Fully Integrated Duals Advantage (FIDA)
Frequently Asked Questions (FAQs)
- FAQs for FIDA is also available in portable document format (PDF, 153KB, 2pg.)
The Department of Health has received many questions on the Federal duals demonstration (MRT101) also known as the Fully Integrated Duals Advantage (FIDA) program. We will be issuing FAQ´s on a periodic basis to help interested parties as we move forward. More information is available on both the Medicaid Redesign Team website and the Centers for Medicare and Medicaid Services (CMS) website.
Question 1: What is the process for applying to be a FIDA plan?
Question 2: Will the State be adding any elements to the federal model of care?
Question 3: What will be the role of the partial cap managed long term care (MLTC) plans in the FIDA regions after January 1, 2014?
Question 4: What is the process for the required State certification forms?
Question 5: Do we need to apply for FIDA in counties in which we are already approved to provide MLTC? If yes, what is the process?
Question 6: Must FIDA recipients receive the long-term care benefits/services within their home?
Question 7: Will an applicant be disqualified from participating in the program if they are unable to upload a State license or a Medicare-Medicaid Plan State Certification?
Question 8: Is an independent Medicaid contract necessary if we obtain MLTC approval?
Question 9: Will the State be implementing passive enrollment?
Question 10: Does a plan whose Certificate of Authority (COA) is limited to MLTC need to submit an application to have its COA amended to include Medicare so that it can participate in FIDA? If so, please identify the appropriate application.
Question 11: If a plan is using a provider contract that covers both Medicaid and Medicare services, does the plan need to submit the contract to DOH for approval?
If so, which DOH unit will be reviewing these contracts? Will DOH establish a streamlined review if the plan has already had its MLTC provider template agreements approved?
Question 12: If a plan that currently participates in Medicaid Advantage, MAP and MLTC wants to expand its service area in 2014 in order to offer the FIDA product and the MLTC product in additional counties, what type of service area expansion application(s) will be required to be filed?
Question 1: What is the process for applying to be a FIDA plan?
Answer 1: A notice of intent to apply to participate in FIDA needs to be filed with CMS. The last day to file a notice was January 31, 2013.
|top|Question 2: Will the State be adding any elements to the federal model of care?
Answer 2: Yes. New York State will be adding one additional element. This addition is related to self directed care and is posted here.
|top|Question 3: What will be the role of the partial cap managed long term care (MLTC) plans in the FIDA regions after January 1, 2014?
Answer 3: There will be a role for partial cap MLTC plans; however we encourage all plans to pursue full integration or to partner with entities to achieve full integration.
|top|Question 4: What is the process for the required State certification forms?
Answer 4: Forms should be completed and sent to:
Mark KissingerDirector, Division of Long Term Care
New York State Department of Health
Empire State Plaza, Corning Tower, 14th Floor
Albany, NY 12237
mlk15@health.state.ny.us |top|
Question 5: Do we need to apply for FIDA in counties in which we are already approved to provide MLTC? If yes, what is the process?
Answer 5: Yes. FIDA or Medicare-Medicaid Plans (MMPs) have a specific process that is outlined on the federal CMS website. The 2014 application process is posted here and the 2014 application guidance is posted here.
|top|Question 6: Must FIDA recipients receive the long-term care benefits/services within their home?
Answer 6: Recipients receiving services in their homes are eligible. In addition, recipients receiving long term care services and residing in adult care facility settings are also eligible. However, Medicaid assisting living program recipients are not eligible.
|top|Question 7: Will an applicant be disqualified from participating in the program if they are unable to upload a State license or a Medicare-Medicaid Plan State Certification?
Answer 7: No. An applicant will not be disqualified from participating in the 2014 Capitated Financial Alignment program (FIDA in NYS) for failure to upload a State license or other document to CMS by the February 21, 2013 application deadline. Rather, the lack of a State license on February 21st will be treated as a deficiency that can be remedied during the cure period pursuant to section 2.3.4 of the MMP application instructions. The cure periods expire in May 2013.
|top|Question 8: Is an independent Medicaid contract necessary if we obtain MLTC approval?
Answer 8: The three-way agreement with CMS, the State and the plan will govern.
|top|Question 9: Will the State be implementing passive enrollment?
Answer 9: Yes. There will be passive enrollment. The exact details will be part of the MOU process.
|top|Question 10: Does a plan whose Certificate of Authority (COA) is limited to MLTC need to submit an application to have its COA amended to include Medicare so that it can participate in FIDA? If so, please identify the appropriate application.
Answer 10: Not at this time. Once the FIDA demonstration and subsequent plans are approved, the COA will be modified.
|top|Question 11: If a plan is using a provider contract that covers both Medicaid and Medicare services, does the plan need to submit the contract to DOH for approval?
If so, which DOH unit will be reviewing these contracts? Will DOH establish a streamlined review if the plan has already had its MLTC provider template agreements approved?
Answer 11: This will be part of the MOU discussions.
|top|Question 12: If a plan that currently participates in Medicaid Advantage, MAP and MLTC wants to expand its service area in 2014 in order to offer the FIDA product and the MLTC product in additional counties, what type of service area expansion application(s) will be required to be filed?
Answer 12: The regular service area expansion application must be filed.
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