DOH Releases FIDA FAQs Covering Behavioral Health and Hospice Services
The Department of Health (DOH) has issued "frequently asked questions" (FAQs) that explain how the Fully Integrated Duals Advantage (FIDA) program provides coverage of specialized behavioral health services and hospice services. The FAQs are available here.
The FAQs explain that Health and Recovery Plans (HARPs) are designed for people with serious mental illnesses who are beneficiaries of Medicaid only, whereas FIDA plans are intended to serve beneficiaries of both Medicaid and Medicare who need long term care. The FAQs point out that three new HARP services have been added to the FIDA benefit package effective Jan. 2016: Comprehensive Psychiatric Emergency Programs (CPEP); Crisis Intervention Services, Residential Addiction Services. They acknowledge that Residential Addiction Services are not yet available and that CPEP programs are not available in Nassau and Westchester Counties. The FAQs also clarify that the full complement of Office of Mental Health Article 31 services are covered by FIDA plans, but that the expanded behavioral health home and community-based services offered by HARP plans are not available through FIDA. In addition, the FAQs address care planning, care coordination, and billing between FIDA plans and behavioral health providers.
The FAQS describe the relationship between Health Home services and the FIDA program. Health Home services are covered by FIDA plans, and FIDA members may opt to receive Health Home services, but are not required to do so. FIDA care managers are instructed to coordinate with Health Home care care managers.
The FAQs clarify that beneficiaries who are receiving Medicaid or Medicare hospice services may not enroll in a FIDA plan. However, a beneficiary who is already enrolled in a FIDA plan may access hospice services. A FIDA beneficiary who elects hospice would obtain the hospice services and the Medicare Part A and B services through the Medicare fee-for-service (FFS) program. The FIDA plan would no longer receive the Medicare Parts A and B premium, but would continue to cover the Medicaid services and coordinate all services delivered to the beneficiary. The FIDA Plan would also continue to receive the Medicare Part D Component for all non-hospice covered drugs.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124.