The FIDA demonstration project began in January 2015 and runs through December 2017.

To be a FIDA plan, a plan must be approved as a Managed Long–Term Care (MLTC) plan, be approved as a Medicare Advantage (with prescription drug) plan, and meet all the FIDA requirements.

Currently, 21 plans have executed a three–way contract with CMS and NYSDOH and have completed the readiness–review process.

This is based on many elements such as systems, staffing, network adequacy, marketing, and training.

Participants must be:

• 21 or older;
• Entitled to benefits under Medicare Part A and enrolled under both Medicare Parts B and D and receiving full Medicaid benefits; and
• Be a resident of a demonstration county: Bronx, Kings, New York, Queens, Richmond, and Nassau; starting January 1, 2015.
• The program will expand into Westchester and Suffolk counties later this year.
• And meet one of the following three criteria:
  • Require community–based long–term services and supports (LTSS) for more than 120 days,
  • Are eligible for the Nursing Home Transition and Diversion Waiver program, or
  • Are nursing facility clinically eligible and receiving facility–based LTSS.

Exclusions to FIDA eligibility

Under the age of 21. Residents in an Assisted Living Program. In the Foster Family Care Demonstration. Residents of a New York State Office of Mental Health (OMH) facility or of a psychiatric facility. Receiving services from the New York State Office for People With Developmental Disabilities (OPWDD) system. Expected to be Medicaid eligible for less than six months. Eligible for Medicaid benefits only for tuberculosis–related services.

With a "county of fiscal responsibility" code 97, 98, or 99. Residents of Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDD). Eligible to live in an ICF/IIDD, but choose not to. Residents of alcohol/substance abuse long–term residential treatment programs. Eligible for Emergency Medicaid. In the OPWDD Home and Community Based Waiver Services (HCBS) waiver program.

In the Traumatic Brain Injury (TBI) waiver program. Receiving hospice services (at time of enrollment). Eligible for the family planning expansion program. Under 65 (screened and require treatment), in the Centers for Disease Control and Prevention Breast or Cervical Cancer Early Detection program, need treatment for breast or cervical cancer, and are not otherwise covered under creditable health coverage.

…items and services currently covered by:

• Medicare
• Medicaid
• Long–term care
• Behavioral health
• Wellness programs
• Prescription drugs
• HCBS waiver services

There are no FIDA specific costs* to participants, including no co–payments, no premiums, and no deductibles for any covered items or services.

*Medicaid spend–down requirements still apply.

Abdominal Aortic Aneurism Screening

Adult Day Health Care

AIDS Adult Day Health Care

Ambulance

Ambulatory Surgical Centers

Assertive Community Treatment

Assisted Living Program

Assistive Technology (State Plan and Supplemental to State Plan)

Bone Mass Measurement

Breast Cancer Screening (Mammograms)

Cardiac Rehabilitation Services

Cardiovascular Disease Risk Reduction Visit (therapy for heart disease)

Cardiovascular Disease Screening and Testing

Intensive Psychiatric Rehabilitation Treatment Programs

Care Management (Service Coordination)

Cervical and Vaginal Cancer Screening

Chiropractic

Colorectal Screening

Community Integration Counseling

Community Transitional Services

Consumer Directed Personal Assistance Services

Continuing Day Treatment

Day Treatment

Defibrillator (implantable automatic)

Dental

Depression Screening

Determines Necessary

Diabetes Monitoring (Self–Management Training)

Diabetes Screening

Diabetes Supplies

Diabetic Therapeutic Shoes or Inserts

Diagnostic Testing

Durable Medical Equipment

Emergency Care

Environmental Modifications

Family Planning Services

Freestanding Birth Center Services

Home and Community Support Services (HCSS)

