New York

On November 5, 2015, CMS announced their partnership with the New York State Department of Health (NYSDOH) and the Office for People with Developmental Disabilities (OPWDD) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Approximately 20,000 Medicare-Medicaid IDD enrollees in the New York downstate region (New York City, Long Island, Rockland and Westchester Counties) will have an opportunity to receive more coordinated care as a result of this new program.

More Information from CMS:

• Press Release
• Three-Way Contract (PDF)
  • Three-Way Contract Amendment (08/01/2020) (PDF)
    • Summary of Contract Changes (PDF)
    • Summary of Contract Changes (01012021) (PDF)
    • Summary of Contract Changes (11012023) (PDF)
    • Findings at a Glance
    • Findings at a Glance

    Information for the Plan:

    • All state-specific information and guidance for the plan is available on the Information and Guidance for Plans page.

    Information from the state of New York:

    FIDA (*transitioned 12/31/2019*) and NY Integrated Appeals and Grievances Demonstration

    On January 1, 2020, CMS and NYSDOH transitioned remaining FIDA enrollees to MAP plans and aligned D-SNPs. This transition also included extending the FIDA integrated appeals and grievances process to MAP and aligned D-SNP plans. Under the revamped NY Integrated Appeals and Grievances Demonstration, CMS and NYSDOH are testing the integrated appeals and grievances process begun under FIDA with a larger volume of full benefit dual eligible individuals. As of January 2020, approximately 18,000 individuals are enrolled in a MAP and aligned D-SNP plan.

    More Information from CMS on NY Integrated Appeals and Grievances Demonstration:

    • MOU (PDF)
    • Third Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (12/20/2023)
    • Beneficiary Experience Research Results for the Integrated Appeals and Grievances Demonstration in New York (10/01/2022) (PDF)
    • Second Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (04/12/2023)
    • First Brief Evaluation Report for the New York Integrated Appeals and Grievances Demonstration (03/08/2022)
    • Integrated Beneficiary Notices (ZIP) (including):
      • Integrated Coverage Determination Notice
      • Expedited Appeal Request Denial Notice
      • Appeal Extension Notice
      • Appeal Denial Notice

      More Information from CMS on NY FIDA Demonstration (*transitioned 12/31/2019*):

      • Fact Sheet
      • Three-Way Contract (PDF)
        • Summary of Contract Changes (PDF)

        Information for Plans:

        • All state-specific information and guidance for plans is available on the Information and Guidance for Plans page.

        Information for Beneficiaries and Providers:

        • New York FIDA 30-Day D-SNP Notice (PDF)
        • New York FIDA 60-Day MAP Notice (PDF)
        • New York FIDA Ombudsman Program
        • New York FIDA Home Health Provider Frequently Asked Questions (FAQs) (PDF)
        • New York FIDA Medigap FAQs (PDF)
        • New York FIDA Pharmacist Provider FAQs (PDF)
        • New York FIDA Provider FAQs (PDF)

        Information from the state of New York:

        • Summary of FIDA Reforms (12/09/15)
        • FIDA Capitated Duals Demonstration

        Funding Support: