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November 5, 2015

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CMS and New York State Partner to Coordinate Care for Medicare-Medicaid Enrollees with Intellectual and Developmental Disabilities

On November 5, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that CMS is partnering 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.

“We are pleased to partner again with the State of New York to bring more person-centered care to Medicare-Medicaid enrollees,” said CMS Tim Engelhardt, Director, CMS Medicare-Medicaid Coordination Office. “We look forward to working together to provide Medicare-Medicaid enrollees with intellectual and developmental disabilities an opportunity to experience more integrated benefits and coordinated care.”

Background

This partnership will create a program demonstration known as Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) to better serve individuals with intellectual and developmental disabilities who are eligible for both Medicare and Medicaid and will focus on these individuals’ long-term care needs. The FIDA-IDD Demonstration will offer more opportunities for individuals to direct their own services, be involved in care planning, and live as independently in the community as possible.

New York State and CMS is working with Partners Health Plan to offer this FIDA-IDD program in New York City, Long Island, and Rockland and Westchester Counties. Voluntary enrollment in the program will begin no sooner than April 1, 2016.

This demonstration for individuals with intellectual and developmental disabilities shares the general goals and structure of the Fully Integrated Duals Advantage (FIDA) Demonstration, which is already operating in New York, but the two demonstrations involve different populations and Medicare-Medicaid Plans. Other important distinctions between the two demonstrations are that the FIDA-IDD Demonstration does not allow for passive enrollment of eligible individuals and includes a benefit package tailored to support individuals with intellectual and developmental disabilities.

Medicare-Medicaid Enrollees

Improving the care experience for low-income seniors and people with disabilities who are Medicare-Medicaid enrollees – sometimes referred to as “dual eligibles” – is a priority for CMS.

Currently, Medicare-Medicaid enrollees 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 could benefit from better care coordination and management of health care and long-term services and supports.

The Financial Alignment Initiative – Partnerships to Provide Better Care

Through the demonstrations approved under the Financial Alignment Initiative, CMS seeks to provide Medicare-Medicaid enrollees with a better care experience by offering a person-centered, integrated care initiative that provides a more easily navigable and seamless path to all covered Medicare and Medicaid services.

In July 2011, CMS announced the opportunity for states to partner with CMS through one of two models:

·  Managed Fee-for-Service Model in which a state and CMS enter into an agreement through which the state is eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid;

·  Capitated Model in which a state and CMS contract with health plans or other qualified entities that receive a prospective,blended payment to provide enrolled Medicare-Medicaid enrollees with coordinated care.

The New York FIDA-IDD Demonstration uses the Capitated Model.

The FIDA-IDD Demonstration

Approximately 20,000 Medicare-Medicaid IDD enrollees in the New York downstate region (New York City, Long Island, and Rockland and Westchester Counties) will have an opportunity to receive more coordinated care as a result of this new program.

To ensure plan participating in the FIDA-IDD Demonstration are prepared to serve Medicare-Medicaid enrollees, any participating plan must first meet core Medicare and Medicaid requirements, state procurement standards, and state insurance rules (as applicable). The plan must also pass a comprehensive readiness review operated by both CMS and the state which is currently ongoing.

The FIDA-IDD Demonstration does not allow for passive enrollment of eligible individuals, and opt-in enrollment is scheduled to begin no sooner than April 1, 2016.

Putting the Beneficiary First

Care Coordination

Under the demonstration, care coordination services will be available to all enrollees. The participating FIDA-IDD Plan will offer an interdisciplinary care team – built on the enrollee’s specific preferences and goals – to ensure the integration of the enrollee’s medical, behavioral health, long-term services and supports, and social needs.

Quality Measures

The new demonstration includes performance metrics to ensure that enrollees receive high-quality care. CMS and New York State have established quality measures relating to the beneficiary’s overall experience, care coordination, and fostering and supporting community living, among many others.

Beneficiary Feedback and Continuity of Care

The demonstration also includes continuity of care requirements to ensure that enrollees can continue to see their current providers during their transitions into the FIDA-IDD Plan. New York State created an Ombudsman program called the Independent Consumer Advocacy Network (ICAN) to help enrollees with appeals and other issues with the FIDA-IDD program. ICAN is independent, and the services are available for free. This Ombudsman program will support individual advocacy and provide New York State and CMS with feedback on plan performance for the demonstration, with a focus on compliance with principles of community integration, independent living, and person-centered care.

Comprehensive Evaluation

CMS is funding and managing an external evaluation of each demonstration under the Financial Alignment Initiative. The evaluation for the FIDA-IDD Demonstration will measure quality, including overall beneficiary experience of care, care coordination, and support of community living, as well as changes in Medicare and Medicaid costs. CMS will develop a unique, FIDA-IDD-specific evaluation using a comparison group to analyze the impact of the demonstration.

A Transparent Process Supporting Public Input

The FIDA-IDD Demonstration is the product of an ongoing planning and development process through which the public helped shape the demonstration’s design. To develop this demonstration, New York:

·  Worked with a diverse group of stakeholders, including individuals with developmental disabilities, parents and other family members, advocates, provider agency leaders and staff, and experts from outside the developmental disabilities service system;

·  Held public information sessions with external stakeholders to inform demonstration development and policy; and

·  Posted its draft proposal for public comment and incorporated the feedback into its demonstration proposal before officially submitting it to CMS. The proposal was then posted by CMS for public comment.

Additional Information

The Memorandum of Understanding (MOU) between CMS and New York State that establishes the demonstration parameters, is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/NYMOUIDD.pdf.