Health/Wellness Education

Hearing Services

HIV Screening

Home Delivery and Congregate Meals

Home Health

Home Infusion Bundled Services

Home Infusion Supplies and Administration and Medicare Part D

Home Infusion Drugs

Home Maintenance Services

Home Visits by Medical Personnel

Immunizations

Independent Living Skills and Training

Inpatient Hospital Care (including Substance Abuse and Rehabilitation Services)

Inpatient Mental Health Care

Personalized Recovery Oriented Services

Inpatient Mental Health over 190–day Lifetime Limit

Inpatient Services during a Non–covered Inpatient Stay

Kidney Disease Services (including End Stage Renal Disease services)

Mammograms

Medicaid Pharmacy Benefits as Allowed by State Law

Medical Nutrition Therapy

Medicare Part B Prescription Drugs

Medicare Part D Prescription Drug Benefit as Approved by CMS

Medication Therapy Management

Mobile Mental Health Treatment

Moving Assistance

Non–Emergency Transportation

Nursing Facility (Medicaid)

Nutrition (includes Nutritional Counseling and Educational Services)

NYS Office of Mental Health Licensed Community Residences

Obesity Screening and Therapy to keep weight down

Opioid Treatment Services – Substance Abuse

Other Health Care Professional Services

Other Supportive Services the Interdisciplinary Team

Outpatient Blood Services

Outpatient – Medically Supervised Withdrawal– Substance Abuse

Outpatient Mental Health

Outpatient Rehabilitation (OT, PT, Speech)

Outpatient Substance Abuse

Outpatient Surgery

Palliative Care

Pap Smear and Pelvic Exams

Partial Hospitalization (Medicaid)

Partial Hospitalization (Medicare)

PCP Office Visits

Peer–Delivered Services

Peer Mentoring

Personal Care Services

Personal Emergency Response Services

Podiatry

Positive Behavioral Interventions and Support

Preventive Services

Private Duty Nursing Chemotherapy

Prostate Cancer Screening

Prosthetics

Pulmonary Rehabilitation Services

Respiratory Care Services

Respite

Routine Physical Exam (1/year)

Sexually Transmitted Infections (STIs) Screening and Counseling

Skilled Nursing Facility

Smoking and Tobacco Cessation

Social and Environmental Supports

Social Day Care

Social Day Care Transportation

Specialist Office Visits

Structured Day Program

Substance Abuse Program

Telehealth

Transportation

Urgent Care

Vision Care Services

"Welcome to Medicare" Preventive Visit

Wellness Counseling

There are two types of enrollment:

• Opt–in, which is initiated by an individual.
• Passive, which is enrollment by the state that the individual can decline by opting out.
• All enrollments (opt–in and passive) will be through the enrollment broker, NY Medicaid Choice.
• Participants may disenroll at any time during the demonstration.

Eligible for FIDA, but excluded from passive enrollment:

• Native Americans, but they may opt–in to the demonstration at any time;
• Those eligible for the Medicaid buy–in for the working disabled and are nursing–home certifiable;
• Aliessa court ordered individuals;
• Those assigned to a CMS Accountable Care Organization (ACO) at the time they would otherwise be included in passive enrollment;
• Those participating in the CMS Independence at Home (IAH) demonstration; and
• Those enrolled in:
  • Program of All Inclusive Care for the Elderly (PACE);
  • A Medicare Advantage Special Needs Plan for institutionalized individuals;
  • Health Homes; and
  • Employer or union–sponsored coverage for employees or retirees.

• January 1, 2015, effective date for individuals to opt–in to the demonstration.
• April 1, 2015, first effective date for certain individuals who will be passively enrolled. Passive enrollment will be phased–in over time.

Nursing Home Transition

• Individuals residing in nursing homes prior to February 1, 2015, will not be passively enrolled into FIDA.
• Individuals new to custodial status in nursing homes as of January 1, 2015, will be passively enrolled into FIDA on or after August 1, 2015.

