Since 1999, ICS has served New York City as a managed long-term care (MLTC) plan designed to enable our high-needs members—people with disabilities and chronic medical conditions—to live in their homes and communities rather than institutions. In addition to medical need, geographic location, and the ability to live at home, prospective members of ICS have also had to be eligible for Medicaid. Now, after more than two years of planning and preparation, ICS has inaugurated a second plan: ICS Community Care Plus FIDA-MMP—a Fully Integrated Duals Advantage Medicare-Medicaid Plan.
While it has many similarities to our long-standing MLTC plan, which we are now calling ICS Community Care MLTC, this demonstration program has some important differences. Most notably, it is specifically designed to meet the needs of people who are covered by both Medicare and Medicaid—“dual eligibles” in the language of health policy. In other words, it is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide the benefits of both programs to participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.
The ICS Community Care Plus FIDA-MMP is part of an ongoing federal and state redesign of Medicare and Medicaid. As part of this redesign, New York State received a federal grant to develop a demonstration program to coordinate care for people who have both Medicare and Medicaid. The goals of the pilot program are:
- Reducing costs by reducing hospital re-admissions;
- Helping members remain in or return to the community; and
- Creating a patient centered, member-led care model.
These goals are well aligned with ICS’s goals, mission and history. In addition, we believe this new type of plan is the future of long-term managed care in New York. For both of these reasons, ICS is participating in the demonstration program, as one of a number of plans across New York City.
An Expanded Network
Members of our MLTC, including those who are dually eligible—about 60% of ICS’s more than 5,000 members—have certain Medicaid-covered services (dentistry, podiatry, optometry, home care, social day care, home-delivered meals, for example) offered through a network of providers contracted by ICS, which also coordinates payment for members’ non-network fee-for-service health care, including most doctors, hospitalizations, and medical tests.
In addition to all of the services currently offered in the MLTC, ICS Community Care Plus FIDA-MMP will cover the full range of health care services needed by our members through a single expanded network. That network includes more than 1,300 primary care doctors, over 4,150 specialists, more than 2,350 pharmacies, 50 hospitals and skilled nursing facilities, and a wide range of other providers and services, including behavioral healthcare providers.
As of December 20, 2014, those who are dually eligible in New York City have been given the option to enroll in ICS Community Care Plus FIDA-MMP or other FIDA plans. Active enrollment in FIDA continues until April 1. A period of “passive enrollment” follows during which anyone who meets the eligibility requirements for FIDA will be automatically enrolled in a FIDA plan. Anyone who wishes to opt out of the plan may do so at any time; enrollment in a FIDA plan is optional and voluntary.
The heart of FIDA is the “participant,” the person enrolled in the plan. The FIDA model of care is based on the person-centered service plan (PCSP), a customized health care plan devised by participants with their interdisciplinary team (IDT), which in addition to a care manager and other professionals at ICS, can include their caregiver and PCP and anyone they want to involve in their health care decisions.
Those of us who have been preparing for the new FIDA plan have looked forward to it with a mixture of excitement and occasional apprehension akin to stage fright. It is exciting to be part of a demonstration project that could become the standard of care for people who are dually eligible all over the U.S. As ICS President Rick Surpin says, “ICS is proud to be among the pioneers in providing person-centered care to enable people with disabilities and chronic conditions to live at home and participate fully in community life.”
For information on ICS Community Care Plus FIDA-MMP, call us toll-free at 1.877.ICS.1212 (TTY: 1.855.ICS.4TTY), Monday-Friday, 8:00 a.m. to 8:00 p.m. or go here. If you or someone you know is interested in enrolling in ICS Community Care Plus FIDA-MMP, contact the New York Enrollment Broker at 1.855.600.FIDA or TTY 1.888.329.1541 from Monday-Friday, 8:30 a.m. to 8:00 p.m., and Saturday, 10:00 a.m. to 6:00 p.m., or visit www.nymedicaidchoice.com.