NYS DOH and OPWDD announce a partnership to improve care for individuals with intellectual and developmental disabilities (IDD) who are eligible for both Medicare and Medicaid (“Medicare-Medicaid Enrollees”).
THE NEW YORK STATE DEPARTMENT OF HEALTH (DOH) AND THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES (OPWDD) ARE PLEASED TO ANNOUNCE A PARTNERSHIP WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AND PARTNER’S HEALTH PLAN (PHP). THIS PARTNERSHIP IMPLEMENTS THE MEDICARE-MEDICAID FINANCIAL ALIGNMENT INITIATIVE (DEMONSTRATION) TO PROVIDE BETTER, MORE COORDINATED CARE TO INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES (IDD) WHO ARE ELIGIBLE FOR BOTH MEDICARE AND MEDICAID (“MEDICARE-MEDICAID ENROLLEES”).
Known as Fully Integrated Duals Advantage (FIDA-IDD), the new program focuses on individuals who receive long-term care and IDD service needs. The FIDA-IDD expands on the original FIDA Demonstration (implemented in January 2015) that followed an extensive planning and development process through which Medicare-Medicaid enrollees, caregivers, beneficiary advocates, and other stakeholders partnered with New York and CMS to help shape the design of the new program.
The FIDA-IDD program would offer more opportunities for individuals to direct their own services, be involved in care planning, and live independently in the community. Individuals´ existing Medicare and Medicaid benefits would be provided through an integrated benefit design that would also include a dedicated interdisciplinary team to address each individual´s medical, behavioral, long-term supports and services, and social needs. CMS, New York State, and Partners Health Plan will ensure that participants have access to an adequate network of medical and supportive services, including OPWDD services such as habilitation.
New York and CMS expect to contract with Partners Health Plan to coordinate the delivery of covered services for individuals who are eligible and who elect to enroll voluntarily. Up to 10,000 Medicare-Medicaid IDD enrollees in the New York downstate region (New York City, Long Island, Rockland, and Westchester Counties) would have an opportunity to receive more coordinated care as a result of this new program. The targeted start date for enrollment in the program is no sooner than January 1, 2016. In the next several months, New York State and PHP will work through finalization of key protections and design elements.
CMS, OPWDD, and the New York State Department of Health would support a rigorous independent evaluation of both the quality of care which individuals receive, as well as any impact the program has on Medicare and Medicaid costs.
To learn more about the New York-CMS original FIDA partnership or demonstrations in other states, visit:https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html.
The MOU and three-way contract for the New York-CMS original FIDA partnership will serve as the basis for the MOU and three-way contract to be developed for the FIDA-IDD program. The original FIDA MOU and three-way contract can be found at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/NYMOU.pdf and http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/NewYorkContract.pdf.
OPWDD welcomes comments and questions related to the FIDA-IDD. Please submit your comments and questions toFIDA-IDD@opwdd.ny.gov.