New York Posts Duals Demonstration Phase-Out Plan
July 2019 ~
The New York State Department of Health (NYSDOH) has posted its phase-out plan for the Fully Integrated Dual Advantage (FIDA) program -part of the federal dual demonstration initiative that began in 2014.
FIDA will end on December 31. All FIDA enrollees will be transitioned to the Medicaid Advantage Plus plan affiliated with their current FIDA plan unless they choose a different option.
According to the NYSDOH’s FIDA Demonstration Phase-out Plan overview, based on the December 31 end date, the following timeline is currently in motion:
- NYSDOH posts phase-out plan for public comment: June 24, 2019
- Public comment period: June 24 – July 22, 2019
- NYSDOH reviews comments July 22 – August 5, 2019
- NYSDOH submits phase-out plan to CMS no later than August 5, 2019
- NYSDOH and CMS approve phase-out plan: August 19, 2019
- NYSDOH and CMS begin implementing phase-out plan: August 26, 2019
This phase-out plan addresses the following areas:
Beneficiary Assignment and Coverage Options
According to the NYSDOH’s outline, a request has been submitted, asking CMS to allow individuals to be passively enrolled from their current FIDA plan to that plan´s MAP-participating D–SNP for their Medicare benefits. Enrollees would still have the option to elect different Medicare coverage options under this scenario. These passive enrollments would take effect January 1, 2020.
CMS is currently considering whether to allow this passive enrollment based on the following requirements:
- Existing Medicare providers for the FIDA plan and MAP–participating D–SNPs must be comparable;
- Medicare benefits between the FIDA plan and MAP–participating D–SNP must be similar;
- Premium and cost-sharing between the FIDA plan and MAP–participating D–SNP must be similar; and
- Medicare payment for the MAP–participating D–SNPs must be less than or equal to the Medicare fee–for–service rate.
CMS will review the above criteria for each FIDA plan that applies for passive enrollment on a county–by– county basis. FIDA plans that meet these requirements in a particular county will be eligible for passive enrollment of their FIDA participants in that county into that organization´s MAP–participating D– SNP for the same county.
Since members of different FIDA plans may have different transition paths, the NYSDOH has provided detailed Beneficiary Assignment and Coverage Options for Medicaid charts -available, here.
Please note that the MAP–participating D–SNP plan numbers referenced (e.g., H6988–004 are for Contract Year (CY) 2019 and may not be available in CY 2020 or not approved as a MAP–participating D– SNP in CY 2020. MAP–participating D–SNPs submit their bids for CY 2020 in June 2019 and CMS will determine which plans are approved in summer 2019.
Continuity of Care
During the FIDA transition, Effective October 2019, Medicaid plans must accept the transfer enrollment of all enrollees that select or are auto-assigned to the plan.
The transferring enrollee´s new plan must continue to provide services under the enrollee´s existing plan of care, and utilize existing providers, for the earlier of the following:
- one hundred twenty (120) days after enrollment; or
- until the new plan has conducted an assessment and the enrollee has agreed to the new plan of care.
The transferring enrollee´s new plan is required to conduct an assessment within 30 days of the transfer enrollment effective date unless a longer time frame has been expressly authorized by NYSDOH in its sole discretion. Long–stay nursing facility residents shall be allowed to remain in their nursing facilities and be accommodated through an out–of–network arrangement if the nursing facility is not part of the receiving plan´s network.
For Medicare, all beneficiaries will have Medicare´s standard Part D continuity of care protections for prescription drugs (i.e., temporary fills of non–formulary drugs during a transition period). Other continuity of care requirements for MAP–participating D–SNPs, including those outlined in 42 CFR 422.112(b), will apply to Medicare coverage.
For Medicaid coverage, FIDA participants are required to enroll in a Medicaid Managed Long–Term Care plan (i.e., MAP, partially capitated MLTC, or PACE) to access their Medicaid benefits.
Enrollment into Medicaid coverage will be completed by NYSDOH´s independent enrollment broker New York Medicaid Choice (Maximus). FIDA plans are currently able and encouraged to speak with their current FIDA participants about transferring to their 2019 Medicaid Advantage Plus (MAP) plan. The MAP plan is responsible for sending in the MAP–participating D–SNP enrollment request to CMS.
Members will be able to select their Medicare coverage through the normal Medicare enrollment routes, including calling 1–800–MEDICARE, contacting HIICAP (1–800–701–0501), going to Medicare.gov, or directly contacting plans.
For FIDA plans with any counties eligible for passive enrollment of their FIDA participants into the MAP– participating D–SNPs, entities will have the following roles:
- NYSDOH: For Medicaid coverage, NYSDOH will coordinate with New York Medicaid Choice as to which FIDA participants will be passively enrolled. For Medicare coverage, NYSDOH will share with CMS and the MAP–participating D–SNPs a list of FIDA participants eligible for enrollment into the MAP–participating D–SNPs.
