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Medicare Rights Center

Consumer Advocacy and Financial Alignment Demonstrations Health Action 2014 Krystal Knight New York State Policy Director. Medicare Rights Center.

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Medicare Rights Center

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  1. Consumer Advocacy andFinancial Alignment Demonstrations Health Action 2014Krystal KnightNew York State Policy Director

  2. Medicare Rights Center • The Medicare Rights Center is a national, not-for-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

  3. The Coalition • Coalition to Protect the Rights of New York’s Dually Eligible (CPRNYDE) • 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 State

  4. 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, Westchester • Phased enrollment: Voluntary beginning October 1st 2014, Passive beginning January 1st 2015 • MOU signed August 2014 • Readiness Review began October 2014

  5. 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

  6. Advocacy “WINS” • Integrated Appeals • Aid Continuing / Aid Paid Pending • Readiness Review • Interdisciplinary Team

  7. Krystal Knightkknight@medicarerights.org212-204-6219

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