New York signed a Memorandum of Understanding with CMS on 8/23/2013. The New York demonstration targets dual eligible beneficiaries age 21 and older in 8 counties who are eligible for a nursing home level of care and receiving facility-based LTSS or who are eligible for the nursing home transition and diversion 1915(c) waiver or who require community-based LTSS for more than 120 days. Fully Integrated Duals Advantage (FIDA) plans will perform assessments using the state-approved assessment tool and provide person-centered care management and integrated medical, behaviroal health, substance use, and community and facility-based LTSS through Interdiscipinary Teams. The Team makes coverage determinations and authorizes services, which may not be modified by the plan outside the Team.
FIDA plans will combine under one managed care plan: (1) a Medicare Advantage plan, (2) a Part D prescription drug plan, (3) a Medicaid Managed Long Term Care plan, and (4) a regular Medicaid card covering all other Medicaid services. FIDA plans will cover not only Medicaid long-term care services, as MLTC plans do, but also cover ALL other medical care covered by Medicare and Medicaid. In other words, a FIDA member will essentially trade in ALL of their insurance cards -- Medicare (Original or Medicare Advantage), Medicaid, MLTC, Medigap, and Medicare Part D -- and only have one health plan -- their FIDA plan. The program has announced a 6-month delay in enrolling dual eligibles into new FIDA plans and will now begin coverage in January of 2015.
