What is a FIDE SNP?
However, the current definition of FIDE SNP allows certain forms of unaligned enrollment in Medicare and Medicaid coverage, with a member being in one parent’s FIDE SNP for Medicare coverage but a separate company’s (or State FFS) for Medicaid services.
What does Fida stand for in insurance?
Fully Integrated Duals Advantage (FIDA) FIDA: Medicaid and Medicare together – for better health, and a better life! FIDA is a personal health care plan that´s centered on you. One plan that brings together the resources of Medicare and Medicaid.
What is the FIDE and hide SNP for dual eligible plans?
For plan year 2025 and subsequent years, the FIDE and HIDE SNP must cover the entire service area for the dual eligible special needs plan. 4. New Integration Opportunities through Medicaid Contracts
Should the FIDE-SNP definition be changed?
The FIDE-SNP model is a strong catalyst for reaching this goal, but changes to the FIDE-SNP definition are necessary to make it both more meaningful and clearer than it is today. The FIDE-SNP definition is in statute.
What does fide mean in Medicare?
Fully integrated dual eligible special needs plan (FIDE SNP). FIDE SNPs fully integrate care for dually eligible beneficiaries under a single managed care organization. FIDE SNPs were enacted by the Patient Protection and Affordable Care Act (P.L.
What is the difference between hide and FIDE?
However, one key difference between FIDE SNPs and HIDE SNPs beyond their level of integration is that FIDE SNPs may qualify for a frailty adjustment to their Medicare payment from CMS if specific criteria are met, whereas HIDE SNPs are not eligible for that payment adjustment.
What is the purpose of the chronic condition verification form quizlet?
What is the purpose of the Chronic Condition Verification form? It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the CSNP.
What is the difference between D SNP and MMP?
An MMP is an alignment initiative in which Medicare and Medicaid benefits are offered as a single plan in a three-way contract between CMS, the state Medicaid agency (SMA), and the health plan; a D-SNP model is when a health plan holds a contract with Medicare and then a separate contract with the SMA to provide ...
What is a D SNP Medicare plan?
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and Medicaid).
What is Medicare C SNP?
Chronic Condition Special Needs (C-SNP) plans are a type of Medicare Advantage (MA) plan designed to meet the unique needs of people with one or more chronic conditions, including diabetes, end-stage renal disease (ESRD), lung conditions or heart disease.
What is the purpose of chronic condition verification form?
What is the purpose of the Chronic Condition Verification form? It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the CSNP.
How long do plans using the C snip pre enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request?
How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer).
Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage plan?
Which of the individuals below would not likely have the authority to enroll a consumer in a Medicare Advantage Plan? The consumer's spouse, who is neither a Power of Attorney or legal guardian.
What are the three types of Medicare special needs plans?
There are three different types of SNPs:Chronic Condition SNP (C-SNP)Dual Eligible SNP (D-SNP)Institutional SNP (I-SNP)
Is MMP a Medicare Advantage plan?
A Medicare Advantage Medicare-Medicaid plan (MMP) is a private health plan designed to provide integrated and coordinated Medicare and Medicaid benefits for dual eligible Medicare beneficiaries.
What does FBDE mean?
Full Benefit Dual EligiblesMedicare & Medicaid Full Benefit Dual Eligibles (FBDE)
What is FIDA in medical terms?
FIDA: Medicaid and Medicare together – for better health, and a better life! FIDA is a personal health care plan that´s centered on you. One plan that brings together the resources of Medicare and Medicaid. A plan that gives you all the care you need in one place.
Can you add medicaid to your care team?
Have the option to add your Medicare and Medicaid doctors and specialists to your care team. All of whom will be able to share with each other their professional opinions about your health condition. That way, they can provide the most complete care for you and connect you to a wide variety of options for health care and supportive services.
Does FIDA cover Medicare?
In other words, FIDA covers all the benefits that you may receive through your managed long term care (MLTC) plan, Original Medicare or your Medicare Advantage plan, and your Part D plan. Pay no new or additional deductibles, premiums, or copayments/coinsurance to the plan.
Improving and Clarifying the FIDE-SNP Definition
The FIDE-SNP definition is in statute. However, the statutory definition is broad, leaving considerable leeway for CMS to define the model. Overtime, CMS has refined the definition through regulation, rulemaking comments, and guidance (Figure 2).
Leveraging State Medicaid Agency Contracts (SMACs) to Improve FIDE-SNP Integration Now
In upcoming rulemaking cycles, CMS has the opportunity to make changes to the FIDE-SNP definitions to improve beneficiary experience, as suggested above. However, to the extent that CMS does not adopt these recommendations, states can pursue many attributes of a fully integrated model themselves.
Moving Forward
We do a disservice to dual eligible individuals enrolled in FIDE-SNPs when we assume their experience is fully integrated, simply because of the name of the plan. FIDE-SNPs are intended to represent the North Star of current D-SNP integration models.
