FIDA is short for "Fully Integrated Duals Advantage."

It´s a managed care plan specifically for people who receive services through both Medicare and Medicaid.

FIDA puts you at the center of all important care decisions.

In the FIDA program, your health and well–being are central to the care–planning process.

You will be a part of your Interdisciplinary Team (IDT), which is essentially your care team.

Your team will also include your care manager, doctors, and other people that you trust. You will all work together to make decisions about your plan of care.

Making decisions about long–term care can be confusing and frustrating.

If you join a FIDA plan, your care team will work with you to make sure you know which Medicare and Medicaid services you can get.

Your team will connect you to a network of health care and supportive services that can offer you a variety of options and additional services.

They will help you get your services and get you to your appointments.

The FIDA benefit package includes more services than any other managed care plan in New York.

It includes all Medicaid and Medicare services, as well as other services that you may one day need – such as behavioral health, substance abuse, and other services.

…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

To ensure you have a smooth transition of care, your FIDA plan must:

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

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.

• 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.

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.

• Provide you with information and education about FIDA plans in your area.
• Let you know if your doctor works with a FIDA plan.
• Help you learn about navigating the managed care system.

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

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