Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Frequently Asked Questions
Q. What is the FIDA-IDD?
A. FIDA-IDD stands for Fully Integrated Duals Advantage for individuals with Intellectual and Developmental Disabilities (FIDA-IDD). FIDA-IDD is a partnership between the NYS Department of Health (DOH), the Office for People With Developmental Disabilities (OPWDD), the federal Centers for Medicare and Medicaid Services (CMS), and Partners Health Plan (PHP) a not for profit health benefit plan. This partnership creates a demonstration to better serve individuals with intellectual and developmental disabilities (IDD) who are eligible for both Medicare and Medicaid and focuses on these individual’s long-term care service needs. The FIDA-IDD Demonstration offers more opportunities for individuals to direct their own services, be involved in care planning, and live as independently as possible in the community.
Q. Who can join the FIDA-IDD Plan?
A. To join the FIDA-IDD you must be:
- Age 21 or older; and
- Entitled to benefits under Medicare Part A and enrolled in Part B, eligible to enroll in Part D, and eligible for full Medicaid benefits; and
- Eligible for OPWDD services in accordance with NYS Mental Hygiene Law 1.03(22); and
- Determine to be eligible for ICF-IID level of care; and
- Live in Bronx, Kings, New York, Queens, Richmond, Rockland, Nassau, Suffolk or Westchester Counties; and
- US citizen or lawfully admitted to the United States
Q. Who cannot join?
A. You cannot join the FIDA-IDD if you live in:
- A New York State Office of Mental Health (OMH) facility;
- A Skilled Nursing Facility [SNF/Nursing Facility (NF)] or Developmental Center. Upon leaving the SNF/NF or Developmental Center, you are eligible for FIDA-IDD.
- Psychiatric facilities;
- Receiving hospice services (at time of enrollment);
- An alcohol/substance abuse long-term residential treatment program; or
- An Assisted Living Programs
In addition, you cannot join FIDA-IDD if you are:
- Under the age of 21;
- Expected to be Medicaid eligible for less than six months;
- Enrolled in the Section 1915(c) Traumatic Brain Injury (TBI); Nursing Home Transition and Diversion Waiver; or Long Term Home Health Care Waiver
- Eligible only for Emergency Medicaid;
- Under 65 years of age (who have been screened and require treatment) in the Centers for Disease Control and Prevention breast and/or cervical cancer early detection program who need treatment for breast or cervical cancer, and are not otherwise covered under creditable health coverage;
- Eligible for the family planning expansion program; or
- In the Foster Family Care Demonstration.
Q. Do I have to enroll in the FIDA-IDD Plan?
A. No. Enrollment is voluntary. Also, the FIDA-IDD Demonstration does not allow for passive enrollment of eligible individuals and individuals may disenroll from the demonstration at any time. Eligible individuals have the opportunity to opt into the demonstration with coverage starting no earlier than April 1, 2016.
Q. What does the FIDA-IDD offer?
A. The FIDA-IDD Plan covers all Medicare and Medicaid benefits, Long Term Supports and Services, OPWDD Services, social needs, behavioral health services, Part D drug and Medicaid drug coverage. The participating FIDA-IDD Plan will offer a service coordination team to ensure the integration of the your medical, behavioral health, long-term services and supports, and social needs. The team will be built on the enrollee’s specific preferences and goals. You will be part of your care team to plan for all your medical, behavioral, long term supports and services and social needs.
Q. What will the FIDA-IDD program do for me?
A. The FIDA-IDD Plan is a health plan that’s centered on you. The Plan offers personal, complete, and coordinated health care coverage. You are part of the team which includes your Care Manager, your service providers and your doctor. Your team will get to know you and your needs and will work with you to develop your own plan of care. Your team works together to make sure you get all the services in your care plan. Your Care Manager will coordinate your services, from setting up doctor visits to transportation.
Q. What is Care Management?
A. Care Management is a set of activities intended to improve patient care and reduce the need for medical services by helping patients and caregivers more effectively manage health conditions.
Q. What are Care Managers?
A. They are experts in working with individuals to identify their goals and locate the specific support services that enhance well-being. Care Managers will help you create a coordinated plan of care and services that meet your individual needs. Care Managers can also help you if there is a change in your living arrangements or if you need help accessing a certain type of service.
Q. What is an IDT (also known as an Interdisciplinary Team)?
A. The IDT is a team of people that will help you to plan, coordinate and assist you in accessing services and support.
Q. Who is part of the IDT?
A. The IDT is comprised of you the participant and your representative if you have one, your Care Manager, and your primary providers of OPWDD services. In addition, the IDT may include other providers you are seeing, such as behavioral health professionals or your home care aide.
Q. What are some of the advantages to me if I enroll in the FIDA-IDD Plan?
A. Here are some advantages
- You receive care management & coordination of services which will enhance quality of care for you.
- The Plan requires no deductibles, premiums, or copayments/coinsurance, hence saves you money.
- Uses one Health Insurance ID card to receive all of your benefits, to simplify your record keeping.
