Module 1 intro fida final fida provider training

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Fully Integrated Duals Advantage (FIDA)

Provider Education and Training


Who is required to take this training?

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The state of New York requires all FIDA contracted

providers to take this one-time training

If you have completed FIDA training through

another plan, please send a copy of your attestation

to: [email protected]

Who is required:

• Individual and Group Providers

All contracted practitioners with an NPI number

• Facilities

A responsible party is required to complete and

provide subsequent training to providers within the

facility

mailto:[email protected]


Fully Integrated Duals Advantage (FIDA):

Background

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Purpose:

To integrate care management for dually eligible

participants (people who have both Medicare and

Medicaid in NY) who may require home and / or

community-based Long-Term Care Support Services

(LTSS) such as:

• Social Services

• Mental Health and / or substance abuse services

To coordinate all LTSS necessary

To incorporate physical and behavioral health with

independent living and reduce healthcare

fragmentation


FIDA: Participants

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Age 21 or older, residing in NYC, Long Island, or Westchester

who:

• Receive or need community-based long term care services

• Receive or need managed long term care

• Live in nursing homes or who come to be permanently placed

in nursing homes and are both Medicare and Medicaid

eligible

Exclusions: people in the Office for People with Developmental

Disabilities, Traumatic Brain Injury, and Nursing Home Transition &

Diversion Waivers who receive hospice services or live in a

Medicaid Assisted Living Program.


The New FIDA Plans

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The following plans will combine under one managed care

plan to encompass FIDA:

1. Medicare Advantage plan

2. Part D prescription drug plan

3. Medicaid Managed Long Term Care (LTCS) plan

4. Regular Medicaid care covering all other Medicaid

services

FIDA plans will cover Medicaid LTCS as well as ALL other medical care

covered by Medicare and Medicaid.


FIDA: Participant Enrollment

6

Voluntary Enrollment Passive Enrollment

As of 1/1/2015,

participants can

enroll voluntarily

As of 4/1/2015, eligible

participants will be

assigned a FIDA Plan by

NYSDOH if/or:

Plan is not selected

after 60 day min.

advance

notification

Declined

enrollment

Participant does

not opt out


Provider Requirements

7

Some participating provider requirements include:

Training: must meet applicable State minimum training requirements,

including minimum hours and topics of training.

No Balance Billing: may not balance bill participants for covered

services rendered.

HIPAA: compliance with applicable federal and state privacy,

confidentiality and security laws, rules and/or regulations, including

without limitation, the federal Health Insurance Portability and

Accountability Act of 1996 (HIPAA)

For more information regarding contractual obligations, see the

ValueOptions Provider Handbook

http://www.valueoptions.com/providers/Handbook/ValueOptions_Provider_Handbook.pdf


FIDA Covered Behavioral Health Services

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OMH licensedcommunity residences

Substance abuse (SA) programs

Peer-delivered services

Intensivepsychiatric rehabilitation treatment programs

Opioid treatmentservices – SA

Mobile mental health treatment

Day treatment Assertive communitytreatment (ACT) MI

Outpatient-medically supervised withdrawal – SA

Continuing day treatment

Inpatient hospitalpsychiatric/impatient mental health over 190-day lifetime Limit

Peer mentoring Personalizedrecovery oriented services (PROS)

Outpatientmental health

Inpatient hospital care acute –including substance abuse and rehab services

Outpatient substance Abuse

Community integrationcounseling

Structured day program

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Module 1 intro fida final fida provider training