New York

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

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

January 1, 2021 - CMS, NY, & the participating plan execute an updated three-way contract

October 10, 2023: CMS & NY extend the MOU for Integrated Appeals and Grievances Demonstration through 12/31/2025

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) 
  • Three-Way Contract Amendment (08/01/2020) (PDF)
    • Summary of Contract Changes (PDF)
  • Three-Way Contract Amendment (01/01/2021) (PDF)
    • Summary of Contract Changes (01012021) (PDF)
  • Three-Way Contract Amendment (11/01/2023) (PDF)
    • Summary of Contract Changes (11012023) (PDF)
• MOU (PDF)
• Third Evaluation Report for the New York Fully Integrated Duals Advantage - Intellectual and Developmental Disabilities (NY FIDA-IDD) Demonstration under the Medicare-Medicaid Financial Alignment Initiative (08/09/2023)
  • Findings at a Glance
• Combined First and Second Evaluation Report for the New York Fully Integrated Duals Advantage - Intellectual and Developmental Disabilities (NY FIDA-IDD) Demonstration under the Medicare-Medicaid Financial Alignment Initiative (06/01/2022)
  • Findings at a Glance
• 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)
• New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 3 (PDF)
• New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 4 (PDF)
• New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (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 IDD Capitated Duals Demonstration project

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)

• Third Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (12/20/2023)

• Beneficiary Experience Research Results for the Integrated Appeals and Grievances Demonstration in New York (10/01/2022) (PDF)
• Second Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (04/12/2023)
• First Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (03/08/2022)
• Integrated Beneficiary Notices (ZIP) (including):
  • Integrated Coverage Determination Notice
  • Expedited Appeal Request Denial Notice
  • Appeal Extension Notice
  • Appeal Denial Notice
• CY 2022 Evidence of Coverage (Chapter 9) (DOCX)
• 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)
  • Summary of Contract Changes (PDF)
• MOU (PDF)
• State Proposal (PDF)
• Combined Second and Third Evaluation Report for the New York Fully Integrated Duals Advantage (FIDA) capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative (07/07/2021)
• 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)
• 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)
• New York FIDA Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 5 (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:

• Summary of FIDA Reforms (12/09/15)
• FIDA Capitated Duals Demonstration

Funding Support:

• Beneficiary Counseling & Ombudsman Programs

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