DOH Announces FIDA Reforms

The New York State Department of Health (DOH) and the Centers for Medicare and Medicaid Services (CMS) have agreed on significant reforms to the Fully-Integrated Duals Advantage (FIDA) program, in response to sluggish enrollment figures.  Since FIDA's launch in New York City and Nassau County early this year, 7,540 dually-eligible beneficiaries have enrolled in the program. Over 50,000 beneficiaries have opted out of the program.

The reforms announced last week include the following key components:

• Flexible composition and streamlined procedures for the Interdisciplinary Team (IDT), including making IDT training voluntary and permitting plans to authorize services covered by the person-centered services plan that are beyond the scope of practice of IDT members. 
• Streamlined procedures for assessing beneficiaries who transfer to a FIDA plan from an affiliated MLTC/PACE/MAP plan.
• Assessment by the contract management team of the FIDA plan's IDT performance based on specified measures.
• Flexible marketing rules that allow plans to market multiple lines of business; to compare benefits among different types of plans; to make in-person marketing visits if solicited by the beneficiary; to make FIDA calls to beneficiaries enrolled in affiliated plans; to submit enrollment requests to Maximus; and to send approved educational materials to beneficiaries who have opted out.
• Suspension of passive enrollment further notice.
• Commencement of enrollment in Region 2 (Suffolk and Westchester Counties) after mid-2016.
• Elimination of bi-weekly and monthly dashboard reports and streamlining of reporting measures.

In addition to these programmatic reforms, and its earlier agreement to increase 2016 rates to offset the CMS-HCC risk adjustment model’s under-prediction of costs for dual eligibles, CMS has agreed to review FIDA plan premiums. DOH reported at the Dec. 10th Managed Care Policy and Planning Meeting (P&P Meeting) that CMS has committed to an upward adjustment related to the Medicare Part A and B rates for all of 2016 and 2017. CMS is also conducting an additional analysis of the Part D bids. CMS has indicated that it "is open to reconsidering the assumptions used in determining the adjustment for CY 2016 based on revised projections of enrollment and recent experience in the demonstration." 

Finally, DOH announced at the P&P Meeting that, effective upon execution of contract amendments, the 2015 and 2016 FIDA quality withhold payments will be tied to participation in FIDA through Dec. 31, 2016. Organizations that exit the program prior to the Jan. 1, 2017 will be excluded from quality payments.

A complete summary of the reforms is available here, and a letter to plans from DOH is available here.

Contact:  Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.