DOH Releases Reforms to FIDA Interdisciplinary Team Policy

As part of a series of reforms to the Fully-Integrated Duals Advantage (FIDA) program, the Department of Health has released simplified and flexible procedures for the FIDA Interdisciplinary Teams (IDTs) that develop Person-Centered Service Plans (PCSPs) for FIDA beneficiaries (known as “Participants”). The complete text of the revised IDT policy is available here.

Key elements of the reforms include the following:

Flexible Composition: Instead of requiring a broad array of providers to participate in the IDT, the revised IDT policy permits the IDT to be tailored to the preferences of the individual Participant. At the Participant’s option, it may be comprised only of the care manager and the Participant or may include other caregivers and/or providers. FIDA plan utilization management staff, however, may not participate in IDT meetings and are not members of the IDT. (p. 3)

IDT Meetings: FIDA care managers must schedule IDT meetings at a time convenient for IDT members “with current goals and objectives related to the Participant and any proposed changes to the PCSP.” (p. 4) Provider participation in the IDT, therefore, may vary depending on the issue under discussion.“When in-person meetings are not possible, those IDT members should participate telephonically or by video conference. In instances when all members of the IDT cannot meet at the same time and the Participant does not request that all IDT members meet at the same time, the Care Manager can meet separately with the IDT members and ensure the PCSP is shared with all IDT members for review and approval.” (p. 8)

IDT Communication: Each IDT develops its own procedures for “candid and complete communication” among its members. Plans are “responsible for effective and efficient information-sharing among providers even when they do not participate in the IDT or in a given meeting of the IDT, including sharing any revisions to the PCSP.” (p. 4)

IDT Training for Providers: IDT training is no longer required. However, FIDA Plans must "encourage IDT members to participate in the approved training on the person-centered planning processes, cultural competence, disability, accessibility and accommodations, independent living and recovery, and wellness principles." The training is available here. (p. 5)

Primary Care Provider Approval: “Primary care providers may choose not to participate in IDT meetings but, if willing, can review and sign off on the completed PCSP.” (p. 2)

Authorizations: Care decisions made by the IDT and incorporated into the PCSP serve as service authorizations, provided that such decisions are within the scope of practice of the IDT members. If a service is proposed that requires authorization by a professional with a specific license or certification, and the IDT meeting does not include such a provider, the ultimate decision to authorize the services rests with the FIDA Plan via its utilization management process. (p. 4)

Procedures at Transitions: When Participants enroll in a FIDA Plan from an affiliated MLTC plan, they must be assessed no later than six months from the date of their last MLTC (UAS) assessment. (p. 2) FIDA plans must contact these Participants and review any available medical record and claims history, “to ensure that there are no changes in the Participant’s health status and needs that would trigger the necessity for an updated assessment.” The PCSP for these Participants must be completed within 90 days of the effective date of enrollment. (p. 7-8) “All other Participants must be assessed in a timely manner so that their PCSP can be developed and implemented within 90 days following their effective date of enrollment. The FIDA Plan must also perform the UAS at any time upon the request of the Participant.” (p. 2)

IDT Performance Monitoring: The Department of Health (DOH)/Centers for Medicare and Medicaid Services (CMS) and the Contract Management Team (CMT) will evaluate each FIDA plan’s IDT policy implementation. The CMT will assess IDT performance based on the following measures:

In the last six months, did anyone from your health plan, doctor’s office, or clinic help coordinate your care among these doctors or other health providers? (Source: CAHPS, Item OHP3)

How satisfied are you with the help you received to coordinate your care in the last 12 months? (Source: CAHPS, Item OHP5)

Percent of Participants discharged from a hospital stay who were readmitted to a hospital within 30 days, either from the same condition as their recent hospital stay or for a different reason (Source: NCQA/HEDIS)

Percent of patients 65 years or older discharged from any inpatient facility and seen within 60 days following discharge by the physician providing on-going care who had a reconciliation of the discharge medications with the current medication list in the medical record documented. (Source: NCQA/HEDIS)

Percent of all Participants who saw their primary care doctor during the year (Source: HEDIS)

Follow-up After Hospitalization for Mental Illness (Source: NCQA/HEDIS)

Reporting of the number of nursing home certifiable Participants who lived outside the Nursing Facility (NF) during the current measurement year as a proportion of the nursing home certifiable Participants who lived outside the NF during the previous year (Source: NYSDOH)

Percent of Participants in the FIDA Demonstration who reside in a NF, wish to return to the community, and were referred to preadmission screening teams or the Money Follows the Person Program (Source: NYSDOH)

FIDA plans must update their Medicare-Medicaid Plan Model of Care (MOC) elements to reflect these changes to the IDT Policy.

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