FIDA FAQ on HARP-like benefits, Health Homes, & Hospice
HARP/BEHAVIORAL HEALTH-RELATED QUESTIONS:
- FAQs also available in Portable Document Format (PDF, 226KB)
1. What are the three HARP State Plan services just included in the FIDA benefit package?
A. The three Health and Recovery Plan (HARP) services have been added to the Fully Integrated Duals Advantage (FIDA) covered benefits and are reflected in participant-facing materials effective January 1, 2016. These three services are the same for FIDA as they are for HARPs, but are being offered through FIDA because an individual cannot be in both a FIDA and HARP. The three services and definitions will be added to Appendix A of the Three-way Contract when it is amended. They are specifically:
- Comprehensive Psychiatric Emergency Programs (CPEPs) are Office of Mental Health (OMH) licensed programs designed to directly provide or ensure the provision of a full range of psychiatric emergency services, 24 hours a day, seven days a week, for a defined geographic area. Currently, there are 19 licensed CPEPs in New York State operated at 18 Article 28 hospitals.
- Crisis Intervention Services are clinical interventions with an existing client or collateral of the clinic. Crisis covered services need not be anticipated in a treatment plan and except where limited by Current Procedural Terminology (CPT) code, these services may be provided by phone or in person. The minimal service expectation is that each clinic will have the capacity (directly or by agreement) to respond with a clinician to existing clients via phone 24/7. At the clinic´s option, a program may provide face-to-face crisis services 24/7.
- Residential Addiction Services are services delivered by an Office of Alcoholism and Substance Abuse Services (OASAS) designated Part 820 Residential program.
The FIDA Program already covers many Behavioral Health (BH) services.
2. Will the Participant have access to the expanded Home and Community Based Services (HCBS) services that HARPs will provide?
A. No. FIDA Plans will not be covering the expanded BH HCBS services that will be provided through HARPs.
3. Are FIDA Plans required to include the OMH suite of Article 31 clinic services in their benefit list or can they limit mental health services to those covered by Medicare?
A. Yes, FIDA Plans are required to cover Article 31 services. Plans are not able to limit their coverage to Medicare covered services only. Please see Appendix A of the three-way contract for the complete description of all services that Plans must cover.
4. Can an individual be eligible for both FIDA and HARPs?
A. No, FIDA is for dual-eligible individuals, which means the individual has both Medicaid and Medicare. HARPs is for Medicaid-only individuals.
5. Is continuing day treatment still a covered service under FIDA?
A. Yes. For a full list of covered items and services, please see Appendix A of the Three-way Contract.
6. Are crisis visits covered under FIDA?
A. Yes, crisis visits will be covered by a FIDA Plan as they are an OMH service. Note the following language in Appendix A of the FIDA Three-way contract states: "As a term and condition of this Demonstration, the FIDA Plan will be required to provide all Medically Necessary Medicare Parts A, B, and D and Medicaid State Plan and 1115(a) and 1915(c) waiver Items and Services. Table A-1 provides a list of FIDA Demonstration Covered Item and Services. Table A-1 will be updated to address any changes due to State Plan Amendments, 1115(a) demonstration amendments, and 1915(c) waiver amendments during the Demonstration."
7. How can FIDA Plans contract for Residential Addiction Services when there are no state approved providers yet?
A. The state recognizes that Part 820 Residential Addiction Services are not yet available. As such programs become available FIDA plans must incorporate them into the networks. If such programs are not yet available the plan is not held to the Part 820 contracting requirement.
8. Who can provide Crisis Intervention Services?
A. Crisis Intervention Services can be provided by any OMH clinic. You can locate these and other NYS mental health providers by using the search tool on the OMH website.
9. Are there approved CPEP providers that we should be looking to contract with?
A. Yes. CPEP providers are listed by county below. Please note, there are currently no CPEP providers in Nassau and Westchester counties. FIDA Plans servicing these counties will be issued Statements of Agreement for this service in these counties.
