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Consumer Advocacy on the FIDA Demonstration - Fully Integrated Dual Advantage - Managed Care Covering Medicare and Medicaid Services Starting 2015

Views: 6111
Posted: 04 Jun, 2014
by Valerie Bogart (New York Legal Assistance Group)
Updated: 04 Feb, 2015
by Valerie Bogart (New York Legal Assistance Group)

A new managed care Demonstration program will begin on January 1, 2015 in NYC, Long Island and Westchester, for Dual Eligibles  (those receiving Medicaid and Medicare) who also need home care or nursing home care.  See this article for more information about this program.  

This article gives links to advocacy positions by consumer advocates responding to the series of policies and procedures, including draft enrollment notices, that have been released by the State Dept. of Health as the FIDA Demonstration has been developed, moving toward implementation early in 2015. 

The Coalition to Protect the Rights of NY Dual Eligibles (CPRNYDE)(http://www.nyduals.org website launched August 2013)  is the author of many of the consumer comments.   The Steering Committee of the Coalition is composed of:

Consumer Directed Personal Assistance Association of New York State
Center for Disability Rights
Center for Independence of the Disabled/NY
Community Services Society
Empire Justice Center
Legal Aid Society NYC
Medicare Rights Center
New York Association on Independent Living
New York Legal Assistance Group 
For updates on Duals Demonstrations nationally see The Dual Agenda - a newsletter of Community Catalyst, a national organization working on various health access initiatives.

Date State Action Consumer Response
March 2012 Initial Demo Proposal (3/22/2012) Comments (Apr. 20, 2012)
May 2012 2nd Draft Proposal (5/3/2012) Comments (May 17, 2012)
5/25/12 FINAL Demo Proposal to Integrate Care for Dual Eligible Individuals  

Comments - NYS Dual Eligible Coalition (6/30/12)

Comments - Community Catalyst (6/28/12)

1/9/2013 DOH proposed Quality Measures (Oct. 2012) Performance Standards and Quality Measures for FIDA Program (Jan. 9, 2013)
2012-2013 APPEALS - NYS Unique Integrated Appeal Process

APPEALS - Consumer Coalition Comments on Creating an Appeals System for FIDA  (April 2012)

Consumer Coalition Letter on Changes, emphasizing nursing home resident enrollment, community integration (May 19, 2013)

4/25/13 Amended Demo Proposal Letter to NYSDOH re the dual demonstration addendum 05-19-13
8/2013

DOH Draft Readiness Review Tool -8/26/13 draft for comment

DOH & CMS response to comments received on Readiness Review tool (9/23/2013)

Consumer Comments on Readiness Review tool (9/6/13)
8/2013 Memorandum of Understanding - Aug. 2013 Consumer Comments on MOU between State, CMS (Sept. 23, 2013)
11/27/13 Consumer Letter on Priorities in Three-Way Contract between State, CMS and Plans (11/27/13)
12/2013 CARE COORDINATION NYLAG Presentation on Panel at Care Coordination Roundtable, sponsored by NY Coalition to Protect NY Dual Eligibles - Challenges and Promising Practices of Care Coordination in MLTC (12/2013)
April 2014 ADA COMPLIANCE:  Consumer Coalition Letter to DOH and CMS Recommending Requirements for FIDA Plans to Attest to and Demonstrate Compliance with ADA, with table comparing NYS with other state requirements (April 16, 2014)
May 2014

State's Draft FIDA Enrollment Notices (5/21/14):

5/30/14 Consumer Coalition Letter to DOH and CMS Recommending Revisions to Draft Notices with Proposed Edited Language of:

July 2014 DOH announces delay of FIDA roll-out to January 2015
June 2014 Inter-Disciplinary Care Team (IDT) - Final NYS DOH Policy *6/5/14)

Consumer Coalition Comments on Earlier Draft IDT Policy (12/13/13)

Consumer Coalition comments on revised draft  (5-18-2014)

June-July 2014 ENROLLMENT ISSUESState DOH FAQ June 20, 2014 Consumer Coalition Letter to DOH and CMS raising concerns about enrollment issues in FIDA, (July 14, 2014)
June 2014 QUALITY - Draft Quality Strategy of NYS DOH for Managed Care (Available for public comment June 13, 2014) Consumer Coalition Comments on Draft Quality Strategy
July 2014

Three-Way Contract for FIDA - between NYS DOH, CMS and FIDA plans.

