April 18, 2013
Addendum to NYSDOH´s May 25, 2012
Demonstration Proposal to Integrate Care for Dual Eligible Individuals and
REQUEST FOR PUBLIC COMMENT

Introduction

NYSDOH is submitting this addendum to its May 25, 2012 Demonstration Proposal. The purpose is to modify the target population of its FIDA demonstration and the timeline for its FIDA demonstration enrollment. Stakeholders are encouraged to review this addendum and submit public comments, following the process articulated below.

The FIDA demonstration is a comprehensive managed care option that is specifically tailored to meet the complex needs of New York's full dual eligibles. NYSDOH originally proposed to enroll full dual eligibles who require 120 or more days of Long-Term Supports and Services (LTSS) beginning in January 2014 and ending in December 2016. NYSDOH hereby revises its proposal to expand the target population and to stagger enrollment for the target population, with enrollment of the first portion of the target population beginning in April 2014. Pending CMS approval, the demonstration will now run from April 2014 through December 2017.

Target Population for FIDA

The FIDA demonstration target population will now include:

  1. Full dual eligibles who require 120 or more days of Community-Based Long-Term Supports and Services (LTSS) and
  2. Full dual eligibles who require Medicaid covered Facility-Based Long-Term Supports and Services (LTSS).

The additional population includes all individuals who have been determined to meet the Medicaid nursing facility clinical eligibility requirements and who reside in a long-term care facility at the time of enrollment.

For the entire duration of the demonstration, FIDA plans will be required to either enter into contracts or make other payment arrangements with all nursing facilities in the FIDA demonstration service area so that Participants´ residency and access to services are not interrupted.

Timeline for FIDA Enrollment

The FIDA demonstration enrollment will now be phased. The phasing will proceed as follows:

  1. Community-based LTSS Participants.
    1. Voluntary Enrollment.
      Community-based LTSS Participants may choose to enroll beginning in April 2014 and for the duration of the demonstration. Enrollments may be requested from January 2014 on but will not be effective until April 2014, when the demonstration officially begins.
    2. Passive Enrollment.
      Beginning in April 2014, Community-based LTSS Participants, excluding Assisted Living Program Participants, will begin to receive notices that they need to select a FIDA plan or they will be passively enrolled into a FIDA plan beginning in July 2014.

  2. Facility-based LTSS Participants.
    1. Voluntary Enrollment.
      Facility -based LTSS Participants may choose to enroll beginning in October 2014. Enrollments may be requested from July 2014 on but will not be effective until October 2014, when the demonstration will open to this population.
    2. Passive Enrollment.
      Beginning in October 2014, Facility-based LTSS Participants will begin to receive notices that they need to select a FIDA plan or they will be passively enrolled into a FIDA plan beginning in January 2015.

Request for Public Comment

NYSDOH requests stakeholder input into this Addendum. Stakeholder input is due by May 19, 2013. Several opportunities to submit comment and/or participate in discussions around the Addendum are available and are described below.

  • Submit written comments to: mltcworkgroup@health.ny.gov;
  • Participate in the public webinar on Wednesday, April 24th at 3:00 p.m.:
    • To register for the event, please go to:
      https://uasny.webex.com/uasny/onstage/g.php?t=a&d=669625825
After you register, you will receive a confirmation email from "messenger@webex.com". This email will include instructions for joining the event. This is an automatically generated confirmation. Please check your spam folder or talk with your IT unit if you do not receive a confirmation within one hour of registering for the event. Please be sure that the computer you will use has a sound card that will enable you to use speakers or a headset. There is no conference call in number.
  • Mail your comments to:
    Mark Kissinger
    Director, Division of Long Term Care Office of Health Insurance Programs New York State Department of Health
    Empire State Plaza, Corning Tower, 14th floor
    Albany, New York 12237
  • Submit your comments by fax to: (518) 486-2564
  • For those unable to submit comments by e-mail or fax, please call: (518) 402-5673

Please help us gather a broad range of public comments by sharing this Addendum with your networks or any other stakeholders you believe would have interest.