New York Fully Integrated Duals Advantage (FIDA) Demonstration

Frequently Asked Questions for Providers

Question 1: What is FIDA?

Question 2: Is FIDA just for Medicaid services, or will it involve Medicare services as well?

Question 3: Who is eligible for FIDA?

Question 4: When can participants enroll in FIDA?

Question 5: Is FIDA mandatory for dually eligible participants in New York State?

Question 6: How do I join the FIDA Plan´s networks?

Question 7: Can I continue to see my patients who join a FIDA Plan even if I´m not participating?

Question 8: How can my patients get help understanding their coverage options under FIDA?

Question 9: How can I find out more about FIDA and the continuity of care protections?


Question 1: What is FIDA?

Answer 1: FIDA is a joint Medicare and Medicaid demonstration designed to integrate care for New Yorkers who have both Medicare and Medicaid and who reside in the targeted geographic area. Beneficiaries who choose to participate will receive both Medicare and Medicaid coverage, including Part D prescription drugs, from a single, integrated FIDA managed care plan. FIDA builds off the existing Managed Long Term Care (MLTC) program. FIDA will be jointly administered by the federal Centers for Medicare & Medicaid Services (CMS) and the New York State Department of Health (NYSDOH).

We have developed this frequently asked questions (FAQ) document for pharmacists in New York because pharmacists are often the first providers a participant encounters after joining a new plan like FIDA, when participant confusion and system transaction issues are most likely to occur. We hope this information will help you understand FIDA, and be prepared to help former, current, or prospective FIDA participants who come to you for services.

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Question 2: Is FIDA just for Medicaid services, or will it involve Medicare services as well?

Answer 2: In FIDA, participants will get all their covered Medicare and Medicaid services from one plan, including long-term services and supports (LTSS) and prescription drugs. Their FIDA Plan will help improve the coordination of their Medicare and Medicaid benefits.

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Question 3: Who is eligible for FIDA?

Answer 3: FIDA builds upon the existing New York State Managed Long Term Care (MLTC) program. As such, the vast majority of people eligible for FIDA are already enrolled in a plan participating in the MLTC program. In general, individuals who meet all of the following criteria will be eligible to enroll in a FIDA Plan:

  • Reside in one of eight counties: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk or Westchester;
  • Age 21 or older at the time of enrollment;
  • Entitled to benefits under Medicare Part A and enrolled in Medicare Part B and eligible to enroll in Part D, and receiving full Medicaid benefits; and
  • Individuals must also meet one of the two following criteria:
    1. Require community-based long term care services for more than 120 days.
    2. Be eligible for but not already receiving facility-based or community-based LTSS ("New to Service").
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Question 4: When can participants enroll in FIDA?

Answer 4: NY started to send notices to eligible individuals about their enrollment options in December 2014. Eligible participants who sign up for a FIDA Plan can be covered by the FIDA Plan as early as January 1, 2015 in the Bronx, Kings, Nassau, New York, Queens, and Richmond Counties (Region I) and as early as April 1, 2015 in Suffolk and Westchester Counties (Region II). Current MLTC enrollees who have not already made an affirmative choice of FIDA plan or opted-out of FIDA, will be passively enrolled into a FIDA Plan starting as soon as April 1, 2015 in Region 1 and as soon as July 1, 2015 in Region II through a process called "passive enrollment." MLTC enrollees will receive notices with his/her FIDA plan name, important information and phone numbers about the program and information on how to opt-out.

Some individuals are eligible to sign up for a FIDA Plan but will not be passively enrolled. In particular, some groups of people will not be passively enrolled but are eligible to opt-in, including but not limited to: Native Americans, PACE program enrollees, enrollees in a Medicare Advantage Special Needs Plan for institutionalized individuals, individuals participating in the CMS Independence at Home demonstration, enrollees in Employer or Union Sponsored coverage for employees or retirees, enrollees in a Health Home, individuals with coverage mandated by the Aliessa federal court decision, individuals eligible for the Medicaid coverage buy-in for working disabled, and individuals who are eligible for the Nursing Home Transition & Diversion (NHTD) 1915(c) waiver.

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Question 5: Is FIDA mandatory for dually eligible participants in New York State?

Answer 5: No. FIDA is not mandatory for anyone in New York State. Individuals can opt-out of FIDA at any time, before or after passive enrollment, to keep their Medicare and Medicaid the same as it is today. Eligible participants who disenroll from FIDA will continue to receive Medicaid services through the MLTC program, and they will continue to have a choice of Original Medicare or Medicare Advant age and a prescription drug plan.

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Question 6: How do I join the FIDA Plan´s networks?

Answer 6: You are encouraged to consider joining the networks of one or more of the FIDA Plans in order to provide continuous care to eligible participants and to be part of this important in itiative to coordinate care. The FIDA Plans are currently contracting with providers. If you're a provider serving New Yorkers who have both Medicare and Medicaid and who reside in one of the eight FIDA counties and the FIDA Plans haven´t contacted you already, you can reach out to them directly for more information. A list of the MLTC plans and their FIDA counterparts is included with this letter.