• All FIDA–eligible duals received the FIDA program announcement letter in December 2014
• The program announcement letter is the first notification a participant receives and marks the start of potential opt–in enrollment.
• NY Medicaid Choice will send participants passive enrollment reminder notices before their scheduled date for passive enrollment.

• NY Medicaid Choice will enroll individuals and provide education and assistance.
• Individuals who are eligible for FIDA and enrolled in a MLTC plan will "transition in place" to the FIDA plan offered by the parent organization of their MLTC plan.
• Individuals will be informed about FIDA and offered an opportunity to select a FIDA plan or to opt–out of the program.

To ensure a smooth transition of care for participants, a FIDA plan must:

• Make arrangements to help ensure that all community–based supports, including non– covered services, are in place prior to a participant´s move.
• Make sure participating providers are fully knowledgeable and prepared to support the participant.

Each FIDA plan must ensure that:

• Participants have access to all of their providers and authorized services, including prescription drugs, for at least 90 days or until their person–centered service plan is finalized and implemented – whichever is later.
• Participants can stay in their current nursing homes. FIDA plans must have contracts or payment arrangements with all nursing homes, so that FIDA enrollees who are already in a nursing home can stay at that same nursing home for the duration of the demonstration.

• Each participant must have an individualized comprehensive care plan. FIDA plans are required to use an Interdisciplinary Team (IDT) approach.
• Led by an accountable care manager, the team will ensure integration of the participant´s medical, behavioral health, community–based or facility–based LTSS, and social needs.
• The IDT will be based on a participant´s specific needs, and deliver services with respect to linguistic and cultural competence, and dignity.

A participant´s IDT must be made up of:

• The participant or, in the case of incapacity, an authorized representative;
• The participant´s designee(s), if desired by the participant;
• A primary care provider (PCP) or a designee with clinical experience from the PCP´s practice who has knowledge of the participant´s needs;
• Behavioral health professional, if there is one, or a designee with clinical experience from the professional´s behavioral health practice who has knowledge of a participant´s needs;
• The FIDA plan care manager;
• The participant´s home care aide(s), or a designee with clinical experience from the home care agency who has knowledge of the participant´s needs;
• The participant´s nursing facility representative, who is a clinical professional, if receiving nursing facility care; and
• Other providers either as requested by the participant or designee; or as recommended by the IDT.
• The RN who completed the participant´s assessment, if approved by the participant or designee.

This network will act as a resource and advocate for participants and families as they navigate the MLTC and FIDA program systems. It will also serve beneficiaries of LTSS in Mainstream Managed Care plans.

The contract for this statewide ombudsman program was awarded to a network of not–for–profit organizations, with Community Service Society of New York (CSS) serving as the entity responsible for coordinating services.

The CSS network will provide consumers with direct assistance in navigating their coverage and in understanding and exercising their rights and responsibilities.

CSS will be known as the Independent Consumer Advocacy Network (ICAN) and can be reached by calling 1 (844) 614–8800 or online at: www.icannys.org.

• The grievances and appeals process incorporates the most consumer– favorable elements of the Medicare and Medicaid grievance and appeals systems into a consolidated, integrated system for participants.
• All notices are consolidated and being jointly developed by CMS and NYSDOH. Notices must communicate the steps in the integrated appeals process, as well as the availability of the participant ombudsman to assist with appeals.
• Providers can file an appeal on behalf of a participant but do not have a FIDA– specific right to appeal plan payment decisions.

Find out more:

Call NY Medicaid Choice at: 1 (855) 600–3432

For TTY service, call: 1 (888) 329–1541

For an interpreter, call: 1 (855) 600–3432, and press Option 1

Visit the NY Medicaid Choice website: http://www.nymedicaidchoice.com

Or visit the FIDA website: http://www.health.ny.gov/health_care/medicaid/redesign/fida/

All phone services are free.

If you have questions related to FIDA, email us: FIDA@health.ny.gov

New York State´s Medicaid Reform Team (MRT) website: http://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm

Subscribe to our listserv: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm

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