Comments on drafts of 3-way contracts

Attached files
file CCatalyst response to NY proposal 6 28 12 final.pdf (236 kb)
file CPRNYDE letter to NYSDOH re draft IDT policies and procedures 12-13-13 rev.pdf (79 kb)
file FIDA enrollment letter to CMS and NYSDOH 07-14-14 FINAL.pdf (254 kb)
file Letter from beneficiary advocates re NYS dual eligible demonstration 6-30-12 pdf.pdf (242 kb)
file Comments from beneficiary advocates re NYS dual eligible demonstration.pdf (291 kb)
file 1 - FIDA Program Announcement Notice - 5 21 14.pdf (132 kb)
file FIDA 90-day (Announcement) Notice- 5 21 14.pdf (214 kb)
file FIDA 60 day and 30 day Notices combined 04-20-2015.pdf (356 kb)
file CPRNYDE Comments on the FIDA MOU Sep 2013.pdf (453 kb)
file FIDA 90-day (Announcement) Notice - CPRNYDE comments 05-30-14.pdf (413 kb)
file 1 - FIDA Program Announcement Notice - CPRNYDE comments 05-30-14.pdf (211 kb)
file CPRNYDE letter to MMCO and NYSDOH re Contract Priorities FINAL 11-27-13 .pdf (117 kb)
file Incentives for Com-Based Services in NYS MLTC 032312.pdf (126 kb)
file CPRNYDE Response to the 2012 DOH Report - April 5 2013.pdf (756 kb)
file Consumer Advocate Recs on Performance Standards and Quality Measures 010913.pdf (218 kb)
file Recs re Performance Standards and Quality Measures - with State rec measures 010913.pdf (154 kb)
file 2014-05-30 CPRNYDE letter re FIDA notices.pdf (357 kb)
file Comments re NYSDOH demonstration proposal to integrate care for dual eligible individuals.pdf (2.63 mb)
file CPRYDE Integrated Appeals March 2013.pdf (781 kb)
file FIDA Enrollment FAQ 062014.pdf (172 kb)
file CPRNDYE comments on revised IDT 05-18-14.pdf (103 kb)
file ADA compliance ltr to CMS and DOH_FIDA implementation - FINAL.pdf (546 kb)
file CPRNYDE comments on 2014 Quality Strategy 07-13-14 - FINAL.pdf (419 kb)
file CPRNYDE Readiness Review Comments 09-06-13.pdf (555 kb)
file NY Readiness Review 08-26-13_Draft for Plan Comment.pdf (895 kb)
file CMS-DOH Responses to Comments on Draft Readiness Readiness Review Tool.pdf (664 kb)
file Final Three-Way Contract Generic 7_03_14.pdf (1.63 mb)
file CIDNY Comments FIDA draft three-way contract 05 02 14.pdf (208 kb)
file NYLAG Comments on 3-way contract.pdf (272 kb)
file CPRNYDE Comments re FIDA draft three-way contract 05-05-14.pdf (264 kb)

Also read
document Managed Long Term Care
document Medicaid Managed Care
document "FIDA (Fully-Integrated Dual Advantage)" - Managed Care Expansion for Dual Eligibles in NYC Metro Area - Delayed Until Jan. 2015
document New Permanent Nursing Home Residents in NYS Required to Enroll in Medicaid Managed Care Plans or MLTC Plans - Effective since October 2015 Statewide

Also listed in
folder Medicare Part D
folder Medicaid -> Other Services
folder Medicaid -> Home Care
folder Medicare Part D -> Selecting a drug plan

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