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Question 7: Can I continue to see my patients who join a FIDA Plan even if I´m not participating?

Answer 7: Yes, for a limited amount of time (and possibly longer for patients whose care team or FIDA Plan has authorized their continuing to see you as an Out-Of-Network provider). FIDA includes important continuity of care provisions:

  • All participants new to a FIDA Plan will have a transition period during which they can continue a current course of treatment with their existing provider. The transition period will last for ninety (90) days from the time of enrollment or until the FIDA Plan participant´s Person-Centered Service Plan is finalized and implemented, whichever is later. During the transition period, participants can maintain existing providers theyve seen in the past 6 months, regardless of whether those providers are in the FIDA Plan´s network. The FIDA Plan must make reasonable efforts to bring these providers into the FIDA Plan network.
  • Participants new to a FIDA Plan in an outpatient setting can receive up to a 90 days´ temporary supply of drugs when a refill of a non-formulary drug is requested. Participants in a long term care setting can receive at least 91 days (and up to 98 days).
  • After the transition period, participants will need to see doctors and other providers in the ir FIDA Plan´s network.
  • There are three exceptions to the transition period described above:
    1. If the participant is a resident of a nursing facility, he/she can continue to live in that nursing facility for the duration of FIDA, even if the nursing facility does not participate in FIDA Plan´s network. For Nursing Facility services that are part of the traditional Medicaid benefit package, FIDA Plans will be required to pay out-of-network the Medicaid fee-for-service rate until at least December 31, 2015.
    2. If the participant is receiving services from a behavioral health provider at the time of his/her enrollment, he/she may continue to get services from that provider until treatment is complete, but not for more than two years. This is the case even if the provider does not participate in FIDA Plan´s network. The FIDA Plan will receive payment for these services at least at the applicable Medicaid fee for service rate.
    3. If the participant´s care team or FIDA Plan has approved the participant to see an out-of-network provider.
  • Also during the transition period, for FIDA Plans are required to pay out-of-network providers at least the lessor of the providers charges or the Medicare fee-for-service rate.
  • After the transition period, the FIDA Plan will no longer be required to pay for your patients care if you remain out-of-network, unless the FIDA Plan or the participant´s IDT has authorized him/her to continue to see you.
    1. Please note: If a participant needs to get services from you and you are an out-of-network provider, he/she must work with their FIDA Plan or IDT to get approval to see an out-of-network provider. If he/she goes to an out-of-network provider without first getting Plan or IDT approval, he/she may have to pay the full cost of the services.
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Question 8: How can my patients get help understanding their coverage options under FIDA?

Answer 8: For questions about FIDA, participants can call New York Medicaid Choice at 1-855-600-3432 (TTY users: 1-888-329-1541; 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.

In addition,New York State has created an ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide free, confidential assistance on any services offered by FIDA. ICAN may be reached toll-free at 1-844-614-8800 or online at www.icannys.org.

Finally, for questions about Medicare benefits, patients can call Medicare at: 1-800-MEDICARE (1-800-633-4227). (TTY users: 1-877-486-2048). 1-800-MEDICARE is available 24 hours a day, 7 days a week. The call and the help are free. Online: www.medicare.gov.

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Question 9: How can I find out more about FIDA and the continuity of care protections?

Answer 9: 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.

For more information on the continuity of care provisions, please refer to Section 2.6.6 on page 68 of the FIDA Three-Way Contract at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/NewYorkContract.pdf.

FIDA PLAN MLTC/MAP/PACE PLAN
Aetna Better Health FIDA Plan Aetna
AgeWell New York FIDA AgeWell
AlphaCare Signature FIDA Plan AlphaCare
HealthPlus Amerigroup FIDA Plan HealthPlus/Amerigroup
ArchCare Community Advantage FIDA Plan ArchCare
CenterLight Healthcare FIDA Plan CenterLight
FIDA Care Complete Centers Plan
Elderplan FIDA Total Care Elderplan/HomeFirst
RiverSpring FIDA Plan Elderserve
Fidelis Care FIDA Plan Fidelis
GuildNet Gold Plus FIDA Plan GuildNet
Healthfirst AbsoluteCare FIDA Plan Healthfirst/Senior Health Partners
EmblemHealth Dual Assurance FIDA Plan EmblemHealth/HIP
ICS Community Care Plus FIDA MMP ICS/Independence Care System
Integra FIDA Plan Integra
MetroPlus FIDA Plan MetroPlus
North Shore-LIJ FIDA LiveWell North Shore
SWH Whole Health FIDA Senior Whole Health
VillageCareMAX Full Advantage FIDA Plan VillageCare
VNSNY Choice FIDA Complete VNS/VNS
WellCare Advocate Complete FIDA WellCare
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