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Statement by CPRNYDE on the New York FIDA MOU

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Statement by the Coalition to Protect the Rights of New York’s Dually Eligible on the NY FIDA MOU

New York, NY–Today the Centers for Medicare & Medicaid Services (CMS) released its Memorandum of Understanding (MOU) with the New York State Department of Health (NYSDOH) to introduce a new model for integrating and coordinating care for 170,000 people eligible for both Medicare and Medicaid, known as “dual-eligibles.” The new Fully Integrated Duals Advantage, or FIDA, demonstration will be implemented in New York City, Long Island and Westchester County no earlier than July 1, 2014.

The MOU released today outlines many of the provisions of the FIDA demonstration, with additional program details to be negotiated as part of a Three-Way Contract among CMS, NYSDOH and new FIDA insurance plans. In a preliminary review of the MOU, it is heartening to see that many of the consumer protections recommended by the Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) have been included. For example, the MOU provides for the following:

  • An integrated appeals system, which streamlines the Medicare and Medicaid appeals processes and provides continuation of benefits during pending appeals. The integrated appeals system does not include Part D prescription drug appeals, but the MOU alludes to the opportunity for continued discussion about that issue.
  • The establishment of a new FIDA Participant Ombudsman, which will independently advocate on behalf of dual-eligibles enrolled in the demonstration and support their access to person-centered care in the community.
  • A requirement for FIDA plans to develop meaningful ongoing stakeholder and member engagement and participate in continuous quality improvement. The MOU also encourages FIDA plans to include their enrollees in governance, but stops short of requiring such participation.

The MOU will require a more thorough review, particularly with regard to enrollment protocol, rate-setting and reimbursement methodology, and protections related to care coordination and compliance with the Americans with Disabilities Act and other laws. It is also important that NYSDOH develops and effectively disseminates quality metrics that account for the specifics of the dually eligible population and enable consumers to make educated plan choices.

Coverage under FIDA plans for eligible individuals will begin no earlier than July 1, 2014. While CPRNYDE advocated for a purely voluntary enrollment process for the demonstration, which was not included, we were pleased that NYSDOH and CMS did include a passive enrollment process that:

  • Allows beneficiaries to opt out of the demonstration entirely;
  • Allows beneficiaries to switch into a different FIDA plan (or other plan for which they might be eligible) on a monthly basis; and
  • Employs an intelligent assignment algorithm that prioritizes continuity of providers and services.

As the Medicare Rights Center and CPRNYDE analyze the MOU more closely, we look forward to working with NYSDOH, health plans and provider groups to develop the forthcoming Three-Way Contract to ensure that the implementation of this new demonstration, which affects some of New York’s frailest and most vulnerable residents, improves the quality, accessibility and affordability of their care.

The Coalition to Protect the Rights of New York’s Dually Eligible is led by the Medicare Rights Center as a joint effort of the Center for Disability Rights, Center for Independence of the Disabled NY, Community Services Society of NY, Empire Justice Center, Legal Aid Society, New York Association on Independent Living, and New York Legal Assistance Group.

Consisting of more than 40 organizations representing a diverse group of interests, agencies and perspectives, the Coalition works to shape New York’s demonstration project created by the Affordable Care Act to provide quality care for the state’s unique dual eligible population.

The Coalition is part of Voices for Better Health, a multi-year, four-state effort funded by The Atlantic Philanthropies and supported nationally by Community Catalyst.

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For more information about the Coalition to Protect the Rights of New York's Dually Eligible (CPRNYDE), please send us an email.