- D–SNPs: For Medicare coverage, the MAP–participating D–SNPs will submit the enrollment transactions to CMS. It is the FIDA plan´s responsibility to determine which beneficiaries are eligible for the MAP–participating D–SNPs in advance of submitting these enrollment transactions to CMS.
- Maximus: Participant notices will be mailed by Maximus.
- CMS: For Medicare coverage, CMS will review the enrollment transactions submitted by the MAP– participating D–SNPs for MAP–participating D–SNP eligibility.
FIDA enrollee transfer to the MAP plan and MAP–participating D–SNP will occur throughout the remainder of 2019 as FIDA participants make alternative coverage decisions.
Some FIDA participants are deciding to transfer to MAP based on FIDA plan outreach about CY2019 MAP options. In February, CMS and NYSDOH distributed an approved script to FIDA plans to use in outreaching to their FIDA participants about CY 2019 MAP plans and MAP–contracting D–SNPs offered by the same parent organizations. (Please see the Appendix for the approved script template.) Most of the FIDA plans submitted scripts for CMS and NYSDOH review and approval and are using these scripts to outreach to participants. This early outreach educates FIDA participants about MAP before FIDA plans distribute the official notices in the fall at which point FIDA participants need to decide on alternative coverage.
Individuals who remain in FIDA and are eligible for passive enrollment will be passively enrolled into a MAP plan and MAP–participating D–SNP in fall 2019. CMS anticipates the final determination for passive enrollment to be completed in August 2019. Per 42 CFR 422.506(a)(2)(ii), Medicare policy requires that FIDA plans send disenrollment/transition letters to members no later than 90 days prior to the plan´s termination date (i.e. October 2, 2019 for a December 31, 2019 termination). CMS and NYSDOH will continue to work together to refine the enrollment timeline
Individuals who are not eligible for passive enrollment into a MAP–participating D–SNP that do not elect to change their coverage during 2019 will be enrolled into a Managed Long–Term Plan effective January 1, 2020.
Sequence of Notices
In late September, CMS will release to FIDA plans an HPMS memo detailing the non–renewal and service area reduction guidance and enrollee notification models.
- October 2, 2019, FIDA participants will receive the DOH/CMS approved nonrenewal notice informing them that their FIDA plan is ending December 31, 2019. This letter will be mailed by the FIDA plan.
- November 1, 2019, the first of two additional letters will be mailed to FIDA participants eligible for passive enrollment. Both letters will be mailed by Maximus. The first letter will be mailed 60 days prior to the effective date of enrollment.
- December 1, 2019, the second letter will be mailed to provide 30–days prior to the effective date of enrollment. These letters will list the name of the plan that the FIDA participant will be enrolled into if they do not take action. The effective date of enrollment will be January 1, 2020.
Content of Notices
NYSDOH and CMS will draft the FIDA participant notices that will be mailed by the applicable FIDA plan and Maximus. The letters will include notification that the participant´s FIDA plan is ending December 31, 2019 and provide both Medicaid and Medicare plan options.
Under Section III.L.4.c of the MOU, notices should include all applicable beneficiary appeal rights under Medicaid rules, including rights regarding the changes in covered services that result from the transition to the MAP plan and MAP–participating D–SNP. Beneficiary notices shall be made available in Prevalent Languages and Alternative Formats.
Identification of Sources of Help and Referrals
NYSDOH continues to work with its partners to be a resource for assistance during the transition period, including:
- Maximus, NYSDOH´s enrollment broker, will serve as the FIDA participant´s support system for all Medicaid enrollment and disenrollment (including from one health plan to another) needs, and will also be providing unbiased choice counseling.
- Independent Consumer Advocacy Network (ICAN) will provide unbiased assistance to members who get long–term care services. ICAN will help answer FIDA participant questions related to Medicare and Medicaid, options.
- The New York State Office for Aging (NYSOFA), Health Insurance Information, Counseling and Assistance (HIICAP) will continue to provide Medicare–Medicaid eligible individuals who qualify for FIDA complete, accurate and impartial information about FIDA.
Training Schedule for Beneficiary Supports
NYSDOH will be providing ICAN, New York State Office for Aging (NYSOFA), Health Insurance Information, Counseling and Assistance (HIICAP) and Maximus with copies of each of the member communications that will be used during this transition period.
Customer Service Scripts
DOH has developed a customer service script for Maximus call center representatives to use when assisting those participants already enrolled in a FIDA plan (Attachment A). In addition, DOH has developed a script that the FIDA plans will use when speaking with FIDA participants about the option of enrolling in the plan´s MAP plan (Attachment B).
Public Information Strategy
The FIDA plans will outreach to long–stay, nursing facility residents about their plan ending at the end of 2019.
In addition to the formal 30–day comment period, NYSDOH, with CMS´ collaboration as appropriate, will continue to engage with stakeholders both before release of the draft phase-out plan and afterward.
The formal posting for comment will be “well-publicized” and made easily accessible, including compliant with Section 508 of the Rehabilitation Act.
Source(s): The New York Department of Health;