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New York's Dual Demonstration Proposal to CMS: Health Homes; FIDA; and OPWDD Models

The New York State Department of Health (NYSDOH) invites you to participate in a second round of stakeholder feedback sessions to obtain your input on the revised draft of the NYSDOH Demonstration Proposal to Integrate Care for Dual Eligible Individuals https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/NYProposal.pdf

NYSDOH has made important changes to its proposed program developed in response to a demonstration opportunity from the Centers for Medicare and Medicaid Services (CMS). This program would provide a comprehensive package of services to most individuals that are enrolled in Medicare and Medicaid ("dual eligible") in order to better streamline care and coordinate services. This will be done through several coordinated approaches that now involves both Managed Fee-For-Service (MFFS) and capitated models.

The MFFS approach would begin in July 2012 and would provide integrated care coordination through Health Homes to dual eligibles that have two or more chronic conditions, HIV/AIDS and/or one mental health illness and do not require 120 or more days of long-term supports and services (LTSS). The MFFS dual program will facilitate access to and transition their members in need of long term care services greater than 120 days to MLTC (where available) or fee-for-service long term care providers. The capitated approach would begin in January 2014, would be called FIDA, the Fully- Integrated Duals Advantage program, and would provide a comprehensive package of services to dual eligibles in the eight NY counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester that require more than 120 days of longterm supports and services (LTSS).

Your input continues to be critical to designing a successful program and seek your feedback on the revised proposal, particularly on the new elements. As before, we plan to capture your comments on any and all aspects of the draft proposal, your positive experiences and challenges in navigating care for individuals who are dual eligible, and ideas for ways to improve care and services. Feedback will be used again to guide revisions to the proposal and inform the program's operational plan. NYSDOH will offer two sessions, one in person and one virtual:

Update May 2, 2013 - New York's Dual Demonstration proposal to CMS

The New York State Department of Health (NYSDOH) has made important changes to its original intent to participate in a demonstration program through the Centers for Medicare and Medicaid Services (CMS). The demonstration's original proposal provided a comprehensive package of services to most individuals that are enrolled in Medicare and Medicaid ("dual eligible") in order to streamline care and coordinate services. Approaches involved both Managed Fee-for-Service (MFFS) and capitated models.

NYSDOH had applied to participate in the Centers for Medicare and Medicaid Services (CMS) Medicaid Fee-for-Service (MFFS) duals demonstration project. However, after much deliberation the Department has decided to withdraw this proposal and focus its efforts on transitioning duals to Managed Care and its participation in the Fully-Integrated Duals Advantage Plan (FIDA) capitated duals demonstration project. The NYSDOH will continue its commitment to enroll qualifying fee-for-service dually eligible members in the Health Home program and maintain the strong focus on providing guidance to State Designated Health Homes in the areas of best practices, quality measures, and positive health outcomes.

All Designated Health Homes received a letter from NYSDOH acknowledging their ability to serve dually eligible individuals residing in and receiving services in their counties. Health Homes will be assigned dually eligible Medicaid and Medicare Fee-for-Service members who qualify for Health Home services by NYSDOH. Health Homes continue to be responsible for all requirements outlined in their original designation letters.

Webinar

On May 10, 2012, NYS Department of Health held an informational webinar on the DOH Proposal to Integrate Care for Dual Eligibles for interested parties . To view the copy of the May 10th webinar and powerpoint from the webinar :

In person

The public was invited to a meeting held on May 14, 2012 at Ellis Hospital, Schenectady, NY to discuss the DOH Dual Demonstration Proposal to CMS: Health Homes, FIDA, and OPWDD Models.

If you were unable to attend either opportunity, we would still welcome your feedback on the draft proposal. Please follow this link to find out how to submit written comments:

http://www.health.ny.gov/facilities/long_term_care/dual_elig.htm