Let`s Learn Medicare!

Consumer Advocacy and
Financial Alignment Demonstrations
Health Action 2014
Krystal Knight
New York State Policy Director
Medicare Rights Center
The Medicare Rights Center is a national, notfor-profit consumer service organization that
works to ensure access to affordable health
care for older adults and people with
disabilities through:
 Counseling and advocacy
 Educational programs
 Public policy initiatives
© 2013 Medicare Rights Center
The Coalition
 Coalition to Protect the Rights of New York’s Dually Eligible
 Made up of over 45 consumer advocacy organizations
 Steering Committee:
Medicare Rights Center
Empire Justice Center
New York Legal Assistance Group
Center for Independence of the Disabled, New York
Legal Aid Society
New York Association of Independent Living
Community Service Society
Consumer Directed Personal Assistance Association of New York
© 2013 Medicare Rights Center
Fully Integrated Dual Advantage (FIDA)
170,000 duals receiving 120 days or more of long
term care in the community or SNF
Capitated model
Geographic area: New York City, Long Island,
 Phased enrollment: Voluntary beginning October 1st
2014, Passive beginning January 1st 2015
MOU signed August 2014
Readiness Review began October 2014
© 2013 Medicare Rights Center
Policy Priorities
Core Areas of Focus
 Enrollment
 Network adequacy
 Plan payment and performance measures
 Stakeholder and beneficiary engagement
 Appeals and grievance procedures
 Monitoring and oversight
 Participant Ombudsman
 ADA compliance
© 2013 Medicare Rights Center
Advocacy “WINS”
Integrated Appeals
Aid Continuing / Aid Paid Pending
Readiness Review
Interdisciplinary Team
© 2013 Medicare Rights Center
Krystal Knight
© 2013 Medicare Rights Center