FIDA Reform Letter

December 9, 2015

Dear Colleague:

The New York State Department of Health (DOH) has recently collaborated with the Centers for Medicare and Medicaid Services (CMS) to amend the State's Fully Integrated Duals Advantage Program, or FIDA. FIDA was designed with the goal of providing coverage for people dually eligible for Medicare and Medicaid with one integrated and enhanced plan. New York is one of 11 states participating in the federal government's dual demonstration program.

This fall, DOH and CMS initiated discussions on FIDA reforms with participants, providers, plans, and other various stakeholders. As a result of the stakeholder engagement process, DOH is hitting the reset button on FIDA to address barriers to enrollment.

At the core, FIDA remains true to its original key components:

  • Fully integrated delivery of Medicaid and Medicare services
  • Person-centered care that promotes independence in the community
  • Improved quality through care coordination
  • High quality cost-effective health care

In the FIDA reforms, specific attention was paid to improved flexibility for the participant, plans, and providers, including the following changes:

  • The participant's right to choose the Interdisciplinary Team (IDT) members.
  • A more flexible IDT, with added accommodations and fewer restrictions for IDT training, provider participation, member meeting times, and the development of the participant's Person Centered Service Plan (PCSP).
  • Primary Care Providers may sign off on a completed PCSP without attending IDT meetings.
  • Plans have authorization over any medically necessary services included in the PCSP that are outside of the scope of practice of IDT members
  • Ease of transition and timing of assessments for FIDA Plan enrollment.
  • Simplified procedures for information sharing and communication.

Although plans' concerns regarding Medicare rates have hindered participation, these programmatic changes are anticipated to help the Program grow in 2016. In addition to these reforms, CMS has committed to reviewing its payment of health plans participating in the demonstration in addition to increasing rates for 2016 to offset the CMS-HCC risk adjustment model's under prediction of costs for full benefit dual eligible beneficiaries.

Eligibility for FIDA remains the same and participants will still have access to the Ombudsman program known as the Independent Consumer Advocacy Network (ICAN). DOH will monitor the impact of these changes prior to expanding to Suffolk and Westchester Counties. DOH is hopeful the FIDA reforms will reiterate the benefits of a combined Medicare and Medicaid health program.


Mark L. Kissinger
Director, Division of Long Term Care
Office of Health Insurance Programs