SLMB Only) – These individuals are entitled to Medicare Part A, have countable income of greater than one hundred percent (100%) FPL, but less than one hundred twenty percent (120%) FPL, resources within the federally defined limits, and are not otherwise eligible for Medicaid.

• A licence holder referred to in this regulation shall appoint an independent certified public accountant, duly registered in accordance with the requirements of law, who shall audit the licence holder’s annual financial statements in accordance with generally accepted auditing standards.

• CMS strictly prohibits Balance Billing. SLMB Only (Specified Low Income Medicare Beneficiary)/ Medicaid Status Code 03: Medicare copay not covered. SLMB+ (Specified Low Income Medicare Beneficiary plus Full Medicaid)/Medicaid Status Code 04: Conditional – verify Medicaid DME benefits and bill Medicaid for the Medicare copay when covered. QDWI (Qualified Disabled and Working Individuals)/Medicaid Status Code 05: Medicare copay not covered.

• Benefit Individuals who apply for SLMB Only get payment (Buy-in) only for their Medicare Part B premium and no other benefits.

• Units for rebatable drugs furnished to Medicare beneficiaries with Medicaid coverage that does not include cost-sharing assistance (i.e., SLMB Only, Qualified Disabled and Working Individuals (QDWI), and Qualifying Individuals (QI) beneficiaries) will be included in rebate calculations.

• This D-SNP enrolls (check all that apply): □ Qualified Disabled and Working Individual □ Qualified Medicare Beneficiary (QMB) Plus □ Qualified Medicare Beneficiary (QMB) Only □ Qualifying Individual □ Specified Low-Income Medicare Beneficiary (SLMB) Plus □ Specified Low-Income Medicare Beneficiary (SLMB) Only □ Other Full Dual Eligible (FDE) The Medicaid benefits under the D-SNP The D-SNP must coordinate Medicaid benefits as described above in Section B, subparagraph 1.

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