DOH Seeks Input into FIDA Future

In a webinar presented on July 22, 2016, the Department of Health (DOH) announced that it would like input into whether the Fully-Integrated Duals Advantage (FIDA) program should be extended through Dec. 31, 2019. DOH is also looking for stakeholder views on whether to expand FIDA into Suffolk and Westchester Counties in January 2017 or in 2018. Stakeholders who would like to provide feedback on these or other issues may submit it here.

DOH noted that there are currently over 5,000 beneficiaries enrolled in FIDA plans. The counties with the greatest numbers of residents potentially eligible for FIDA enrollment are Brooklyn (47,097 eligibles) and Queens (23,501). Disenrollments from FIDA have slowed significantly since its inception, with only 184 disenrollments in June compared with 747 disenrollments in January. The highest numbers of opt-outs from FIDA enrollment are concentrated in zip codes with large numbers of FIDA eligibles who speak Russian, Chinese, or Spanish or large numbers of FIDA eligibles who are currently enrolled in a Medicare Advantage plan. A snapshot of FIDA eligibles, enrollment by plan/county, opt-outs, enrollment by age/gender, and new enrollments will be posted quarterly on the MRT 101 page of the DOH website.

The webinar also included information about the FIDA program’s integrated appeals process. The first FIDA appeals were filed in June 2016. To date, the hearing office has received 65 appeals; nearly half were for personal care. The Integrated Appeals Hearing Office (IAHO) is now posting FIDA appeal decisions here.

DOH described some of the program reforms that have been implemented over the past year. The composition of the interdisciplinary team (IDT) that develops the care plan is now more flexible and is based on the beneficiary’s preferences. The IDT can be small, consisting of just a care manager and beneficiary, or broader, with a variety of members. Moreover, provider participation is adjustable depending on availability, the topic for discussion, and the needs, wishes, and goals of the beneficiary. Primary care providers may review and approve a completed care plan without attending IDT meetings. In addition, IDT training is no longer mandatory, but it is encouraged.

The FIDA reforms also include some relaxation of marketing restrictions. For example, plans may now market multiple lines of business and provide comparisons of their partially-capitated, PACE, Medicaid Advantage Plus, and FIDA products. They may also send, with prior approval from DOH, FIDA educational and/or promotional materials to beneficiaries who have opted out. DOH will be conducting a four-month advertising campaign to promote FIDA and disseminating outreach mailings to Medicare providers who serve FIDA eligible beneficiaries, to beneficiaries who have opted out of FIDA, and to beneficiaries who have joined a managed long term care plan since December 2014.

The webinar slides are available here. Additional information about FIDA is available here and here.

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