An FDR is a First Tier, Downstream or Related Entity. An FDR provides administrative or health care services relating to Healthfirst Medicare contracts. Healthfirst’s FDRs include hospitals, providers, ancillaries, and some vendors.
First Tier Entity: any party that enters into a written arrangement, acceptable to CMS, with an MAO or Part D plan sponsor or applicant to provide administrative services or health care services to a Medicare eligible individual under the MA program or Part D program.
Downstream Entity: any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit or Part D benefit, below the level of the arrangement between an MAO or applicant or a Part D plan sponsor or applicant and a first tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services.
Related Entity: any entity that is related to an MAO or Part D sponsor by common ownership or control and
- Performs some of the MAO or Part D plan sponsor’s management functions under contract or delegation;
- Furnishes services to Medicare enrollees under an oral or written agreement; or
- Leases real property or sells materials to the MAO or Part D plan sponsor at a cost of more than $2,500 during a contract period.
An affiliate is a person, provider or entity who provides care, services, or supplies under the Medicaid program, or a
person who submit claims for care, services, or supplies for or on behalf of another person or provider for which the
Medicaid program is or should be reasonably expected by a provider to be a substantial portion of their business