- Includes a Care Manager who can schedule doctor´s appointments, arrange transportation and help get your medicine.
- Allows you to add your caregivers or someone else that you trust to your care team (also known as the IDT) to help make decisions regarding your care
- The Plan provides extra resources to help you navigate the managed care system or the appeals process through the new Ombudsman, called the Independent Consumer Advocacy Network (ICAN).
- The Plan offers approved items, services, and prescription medicines at no cost to you.
Q. What services will FIDA-IDD cover?
A. FIDA-IDD allows you access to the full set of Medicare and Medicaid services available to you including:
- Comprehensive coverage
- Interdisciplinary Team Approach
- Care Management
- Primary care, specialist, and hospital care
- Long Term Supports & Services
- Behavioral Health
- OPWDD waiver services if you are enrolled in the 1915(c) HCBS Waiver Services
- ICF-IID services if you are not enrolled in the 1915(c) HCBS Waiver Services
- Prescription and non-prescription drugs
Q. If I already have Medicare and Medicaid how does the FIDA-IDD improve medical services?
A. Currently, Medicare-Medicaid individuals navigate multiple sets of rules, benefits, insurance cards, and providers (e.g., Medicare Parts A and B, Part D, and Medicaid). Many Medicare-Medicaid enrollees suffer from multiple or severe chronic conditions and can benefit from better care coordination and care management of medical care, behavioral health and long-term services and supports. The FIDA-IDD plan provides care management. Care management can improve your care and reduce the need for medical services by helping you and your caregiver manage your health care needs and conditions more effectively.
Q. What are the incentives to join this managed care FIDA-IDD plan?
A. The FIDA-IDD program offers you more opportunities to direct your own services if you choose, take part in the planning for your care and services and live as independently as possible in the community. Your existing Medicare and Medicaid benefits are provided through a combined benefit package that includes your own care manager, and a dedicated interdisciplinary team, which you and/or representative are part of, to address each of your medical, behavioral health, long-term supports and services, and social needs. You will have access to a larger network of medical and supportive services, including OPWDD services such as habilitation.
Q. If I join the FIDA-IDD will it affect my waiver services such as Day and Residential programs?
A. No, if you are enrolled in OPWDD’s HCBS waiver program you will remain in the waiver program and receive waiver services through the FIDA-IDD plan upon enrollment. The Plan will be responsible for providing/coordinating your waiver services. The Plan will make payment to the service provider.
Q. Can I disenroll from the FIDA-IDD Plan?
A. Yes. You can leave FIDA-IDD Plan at any time and for any reason because it is a voluntary program. If you decide to disenroll, you will go back to regular Medicaid and original Medicare or a Medicare Advantage plan, and a Part D plan.
Q. When can I enroll in FIDA-IDD Plan?
A. Eligible individuals have the opportunity to enroll in the FIDA-IDD Plan now.
Q. If I enroll, when will the enrollment be effective?
A. Enrollment is prospective and therefore will be effective the first of the month following the month you request to enroll. For example, if you request enrollment on 10/3, your enrollment will be effective 11/1.
Q. If I enroll in the FIDA-IDD Plan, can I continue to see my current providers even if the provider does not participate in the plan’s provider network?
A. Yes, for a limited time. FIDA-IDD includes important continuity of care provisions:
- Individuals new to a FIDA-IDD Plan will have a transition period during which you can continue to see your current providers. The transition period will last for at least ninety (90) days. If your provider agrees to become a network provider, during the contracting process, the FIDA-IDD Plan will continue to pay your provider and you can continue to see your provider beyond the 90 day transition period.
- Your provider must agree to accept payment from the plan. The FIDA-IDD Plan will pay the provider the Medicare or Medicaid fee-for-service rate
- If your providerchooses not to become a network provider, after the transitional period, you will no longer be requiredto pay for the care received out-of-network, unless the FIDA-IDD Plan or your care team has authorized it.
- If you are receiving behavioral health services you can continue to see your behavioral health provider until it is determined the service is no longer necessary. However, this continuation cannot exceed 2 years from the date you enrolled and only applies to the episode of care that was ongoing during your transition from Medicaid fee for service to the FIDA-IDD Plan.
- If you reside in an OPWDD certified residence you can continue to receive residential services from your current provider as long as your care plan continues to describe the need for the service.
Q. How can I get more information about the FIDA-IDD.
A. For questions, you can call New York Medicaid Choice at 1-844-343-2433 (TTY users 1-888-329-1541; a free interpreter: 1-855-600-3432. New York Medicaid Choice is available Monday-Friday, 8:30am-8:00pm and Saturday, 10:00am-6:00pm. The call and the help are free. New York Medicaid Choice also has a website at: www.nymedicaidchoice.com.
Q. How do I enroll in the FIDA-IDD?
A. To enroll in the FIDA-IDD, you can call New York Medicaid Choice at 1-844-343-2433 (TTY: 1-888-329-1541) Monday through Friday, 8:30am-8:00pm, and Saturday, 10:00am-6:00pm).
Questions for the Office for People With Developmental Disabilities (OPWDD).