Press Release

Contact: Mitchell Clark
Senior Communications Associate

August 26, 2013  

Statement by Medicare Rights Center President Joe Baker on the Memorandum of Understanding between CMS and the State of New York for the Fully Integrated Duals Advantage Demonstration

New York, NY –Today, the Centers for Medicare & Medicaid Services (CMS) released its Memorandum of Understanding (MOU) with the New York State Department of Health (NYSDOH) to introduce a new model for integrating and coordinating care for 170,000 people eligible for both Medicare and Medicaid, known as “dual-eligibles.” The new Fully Integrated Duals Advantage, or FIDA, demonstration will be implemented in New York City, Long Island and Westchester County no earlier than July 1, 2014.

The MOU released today outlines many of the provisions of the FIDA demonstration, with additional program details to be negotiated as part of a Three-Way Contract among CMS, NYSDOH and new FIDA insurance plans. In a preliminary review of the MOU, it is heartening to see that many of the consumer protections recommended by the Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) have been included. For example, the MOU provides for the following:

The MOU will require a more thorough review, particularly with regard to enrollment protocol, rate-setting and reimbursement methodology, and protections related to care coordination and compliance with the Americans with Disabilities Act (ADA) and other laws. We additionally hope to better understand how the MOU supports the Olmstead decision and the beneficiary’s right to live and receive services and supports in a fully integrated setting. For all dual-eligibles and their families, it is also important that NYSDOH develops and effectively disseminates quality metrics that account for the specifics of the dually eligible population and enable consumers to make educated plan choices.

Coverage under FIDA plans for eligible individuals will begin no earlier than July 1, 2014. While CPRNYDE advocated for a purely voluntary enrollment process for the demonstration, which was not included, we note that NYSDOH and CMS did include a passive enrollment process that:

As the Medicare Rights Center and CPRNYDE analyze the MOU more closely, we look forward to working with NYSDOH, health plans and provider groups to develop the forthcoming Three-Way Contract to ensure that the implementation of this new demonstration, which affects some of New York’s frailest and most vulnerable residents, improves the quality, accessibility and affordability of their care.

The Coalition to Protect the Rights of New York’s Dually Eligible is led by the Medicare Rights Center as a joint effort of the Center for Disability Rights, Center for Independence of the Disabled NY, Community Services Society of NY, Consumer Directed Personal Assistance Association of New York State, Empire Justice Center, Legal Aid Society, New York Association on Independent Living, and New York Legal Assistance Group.

Consisting of dozens of organizations representing a diverse group of interests, agencies and perspectives, the Coalition works to shape New York’s demonstration project created by the Affordable Care Act to provide quality care for the state’s unique dually eligible population.

The Coalition is part of Voices for Better Health, a multi-year, multi-state effort funded by The Atlantic Philanthropies and supported nationally by Community Catalyst.

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