FIDA ARTICLE

PROVIDER NEWSLETTER (517 words)

Patient-centered, integrated care. . .Introducing Fully Integrated Duals Advantage (FIDA)

If you serve patients who receive both Medicare and Medicaid services, you know that it can be confusing and frustrating for all involved.

The federal Centers for Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) are partnering to integrate care and improve care coordination and health outcomes of those enrolled in Medicare and Medicaid through a new managed care program.

It´s called the "Fully Integrated Duals Advantage" program, or "FIDA" for short. FIDA covers all Medicaid and Medicare drugs and services, such as doctor and hospital visits, home health and nursing home care, and behavioral health. The program has no patient cost-sharing: no deductibles, premiums, and copayments/coinsurance.

The backbone of FIDA is a streamlined and seamless patient-centered care model, based on comprehensive, multidisciplinary care planning and management.

The program goal is to increase health care access and organize care around the unique needs and preferences of your patients to improve their health outcomes and satisfaction.

Why should Providers participate in FIDA?

  • FIDA will allow you to collaborate with other providers as part of a care team to develop a single customized care plan to address all of your patient's specific needs.
  • FIDA will save you time as the FIDA Care Manager will document your patient's care plan, and any changes to it, help your patient schedule appointments and arrange for transportation to them, and keep you in the loop about any services or care your patient receives.
  • FIDA may help decrease avoidable hospitalizations by offering you more opportunities to speak with your patients to make sure they understand and follow the goals of their care plans.
  • FIDA will spare you of processing Medicare and Medicaid claims separately: there is one billing process and one payer (the FIDA plan) for both Medicare and Medicaid services.

Who is eligible for FIDA? There are two steps to determining if your patients are eligible.

First - Participants have to be age 21 or older; live in New York City and Nassau County; and be entitled to benefits under Medicare Part A and enrolled under both Medicare Parts B and D and be receiving full Medicaid benefits. The program will expand to Westchester and Suffolk counties later this year.

Second - Participants also must meet one of these three conditions:

  • Live in the community but need long?term services and support for more than 120 days per year,
  • Be eligible for the Nursing Home Transition and Diversion Waiver program, or
  • Be eligible for nursing facility care and get long?term services and supports there.

For questions about benefits, provider networks, how to enroll into FIDA, call New York Medicaid Choice at: 1-855-600-3432 (TTY users: 1-888-329-1541; for a free interpreter: 1-855-600-3432). New York Medicaid Choice is available Monday-Friday, 8:30 am - 8:00 pm and Saturday, 10:00 am - 6:00 pm. The call and the help are free. New York Medicaid Choice also has a website at: www.nymedicaidchoice.com

If you have questions regarding FIDA, please email the New York State Department of Health at: fida@health.ny.gov or visit the MRT 101 website at: https://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm.