Fully Integrated Duals Advantage (FIDA)
Medicare Medicaid Plan (MMP)
Learn how you can attend the next FIDA Participant Advisory Committee (PAC) Meeting or Feedback Session 

Learn More About Fully Integrated Duals Advantage (FIDA)

1. The Basics

Fidelis Care FIDA Plan is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA) Demonstration. 

Participants are assigned a designated nurse care manager and receive individual attention and care planning to help them remain in their own home. Covered services include primary care physician office visits, inpatient hospital care, skilled nursing facilities, home health care, and much more.

Special eligibility rules apply. See below.

2. How to Apply

For information on how to enroll in the FIDA Plan, you can call Fidelis Care at 1-800-247-1447 (TTY: 1-800-695-8544). From October 1 to February 14, our office hours are 8:00 a.m. to 8:00 p.m. seven days a week and from February 15 through September 30, our office hours are Monday through Friday, 8:00 a.m. to 8:00 p.m. We can answer any questions that you might have about long term care, as well as about the specific services that are available to FIDA Participants.

To see if you qualify, call the State Enrollment Broker, New York Medicaid Choice, at 1-855-600-FIDA (TTY: 1-888-329-1541) from Monday through Friday, 8:30 AM to 8:00 PM, and Saturday from 10 AM to 6 PM.

You can also enroll online at: www.nymedicaidchoice.com (by clinking on this link, you will leave the Fidelis Care website)

FIDA will be available to individuals who meet all of the following criteria:
  • Age 21 or older at the time of enrollment;
  • Entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits; and
  • Reside in the FIDA coverage area: Bronx, Kings, Nassau, New York, Queens, and Richmond Counties.
Additionally, individuals must meet one of the three following criteria:
  • Are Nursing Facility Clinically Eligible and receiving facility-based long-term services and supports (LTSS);
  • Are eligible for the Nursing Home Transition & Diversion (NHTD); or
  • Require community-based long term care services for more than 120 days. Assessments are required to identify an individual’s need for 120 days or more of community-based long term care services.

Individuals will be excluded from joining a FIDA Plan if they: 

  • Are a resident of a New York State Office of Mental Health (OMH) facility or a psychiatric facility; 
  • Are receiving services from the State Office for People with Developmental Disabilities (OPWDD) system – whether receiving services in an OPWDD facility or treatment center, receiving services through an OPWDD Waiver, whether you could be receiving services in an ICF/IID but you have chosen not to, or otherwise; 
  • Are expected to be Medicaid eligible for less than six months; 
  • Are eligible for Medicaid benefits only for tuberculosis related services, breast cancer services, or cervical cancer services; 
  • Are receiving hospice services (at time of enrollment); 
  • Are eligible for the family planning expansion program; 
  • Are a resident of an alcohol/substance abuse long-term residential treatment program; 
  • Are eligible for Emergency Medicaid; 
  • Are enrolled in the 1915(c) waiver program for Traumatic Brain Injury (TBI); 
  • Participate in and reside in an Assisted Living Program; or 
  • Are in the Foster Family Care Demonstration.

Fidelis Care FIDA Plan is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.

3. Browse Resources

Participant Handbook (Evidence of Coverage)

This booklet gives you the details about your Medicare and Medicaid health care, long-term care, and prescription drug coverage. It explains how to get coverage for the health care services and prescription drugs you need.

2017

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General rules for getting your health care, behavioral health, and long term services and supports covered by Fidelis Care FIDA Plan

Fidelis Care FIDA Plan covers all services and items covered by Medicare and Medicaid plus some additional services and items available through the FIDA Program. These include behavioral health, long term supports and services, and prescription drugs. 

Fidelis Care FIDA Plan will generally pay for the services and items you need if you follow the plan rules for how to get them. To be covered:

  • The care you get must be a service or item covered by the plan. This means that it must be included in the plan’s Covered Items and Services Chart. (The chart is in Chapter 4 of the FIDA member handbook). Other services and items that are not listed in the chart may also be covered if your Interdisciplinary Team (IDT) determines they are necessary for you. 
  • The care must be medically necessary. Medically necessary means those services and items necessary to prevent, diagnose, correct, or cure conditions you have that cause acute suffering, endanger life, result in illness or infirmity, interfere with your capacity for normal activity, or threaten some significant handicap. This includes care that keeps you from going into a hospital or nursing facility. It also means the services, supplies, or drugs meet accepted standards of medical practice.
  • You will have and are expected to cooperate with an Interdisciplinary Team (IDT). Your IDT will assess your needs, work with you and/or your designee to plan your care and services, and make sure that you receive the necessary care and services. You can find more information about the IDT in the FIDA member handbook. 

·       In most cases, you must get approval from Fidelis Care FIDA Plan, your IDT, or an authorized provider before you can access covered services and items. This is called prior authorization. To learn more about prior authorization, see page 33 of the FIDA member handbook.

·       You do not need prior authorization for emergency care or urgently needed care or to see a woman’s health provider. You can get other kinds of care without having prior authorization.

  • You will have a Care Manager who will serve as your primary point of contact with your IDT. You can find more information about the Care Manager in the FIDA member handbook.
  • You must choose a network provider to serve as your Primary Care Provider (PCP). Your PCP will also be a member of your IDT. To learn more about choosing or changing a PCP, see page 30 of the FIDA member handbook.

Out of Network Coverage

  • You must get your services and items from network providers. Usually, Fidelis Care FIDA Plan will not cover services or items from a provider who has not joined Fidelis Care FIDA Plan’s network. Here are some cases when this rule does not apply. 
  • The plan covers emergency or urgently needed care from an out-of-network provider. To learn more and to see what emergency or urgently needed care means, see page 36 of the FIDA member handbook.
  • If you need care that our plan covers and our network providers cannot give it to you, you can get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you. To learn about getting approval to see an out-of-network provider, see page 32 of the FIDA member handbook.
  • The plan covers services and items from out-of-network providers and pharmacies when a provider or pharmacy is not available within a reasonable distance from your home.
  • The plan covers kidney dialysis services when you are outside the plan’s service area for a short time. You can get these services at a Medicare-certified dialysis facility.
  • When you first join the plan, you can continue seeing the providers you see now during the “transition period.” In most cases, the transition period will last for 90 days or until your Person-Centered Service Plan is finalized and implemented, whichever is later. However, your out-of-network provider must agree to provide ongoing treatment and accept payment at our rates. After the transition period, we will no longer cover your care if you continue to see out-of-network providers.
  • If you are a resident of a nursing facility, you can continue to live in that nursing facility for the duration of the FIDA Program, even if the nursing facility does not participate in Fidelis Care FIDA Plan’s network.
  • If you are receiving services from a behavioral health provider at the time of your enrollment, you may continue to get services from that provider until treatment is complete, but not for more than two years.

How to get care from out-of-network providers
If you need care that our plan covers and our network providers cannot give it to you, you can get permission from Fidelis Care FIDA Plan or your IDT to get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you. We will discuss the reasons why you and/or your doctor think you need to see an out-of-network provider and help to arrange a prior authorization from your IDT if your medical situation justifies the use of an out-of-network provider. Generally, you may only use out-of-network providers for urgent or emergent care, or if the type of care you need cannot be provided by the providers in our network. Remember, when you first join the plan, you can continue seeing the providers you see now during the “transition period.” In most cases, the transition period will last for 90 days or until your Person-Centered Service Plan is finalized and implemented, whichever is later. During the transition period, our Care Manager will contact you to help you find and switch to providers that are in our network. After the transition period, we will no longer pay for your care if you continue to see out-of-network providers, unless Fidelis Care FIDA Plan or your IDT has authorized you to continue to see the out-of-network provider.

Please note: If you need to go to an out-of-network provider, please work with Fidelis Care FIDA Plan or your IDT to get approval to see an out-of-network provider and to find one that meets applicable Medicare or Medicaid requirements. If you go to an out-of-network provider without first getting Plan or IDT approval, you may have to pay the full cost of the services you get.

Summary of Benefits
The charts in this booklet list important health benefits. For each benefit, you can see what our program covers.

2017

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Annual Notice of Changes

2017

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Note: The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Benefits, formulary, pharmacy network, and provider network may change on January 1 of each year. 

Provider and Pharmacy Directory

This Directory lists health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics), and support providers (such as Adult Day Health and Home Health providers) that you may see as a Fidelis Care FIDA Plan Participant. We also list the pharmacies that you may use to get your prescription drugs. 

View Provider and Pharmacy Directories by County

To find a provider or pharmacy near you, click here.

4. FIDA Plan Contact Information

If you are a Fidelis Care FIDA Plan participant and would like to reach Participant Services call 1-800-247-1447 (TTY: 1-800-695-8544) Monday through Friday, 8 AM to 8 PM. This call is free.

If you would like to reach your Care Manager or the 24-Hour Nurse Advice Line, call 1-800-247-1447 (TTY: 1-800-695-8544). This call is free.

For questions about the FIDA program you can contact New York Medicaid Choice at 1-855-600-3432 (TTY: 1-888-329-1541). Hours are Monday through Friday 8:30 AM to 8 PM and Saturday from 10 AM to 6 PM. This call is free.

Mailing Address:

Fidelis Care FIDA Plan
95-25 Queens Boulevard
Rego Park, NY 11374

Fidelis Care FIDA Plan is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.

Limitations and restrictions may apply. For more information, call Fidelis Care FIDA Plan Participant Services or read the Fidelis Care FIDA Plan Participant Handbook. This means that you need to follow certain rules to have Fidelis Care FIDA Plan pay for your services. Benefits, List of Covered Drugs, and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year.

You can get this information for free in other languages. Call 1-800-247-1447 or TTY/TDD 1-800-695-8544 between 8 AM and 8 PM Monday through Friday. The call is free.

Usted puede obtener esta información de forma gratuita en otros idiomas. Llame al 1-800-247-1447 o al 1-800-695-8544 (TTY) entre las 8 a.m. y las 8 p.m., de lunes a viernes. La llamada es gratuita.

È possibile ottenere queste informazioni gratuitamente in altre lingue. Telefonare al numero
1-800-247-1447 oppure 1-800-695-8544 (TTY) tra le 8 e le 20 da lunedì a venerdì. La telefonata è gratuita.

Вы можете получить данную информацию бесплатно на других языках. Звоните 1-800-247-1447  или 1-800-695-8544 (Телетайп) с 8:00 до 20:00 с понедельника по пятницу. Звонок бесплатный.

您可以通過其他語言免費獲取該信息。週一至週五上午8點至晚8 撥打1-800-247-1447 1-800-695-8544。該電話免費。

다른 언어로 정보를 무료로 받을 있습니다~금요일 오전 8시에서 오후8시까지1-800-247-1447 또는1-800-695-8544 (TTY) 전화해 주십시오.

 통화는 무료입니다.

Ou kapab jwenn enfòmasyon sa gratis nan lòt lang yo. Rele 1-800-247-1447 oswa 1-800-695-8544 (TTY) ant 8 AM ak 8 PM Lendi jiska Vandredi. Apèl la gratis.

You can ask for this notice in other formats, such as Braille or large print. Call Participant Services at 1-800-247-1447 or TTY/TDD 1-800-695-8544 between 8 AM and 8 PM Monday through Friday.

Free Interpreter Services Are Available
Multi-Language Insert (.pdf)

Click here to read our Non-Discrimination Notice. (.pdf)

The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by Fidelis Care FIDA Plan. ICAN may be reached at 1-844-614-8800 between 8 AM to 8 PM Monday through Friday (TTY users should call 711), or online at www.icannys.org (by clicking this link, you will leave the Fidelis Care website). The call and the help are free. Free interpreter service is also available.

(Updated 9/28/2016) H1916_FC FIDA 16011 Pending