Bronx County
Bronx-Lebanon Hospital Center CPEP1265 Franklin Avenue, 2nd Floor, Franklin Tower
Bronx, New York 10456 Tel: 718-901-8222
Jacobi Behavioral Health Care Services CPEP
1400 Pelham Parkway, South West Wing
Bronx, New York 10461 Tel: 718-918-3644
Kings County
Brookdale Hospital CPEP1 Brookdale Plaza, CMC Building,13th Floor
Brooklyn, New York 11212 Tel: 718-240-6330
NYC-HHC, Kings County Hospital Center CPEP
410 Winthrop Street, Building R
Brooklyn, New York 11203 Tel: 718-245-2312
NYC-HHC Woodhull Medical and Mental Health Center
Woodhull CPEP
760 Broadway
Brooklyn, NY 11206 Tel: 718-963-8000
New York County
Beth Israel Medical Center CPEPFirst Avenue at 16th Street, Silver Pavilion, 1st Floor
New York, New York 10003 Tel: 212-420-4614
NYC-HHC, Bellevue Hospital Center CPEP
462 First Avenue
New York, New York 10016 Tel: 212-562-4419
NYC-HHC Harlem Hospital Center CPEP
506 Lenox Avenue, Martin Luther King Pavilion
New York, New York 10037 Tel: 212-939-3328
St. Luke´s Roosevelt Hospital Center CPEP
1000 Tenth Avenue, Roosevelt Hospital Site
New York, New York 10019 Tel: 212-523-4104
The New York and Presbyterian Hospital
Columbia Presbyterian Center CPEP
622 W. 168th Street, Presbyterian Hospital Bldg., 1st Floor
New York, New York 10032 Tel: 212-305-8930
The New York and Presbyterian Hospital
Weill Cornell CPEP
Greenberg Pavilion, 11th Floor
525 East 68th Street,
New York, New York 10065 Tel: 888-694-5700
Queens County
Jamaica Hospital Medical Center CPEP8900 Van Wyck Expressway, Ground Floor
Jamaica, New York 11418 Tel: 718-206-7099
NYC-HHC Elmhurst Hospital Center CPEP
79-01 Broadway
Elmhurst, New York 11373 Tel: 718-334-3556
NYC-HHC Queens Hospital Center
82-70 164th Street, Cellar Floor
Jamaica, New York 11432 Tel: 718-883-3000
Richmond County
Richmond Medical Center/dba Richmond UMCRichmond UMC CPEP
355 Bard Avenue, 1st Floor
Staten Island, New York 10310 Tel: 718-818-6443
10. Are FIDA Plans required to pay Article 31 clinics "government" Medicaid rates?
A. Yes.
11. If continuing day treatment is covered under FIDA, how do providers bill for this Behavioral Health service?
A. The provider would bill the FIDA Plan for the service.
12. Are FIDA care coordinators contacting behavioral health providers to alert them when an individual has enrolled into FIDA?
A. The FIDA Care Manager will contact the BH professional if the Participant is currently receiving BH services. The BH provider may also be invited to participate in developing the Person-Centered Service Plan (PCSP).
13. Will the Participant´s care plan take the place of an OMH/DOH required treatment plan/treatment plan review?
A. The Participant´s PCSP will address the FIDA Participant´s medical, behavioral health, long-term services and supports as well as social needs, but it will not replace a required treatment plan. Existing or necessary OMH required treatment plans must be incorporated into PCSPs. In addition, the FIDA Plans must allow participants to maintain existing BH providers for up to 24 months.
HEALTH HOMES-RELATED QUESTIONS:
14. Are FIDA participants also eligible for Health Homes? Do FIDA enrollees have access to Health Homes?
A. Yes, FIDA Participants are eligible for Health Homes since it is a State Medicaid Plan service. FIDA participants are not required to access health homes.
15. How does FIDA relate/connect to the Medicaid Health Homes program?
A. A FIDA Participant may choose to participate in a Health Home without this impacting their FIDA participation. Should a FIDA Participant choose to participate in the Health Home, the Health Home and FIDA Care Manager will coordinate the care management.
16. Who pays for the health home benefit under FIDA, the plan or FFS Medicaid?
A. The Plan would be required to cover the health home benefit because it is a State Medicaid Plan service that must be covered.
HOSPICE-RELATED QUESTIONS:
17. Can a person receiving Hospice join FIDA?
A. No, an individual currently in receipt of Medicare or Medicaid hospice services is not eligible to enroll in FIDA. However, if an individual requires hospice services after he or she enrolls in a FIDA Plan, he or she may remain enrolled in it.
18. Is Hospice/end-of-life care included or carved out of FIDA?
A. Per Section 4.2.2.2 of the Three-way Contract, if a Participant elects to receive the Medicare hospice benefit, the Participant may remain in the Demonstration Plan, but will obtain the hospice service through the Medicare FFS benefit and the Demonstration Plan would no longer receive the Medicare Parts A/B Component for that Participant as described in this section. Medicare hospice services and hospice drugs and all other original Medicare services would be paid for under Medicare FFS. The FIDA Plan and providers of hospice services would be required to coordinate these services with the rest of the Participant´s care. The FIDA Plan would continue to receive the Medicare Part D Component for all non-hospice covered drugs. Election of hospice services does not change the Medicaid Component.
19. Does a hospice service provider bill FIDA or Medicare/Medicaid Fee-For-Service for its enrollees?
A. Hospice providers would bill Fee-For-Service to either Medicaid or Medicare.
20. Would the FIDA Plan cover all other services not covered by hospice ex: routine medications not covered under Hospice?
A. Yes, the FIDA Plan would cover all other services.
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