New York Codes, Rules and Regulations
Title 14 - DEPARTMENT OF MENTAL HYGIENE
Chapter XIV - Office for People With Developmental Disabilities
Part 635 - General Quality Control and Administrative Requirements Applicable to Programs, services or Facilities Funded or Certified by the Office for People With Developmental Disabilities
Subpart 635-11 - Enrollment in Medicare Prescription Drug Plans and Fully Integrated Duals Advantage Plans for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD)
Section 635-11.5 - FIDA-IDD plan enrollment and reviews for persons not residing in a residential facility or a family care home

Universal Citation: 14 NY Comp Codes Rules and Regs § 635-11.5

Current through Register Vol. 47, No. 12, March 26, 2025

(a) If a person has the ability to choose a FIDA-IDD plan, the person may enroll himself or herself in a FIDA-IDD plan or appoint another party to enroll him or her. If a person has the ability to act in the FIDA-IDD review process, the person may act in the FIDA-IDD review process for himself or herself or appoint another party to act in the FIDA-IDD review process for him or her.

(b) If a person lacks the ability to choose a FIDA-IDD plan, but has a guardian lawfully empowered to enroll him or her in a FIDA-IDD plan, the guardian may enroll the person in a FIDA-IDD plan or appoint another party to enroll the person. If a person lacks the ability to act in the FIDA-IDD review process, but has a guardian lawfully empowered to act in the FIDA-IDD review process for the person, the guardian may act in the FIDA-IDD review process or appoint another party to act in the FIDA-IDD review process for the person.

(c) In all other situations, or if any party specified in subdivisions (a)-(c) of this section who would otherwise enroll the person or act in the FIDA-IDD review process is unwilling or unavailable, any of the following parties, in the order stated, may enroll the person, act in the FIDA-IDD review process or appoint another party to act in the FIDA-IDD review process:

(1) an actively involved spouse;

(2) an actively involved parent;

(3) an actively involved adult child;

(4) an actively involved adult sibling;

(5) an actively involved adult family member;

(6) the Consumer Advisory Board for the Willowbrook Class (only for class members it fully represents).

(d) In all other situations, the person may be enrolled by the CEO (or designee) of the agency providing service coordination for the person. The CEO or designee may also enroll the person or act in the FIDA-IDD review process when any party specified in subdivisions (a)-(c) of this section who would otherwise enroll or act in the FIDA-IDD review process is unwilling or unavailable. If that CEO enrolls the person in the FIDA-IDD plan or acts in the FIDA-IDD review process, he or she shall give written notice of such enrollment and/or action to:

(1) the person's correspondent or advocate, if one is available; and

(2) the DDRO director for the region encompassing the person's residence.

(e) If a party specified in subdivisions (a) through (d) of this section, in the order so specified, makes a decision to enroll in a FIDA-IDD plan; not to enroll in a FIDA-IDD plan; or to disenroll from a FIDA-IDD plan; that decision shall be considered the final decision of the affected individual and any party in a subordinate position, as specified in subdivisions (a) through (d) of this section, may not change that enrollment decision. The party that enrolls the individual shall also be the party authorized to act in the FIDA-IDD review process.

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