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FIDA and MLTC Rate Updates

At both the Managed Care Policy and Planning meeting and Fully Integrated Duals Advantage (FIDA) Plan call, the Department of Health (DOH) outlined its plan to adjust FIDA rates to reflect parity with Managed Long Term Care (MLTC) rates. Up until this point, the different methodologies resulted in disparity between the two sets of rates. By bringing the FIDA Medicaid rates in line with MLTC, DOH anticipates a 4.5 to 5.6 percent increase in FIDA Medicaid rates before risk adjustments. 

DOH is working with the Centers for Medicare and Medicaid Services (CMS) on this issue. They intend to use April 1, 2015 MLTC rates as the base for setting FIDA rates. Rate increases will be effective for the 2015-16 fiscal year retroactive to April 1. Future adjustments in both sets of rates will be coordinated. There will also need to be adjustments for differences between the two programs, e.g., the acute care, Medicare Part D wrap-around and the mental health FIDA benefits, which do not exist in MLTC. With that in mind, this should result in new dollars for the base long term care spending, including increased dollars for care management and quality.

Over the next couple of months, DOH also intends to process MLTC rate adjustments that should increase cash flow to MLTC plans. Included in this processing will be the quality pool and “high-cost high- needs” funding. This represents a redistribution of previous premium withholds.

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827