A personal health care plan thats centered on you. One plan that brings together the resources of Medicare and Medicaid. A plan that gives you all the care you need, in one place. Introducing New York States FIDA program. How is FIDA different? FIDA is short for Fully Integrated Duals Advantage. Its a managed care plan specifically for people who receive services through both Medicare and Medicaid. FIDA puts you at the center of all important care decisions.
Take control of your health care with a FIDA plan In the FIDA program, your health and wellbeing are central to the care-planning process. You will be a part of your Interdisciplinary Team (IDT), which is essentially your care team. Your team will also include your care manager, doctors, and other people that you trust. You will all work together to make decisions about your plan of care. What can your FIDA care team do for you? Making decisions about long-term care can be confusing and frustrating. If you join a FIDA plan, your care team will work with you to make sure you know which Medicare and Medicaid services you can get. Your team will connect you to a network of health care and supportive services that can offer you a variety of options and
additional services. They will help you get your services and get you to your appointments. Which services can you get with a FIDA plan? The FIDA benefit package includes more services than any other managed care plan in New York. It includes all Medicaid and Medicare services, as well as other services that you may one day need such as behavioral health, substance abuse, and other services. Abdominal Aortic Aneurism Screening Adult Day Health Care AIDS Adult Day Health Care Ambulance Ambulatory Surgical Centers Assertive Community Treatment Assisted Living Program Assistive Technology (State Plan and Supplemental to State Plan) Bone Mass Measurement
Breast Cancer Screening (Mammograms) Cardiac Rehabilitation Services Cardiovascular Disease Risk Reduction Visit (therapy for heart disease) Cardiovascular Disease Screening and Testing Care Management (Service Coordination) Cervical and Vaginal Cancer Screening Chemotherapy Chiropractic Colorectal Screening Community Integration Counseling Community Transitional Services Consumer Directed Personal Assistance Services Continuing Day Treatment Day Treatment Defibrillator (implantable automatic) Dental Depression Screening Diabetes Monitoring (Self-Management Training) Diabetes Screening Diabetes Supplies Diabetic Therapeutic Shoes or Inserts Diagnostic Testing Durable Medical Equipment Emergency Care Environmental Modifications Family Planning Services Freestanding Birth Center Services
Home and Community Support Services (HCSS) Health/Wellness Education Hearing Services HIV Screening Home Delivery and Congregate Meals Home Health Home Infusion Bundled Services Home Infusion Supplies and Administration and Medicare Part D Home Infusion Drugs Home Maintenance Services Home Visits by Medical Personnel Immunizations Independent Living Skills and Training Inpatient Hospital Care (including Substance Abuse and Rehabilitation Services) Inpatient Mental Health Care Inpatient Mental Health over 190-day Lifetime Limit Intensive Psychiatric Rehabilitation Treatment Programs Inpatient Services during a Non-covered Inpatient Stay Kidney Disease Services (including End Stage Renal Disease services) Mammograms Medicaid Pharmacy Benefits as Allowed by State Law Medical Nutrition Therapy Medicare Part B Prescription Drugs Medicare Part D Prescription Drug Benefit as Approved by CMS Medication Therapy Management
Mobile Mental Health Treatment Moving Assistance Non-Emergency Transportation Nursing Facility (Medicaid) Nutrition (includes Nutritional Counseling and Educational Services) NYS Office of Mental Health Licensed Community Residences Obesity Screening and Therapy to keep weight down Opioid Treatment Services Substance Abuse Other Health Care Professional Services Other Supportive Services the Interdisciplinary Team Determines Necessary Outpatient Blood Services Outpatient Medically Supervised Withdrawal- Substance Abuse Outpatient Mental Health Outpatient Rehabilitation (OT, PT, Speech) Outpatient Substance Abuse Outpatient Surgery Palliative Care Pap Smear and Pelvic Exams Partial Hospitalization (Medicaid) Partial Hospitalization (Medicare) PCP Office Visits Peer-Delivered Services Peer Mentoring Personal Care Services
