Demonstration Proposal to Integrate Care for Dual Eligible Individuals: FIDA Update

Mark Kissinger, Director,
Division of Long Term Care
April 24, 2013

Meeting Agenda

  • Welcome/Introductions
  • FIDA Changes - Addendum to Demonstration Proposal
  • FIDA Update:
    • Plan Selection Process . NYSDOH FIDA Application
    • Memorandum of Understanding (MOU)
    • Next Steps
  • Comments/Questions

FIDA Changes - Addendum to Demonstration Proposal

  • FIDA proposal was submitted to CMS on May 25, 2012.
  • Addendum published last week and submitted to CMS.
  • Comments sought on Addendum - Due by 5/19/13
  • Nature of changes
    • Eligible population - FIDA population will now include dually eligible nursing home residents receiving facility-based LTSS
    • Start date and phasing of enrollment
    • Duration - April 2014-December 2017

Update - Plan Selection - NYSDOH FIDA Applications

  • Applications were due to CMS via HPMS by February 21st.
    • No additional applications can be submitted.
  • CMS has scored these applications, along with the 11 CMS-required Model of Care (MOC) elements.
    • Plans will have an opportunity to cure deficiencies during the cure period, if they receive a score below 70.
  • The State scored the applications on the 12th MOC element on self direction.
    • Plans that have submitted insufficient or incomplete responses to this element will have two additional opportunities to resubmit this element in HPMS.
    • The first cure period was in April 2013. The second will be in May 2013.
  • Plan Selection Process
    • Plans licensed as an MLTC plan are eligible to serve as a FIDA plan.
      • To be approved as a FIDA Plan, MLTC plans will have to meet all FIDA requirements - which include submitting a successful Capitated Financial Alignment Application (i.e., Medicare-Medicaid Plan application) to CMS.
      • Information provided to eligible individuals will clearly specify the choice of FIDA or PACE. However, PACE enrollees will not be passively enrolled into FIDA plans.
    • NYSDOH may require a State-specific application process.
    • These selections are contingent on the selected entities passing a CMS and State sponsored readiness review. Upon final selection, the State and CMS will ultimately enter into a three-way contract with selected plans.

Update - FIDA Demonstration Implementation: Draft MOU Update

  • For the FIDA program - CMS requested that NYSDOH submit a marked-up draft of the Ohio MOU
    • This is the starting point for negotiations between NYSDOH and CMS to finalize the specifics of the demonstration.
    • NYSDOH has submitted the MOU in draft form and has made revisions based on CMS comments received.
    • The following slides reflect what has been submitted to CMS in draft form. The MOU is subject to change during discussions with CMS.
  • The State and CMS have agreed to have two separate MOUs: (1) FIDA Primary; and (2) FIDA OPWDD.

Update - FIDA Demonstration Implementation: Draft MOU Development

  • Eligible Populations
    • Age 21 and older at the time of enrollment;
    • In need of over 120 days of community based long-term support services or are nursing facility clinically eligible and receiving facility-based LTSS (this is NEW);
    • Eligible for full Medicare Parts A, B and D and full Medicaid;
    • Reside in a FIDA demonstration County;
    • Do not reside in an OMH facility; and
    • Are not receiving services from the OPWDD system.
  • Proposed Enrollment Process
    • In April 2014, begin accepting voluntary enrollments for individuals in need of community-based long-term care services greater than 120 days.
    • In July 2014, begin process of passive enrollment notification for individuals in need of community-based long-term care services greater than 120 days.
    • In October 2014, begin accepting voluntary enrollment for dual eligible individuals that have exhausted Medicare benefit in nursing homes.
    • In January 2015, begin process of passive enrollment notification for dual eligible individuals that have exhausted Medicare benefit in nursing homes.
    • This will be applicable to eligible individuals in the FIDA demonstration area.
    • Eligible individuals can opt-out of passive enrollment.
    • Enrollment broker will provide enrollment counseling and assistance.

Update - FIDA Demonstration Proposal Addendum

  • Addendum re: Target Population change, Enrollment Phasing, and Timeframe is available for public comment at this link: http://www.health.ny.gov/health_care/medicaid/redesign/docs/2013-04-24_addendum_to_fida.pdf
    • Comments due by May 19, 2013
      • Submit written comments to: mltcworkgroup@health.state.ny.us
      • Mail your comments to:
        Mark Kissinger
        Director, Division of Long Term Care
        Office of Health Insurance Programs
        New York State Department of Health
        Empire State Plaza, Corning Tower, 14th floor
        Albany, New York 12237
      • Submit your comments by fax to: (518) 486-2564
      • For those unable to submit comments by e-mail or fax, please call: (518) 402-5673

Update - FIDA Demonstration Implementation

  • Next Steps
    • Continue discussions with CMS regarding the MOU
    • Release guidance to plans on the plan benefit package and non-Part D drugs
    • Finalize the rate package
    • Receive Public Comments on Addendum and incorporate into MOU and other governing documents
    • Hold next stakeholder meeting in June

Questions