New York (NY) Capitated Financial Alignment Model Demonstrations
Guidance for New York (NY) Capitated Financial Alignment Model Demonstrations, including key dates and information on NY Integrated Appeals and Grievances Demonstration.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 31, 2020
New York (NY) Capitated Financial Alignment Model Demonstrations:
NY Fully Integrated Duals Advantage - Intellectual and Developmental Disabilities (NY FIDA-IDD)
NY Integrated Appeals and Grievances Demonstration
NY Fully Integrated Duals Advantage (NY FIDA): *12/31/2019 - transitioned to NY Integrated Appeals and Grievances Demonstration*
| SPOTLIGHT & RELEASES |
| 09/24/2020: CMS released the CY 2021 Evidence of Coverage, and a revised CY 2020 Integrated Coverage Determination Notice, for the NY Integrated Appeals and Grievances Demonstration. More information is available below. |
08/28/2020: CMS released the Quality Withhold Analysis Results for Demonstration Year 4 for NY FIDA, and Demonstration Year 2 for NY FIDA-IDD, MMPs |
Key Dates
November 5, 2015: CMS & NY sign MOU for FIDA-IDD model
January 14, 2016: CMS, NY & the participating plan execute three-way contract for FIDA-IDD model
April 1, 2016: Start of opt-in enrollment in New York, Long Island, Rockland & Westchester Counties for FIDA-IDD model
November 7, 2016: The NY FIDA-IDD model IDT policy is released
January 18, 2018: The NY FIDA-IDD model IDT policy is released
January 1, 2020: The NY Integrated Appeals and Grievances Demonstration begins
February 21, 2020: CMS & NY finalize MOU for Integrated Appeals and Grievances Demonstration
FIDA-IDD Demonstration
On November 5, 2015, CMS announced their partnership with the New York State Department of Health (NYSDOH) and the Office for People with Developmental Disabilities (OPWDD) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Approximately 20,000 Medicare-Medicaid IDD enrollees in the New York downstate region (New York City, Long Island, Rockland and Westchester Counties) will have an opportunity to receive more coordinated care as a result of this new program.
More Information from CMS:
- Press Release
- Three-Way Contract (PDF)
- MOU (PDF)
- Readiness Review Tool (PDF)
- IDT Policy (PDF)
- New York FIDA IDD Evaluation Design Plan (PDF)
- New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
- New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
Information for the Plan:
- All state-specific information and guidance for the plan is available on the Information and Guidance for Plans page.
Information from the state of New York:
FIDA (*transitioned 12/31/2019*) and NY Integrated Appeals and Grievances Demonstration
On January 1, 2020, CMS and NYSDOH transitioned remaining FIDA enrollees to MAP plans and aligned D-SNPs. This transition also included extending the FIDA integrated appeals and grievances process to MAP and aligned D-SNP plans. Under the revamped NY Integrated Appeals and Grievances Demonstration, CMS and NYSDOH are testing the integrated appeals and grievances process begun under FIDA with a larger volume of full benefit dual eligible individuals. As of January 2020, approximately 18,000 individuals are enrolled in a MAP and aligned D-SNP plan.
More Information from CMS on NY Integrated Appeals and Grievances Demonstration:
- MOU (PDF)
- Integrated Beneficiary Notices (ZIP) (including):
- Integrated Coverage Determination Notice
- Expedited Appeal Request Denial Notice
- Appeal Extension Notice
- Appeal Denial Notice
- CY 2021 Evidence of Coverage (Chapter 9) (DOCX)
- CY 2020 Evidence of Coverage (Chapter 9 (DOCX))
- MAP Handbook Addendum (DOCX)
- CY 2020 Annual Notice of Changes (DOCX)
More Information from CMS on NY FIDA Demonstration (*transitioned 12/31/2019*):
- Fact Sheet
- Three-Way Contract (PDF)
- MOU (PDF)
- State Proposal (PDF)
- First Evaluation Report for the New York Fully Integrated Duals Advantage (FIDA) capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (09/24/2019) (PDF)
- Readiness Review Tool (PDF)
- New York Evaluation Design Plan (PDF)
- Letter of Intent to Extend Scheduled End Date (PDF)
- New York FIDA Phase-out Plan (PDF)
- New York FIDA MMP Non-Renewal & Service Area Reduction Guidance Memo (PDF)
- Non-Renewal Notices (ZIP)
- New York FIDA Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (PDF)
- New York FIDA Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 2 (PDF)
- New York FIDA Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
- New York FIDA Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
Information for Plans:
- All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.
Information for Beneficiaries and Providers:
- New York FIDA 30-Day D-SNP Notice (PDF)
- New York FIDA 60-Day MAP Notice (PDF)
- New York FIDA Ombudsman Program
- New York FIDA Home Health Provider Frequently Asked Questions (FAQs) (PDF)
- New York FIDA Medigap FAQs (PDF)
- New York FIDA Pharmacist Provider FAQs (PDF)
- New York FIDA Provider FAQs (PDF)
Information from the state of New York:
Funding Support:
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