Personal Emergency Response Services Personalized Recovery Oriented Services Podiatry Positive Behavioral Interventions and Support Preventive Services Private Duty Nursing Prostate Cancer Screening Prosthetics Pulmonary Rehabilitation Services Respiratory Care Services Respite Routine Physical Exam (1/year) Sexually Transmitted Infections (STIs) Screening and Counseling Skilled Nursing Facility Smoking and Tobacco Cessation Social and Environmental Supports Social Day Care Social Day Care Transportation Specialist Office Visits Structured Day Program Substance Abuse Program Telehealth Transportation Urgent Care Vision Care Services Welcome to Medicare Preventive Visit Wellness Counseling
FIDA coverage in New York State includes items and services currently covered by: Medicare Medicaid Long-term care Behavioral health Wellness programs Prescription drugs Home and Community Based Services waiver services There are no FIDA specific costs* to participants, including no co-payments, no premiums, and no
deductibles for any covered items or services. *Medicaid spend-down requirements still apply. Transition of care To ensure you have a smooth transition of care, your FIDA plan must: Make arrangements to help ensure that all community-based supports, including noncovered services, are in place prior to your move. Make sure participating providers are fully knowledgeable and prepared to support you. Whos eligible for FIDA? Westchester Participants must be:
21 or older; Entitled to benefits under Medicare Part A and enrolled under both Medicare Parts B and D and receiving full Medicaid benefits; and Be a resident of a demonstration county: Bronx, Kings, New York, Queens, Richmond, and Nassau; starting January 1, 2015. The program will expand into Westchester and Suffolk counties later this year. Bronx Suffolk New York Queens Kings Nassau Richmond
And meet one of the following three criteria: Require community-based long-term services and supports (LTSS) for more than 120 days, Are eligible for the Nursing Home Transition and Diversion Waiver program, or Are nursing facility clinically eligible and receiving facility-based LTSS. Enrollment timeline January 1, 2015, effective date for individuals to opt-in to the demonstration. April 1, 2015, first effective date for certain individuals who will be passively enrolled. Passive enrollment will be phased-in over time. Nursing Home Transition Individuals residing in nursing homes prior to February 1, 2015, will not be passively enrolled into FIDA. Individuals new to custodial status in nursing homes as of January 1, 2015, will be passively enrolled into FIDA on or after August 1, 2015. Independent Consumer Advocacy Network This network will act as a resource and advocate for participants and families as they
navigate the MLTC and FIDA program systems. It will also serve beneficiaries of LTSS in Mainstream Managed Care plans. The contract for this statewide ombudsman program was awarded to a network of not-for-profit organizations, with Community Service Society of New York (CSS) serving as the entity responsible for coordinating services. The CSS network will provide consumers with direct assistance in navigating their coverage and in understanding and exercising their rights and responsibilities. CSS will be known as the Independent Consumer Advocacy Network (ICAN) and can be reached by calling 1 (844) 614-8800 or online at: www.icannys.org. FIDA Find out more: Call NY Medicaid Choice: 1 (855) 600-3432 For TTY service, call: 1 (888) 329-1541 For an interpreter, call: 1 (855) 600-3432, and press Option 1 Visit the NY Medicaid Choice website: http://www.nymedicaidchoice.com Or visit the FIDA website: http://www.health.ny.gov/health_care/medicaid/redesign/fida/ All phone services are free.
NY Medicaid Choice staff will: Provide you with information and education about FIDA plans in your area. Let you know if your doctor works with a FIDA plan. Help you learn about navigating the managed care system. If you have questions related to FIDA, e-mail us: [email protected] New York States Medicaid Reform Team (MRT) website: http://www.health.ny.gov/health_care/medicaid/redesign/mrt_101.htm Subscribe to our listserv: http://www.health.ny.gov/health_care/medicaid/redesign/listserv.htm Like MRT on Facebook: http://www.facebook.com/NewYorkMRT Follow MRT on Twitter: @NewYorkMRT
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