Overview of the FIDA Program Benefits

• Overview is also available in Portable Document Format (PDF)

If you join the FIDA program, you will:

• Get full Medicare and Medicaid coverage, long term care services, Part D and Medicaid drugs, and additional benefits from a single, integrated managed care plan. In other words, FIDA covers all the benefits that you may receive through your managed long term care (MLTC) plan, Original Medicare or your Medicare Advantage plan, and your Part D plan.
• Pay no deductibles, premiums, or copayments/coinsurance. A FIDA plan will not cost you more than what you pay today for your care. (If you have Medicaid with a "spend–down" or "excess income," you will have to continue to pay your spend–down to the FIDA plan.)
• Be able to access specialists directly. No need for provider referrals.
• Have a dedicated person ("Care Manager") who can schedule doctor’s appointments, arrange transportation and help you get your medicine. (In most cases, you will keep your current care manager.)
• Have your Medicare and Medicaid doctors and specialists on your care team. They will spend time with you, your caregivers or anyone you trust to discuss the care you may need. In addition, they will have time to share their expert opinions with each other and coordinate your care.
• Use one FIDA Plan phone number for all questions regarding your benefits. You will no longer need to make separate calls to 1–800 Medicare, your Medicare health or drug plan, and your current Medicaid plan about your coverage.
• Have the right to leave FIDA at any time and for any reason. If you decide to do so, you will continue to receive all of your Medicaid long term care benefits through the MLTC program and all of your Medicare benefits through Original Medicare or a Medicare Advantage plan, and a Part D plan.

Covered Items and Services:

Comparing FIDA with MLTC, PACE, and MAP Programs

General Overview of Services	FIDA	MLTC	PACE	MAP
Medicare Part A and Part B services, such as: doctor office visits, specialty care, clinic visits, hospital stays, mental health services, X–ray and other radiology services, chiropractic care, ambulance services, etc.	✓		✓	✓
Medicare Part D brand–name and generic prescription drugs.	✓		✓	✓
Medicaid covered drugs (some covered drugs, including over–the–-counter drugs).	✓	✓	✓	✓
All regular Medicaid services.	✓	✓	✓	✓
All long–term services and supports plus many additional supportive services to help the enrollee in his/her home that s/he cannot currently receive unless s/he is in the NHTD, Long Term Home Health Care Program (LTCHHP), or TBI Waiver program.	✓		✓ *
All Behavioral health services covered by Medicare and Medicaid plus additional services, including Mobile Mental Health Treatment, Crisis Intervention Services, Residential Addition Services, and Comprehensive Psychiatric Emergency Program services.	✓		✓ **
Supplemental benefits (for example, over-the-counter cards).	✓***			✓***
Care Manager is responsible for ensuring the enrollee gets what s/he needs, for example, making doctor's appointments, arranging transportation, etc.	✓	✓	✓	✓
Comprehensive Care Management and a Care Team that works with the enrollee to get all the services s/he needs, even the services not usually covered by the plan (as long as they are medically necessary).	✓		✓

* Coverage of this/these service(s) is within the Plan´s discretion.
** Some of the services.
*** Some of the plans.

