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
04/23/2024: CMS released the New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6. More information is available below. |
3/21/2024: CMS released the NY FIDA-IDD Three-Way Contract Amendment (11/01/2023) & Summary of Contract Changes. More information is available below. |
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)
- 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)
- 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)
- 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)
- New York FIDA-IDD Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 6 (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)
- 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)
- 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)