---

Additional Services and Supports	FIDA	MLTC	PACE	MAP
Adult Day Health Care Services These services are provided to enrollees who are functionally impaired, not homebound, and who requires certain preventive, diagnostic, therapeutic, rehabilitative or palliative items or services. The services include medical, nursing, food and nutrition, social services, rehabilitation therapy, leisure time activities which are a planned program of diverse meaningful activities, dental, pharmaceutical, and other ancillary services.	✓	✓	✓	✓
Community Integration Counseling This service is for people who are having trouble learning how to live with their disability in the community. The service helps individuals to cope with altered abilities or skills and changes in their relation to significant others, to revise their long-term expectations, etc.	✓
Community Transitional Services These services help people who are transitioning from a nursing facility to living at home. They include the cost of moving furniture and other belongings; buying certain essentials items such as linens and dishes; security deposits, including broker's fee to obtain a lease on an apartment or home; set-up fees for deposits for utility (telephone, electricity, etc.).	✓
Comprehensive Psychiatric Emergency Programs (CPEPs) Services This includes a full range of psychiatric emergency services, 24 hours a day, 7 days a week.	✓
Crisis Intervention Services These services allow enrollees to discuss their issues with a mental health clinician and help them decide the best course of action. The services may be provided by phone or in person.	✓
Home and Community Support Services (HCSS) This is a combination of personal care services (ADLs and IADLs) with oversight / supervision services or oversight/supervision as a discrete service primarily at an enrollee's home. These services are provided to an enrollee who requires assistance with personal care services tasks and whose health and welfare in the community is at risk because oversight/supervision of the enrollee is required when no personal care task is being performed.	✓		✓ *
Home Maintenance Services These services include household chores and services that are required to maintain an individual's home environment in a sanitary, safe, and viable manner. The services are provided on two levels: 1) Light chores, for example, cleaning and/or washing of windows, walls, and ceilings; snow removal and/or yard work, etc. 2) Heavy-duty chores, for example, intensive cleaning/chore efforts.	✓	✓ *	✓ *	✓ *
Home visits by Medical Personnel Home visits by medical personnel, including physicians or physician extenders, such as nurse practitioners and physician assistants. This means doctors' appointments at your home.	✓		✓ *	✓ *
Independent living Skills and Training It is one-on-one training about self-care, medication management and other practical day- to-day skills. These services assist in recovering skills that have decreased as a result of the onset of the disability.	✓		✓ *
Medication Therapy Management (MTM) These services are for enrollees who take medications for different medical conditions. They help enrollees and their providers make sure that enrollees' medications are working to improve their health.	✓	✓ **	✓	✓ **
Mobile Mental Health Treatment This service is available to enrolees who have a medical condition or disability that limits their ability to come into an office for regular outpatient therapy sessions.	✓		✓ *
Moving Assistance These services help transport an enrollee's possessions and furnishings when the enrollee must be moved from an inadequate or unsafe housing situation to a viable environment which more adequately meets the enrollee's health and welfare needs and alleviates the risk of unwanted nursing home placement. The services may also be used when the enrollee is moving to a location where more natural supports will be available, and thus allows the enrollee to remain in the community in a supportive environment.	✓	✓ *	✓ *
Medical Transportation This service includes transportation to medical appointments.	✓	✓	✓	✓
Non–Medical Transportation This service includes transportation to non-medical activities, such as religious services, community activities, supermarkets, etc.	✓	✓ *	✓ *	✓ *
Palliative Care These services help prevent or relieve pain and suffering and enhance the enrollee's quality of life. The services include family palliative care education, pain and symptom management, bereavement services, massage therapy, and expressive therapies.	✓		✓
Peer–Delivered Services These services are provided to individuals who are in the process of recovery from mental illness and substance abuse disorders.	✓
Peer Mentoring This service is for enrollees who have recently transitioned into the community from a nursing facility or during times of crisis. This is an individually designed service intended to improve the enrollee's self-sufficiency, self-reliance, and ability to access needed services, goods, and opportunities in the community. The service may include education, teaching, instruction, information sharing, and self-advocacy training.	✓
Personal Care These services are for individuals who need some or total assistance with personal hygiene, dressing and feeding and nutritional and environmental support (for example, making and changing beds, light cleaning of the kitchen, bedroom and bathroom, preparing meals, bathing, dressing, grooming, toileting, feeding, etc.)	✓	✓	✓	✓
Positive Behavioral Interventions and Support Services These services help decrease the intensity and/or frequency of the targeted behaviors and teach safer or more socially appropriate behaviors. These services may include: comprehensive assessment of the enrollee; development and implementation of a holistic structured behavioral treatment plan; training of family, natural supports, and other providers; regular reassessment of the effectiveness of the participant's behavioral treatment plan.	✓		✓ *
Residential Addiction Services These services are 24/7 structured treatment/recovery services in a residential setting provided by OASAS certified programs to persons recovering from substance use disorder. Certified residential programs may provide residential services corresponding to one or more of the following elements of the treatment/recovery process: stabilization; rehabilitation; reintegration in congregate or scatter-site settings.	✓
Respite Services These are individually designed services intended to provide scheduled relief to non-paid supports who provide primary care and support to an enrollee.	✓	✓ *	✓ *	✓ *
Social Day Care These services provide opportunities for individual socialization activities, including educational, craft, recreational and group events.	✓	✓	✓	✓
Structured Day Program Services These services are designed to improve or maintain the enrollee's skills and ability to live as independently as possible in the community. The services include but are not limited to: assessment; training and supervision to an individual with self-care; task completion; communication skills; interpersonal skills; problem-solving skills; sensory/motor skills; mobility; community transportation skills; reduction/elimination of maladaptive behaviors; money management skills; ability to maintain a household.	✓		✓ *
Substance Abuse Program Services These services help enrollees manage addiction to opiates, such as heroin. These services help enrollees control the physical problems associated with opiate dependence and provide the opportunity for enrollees to make major lifestyle changes over time.	✓		✓ *

* Coverage of this/these service(s) is within the Plan´s discretion.
** Some of the services.
*** Some of the plans.