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14 CRR-NY 635-11.4NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK

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)

14 CRR-NY 635-11.4

635-11.4 FIDA-IDD enrollment and reviews for persons residing in a residential facility operated or certified by OPWDD or a family care home.

(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 that person, the guardian may act in the FIDA-IDD review process or may appoint another party to act in the FIDA-IDD review process for the person.

(c) If a party specified in subdivisions (a) or (b) of this section who would otherwise enroll the person or act in the FIDA-IDD review process is unwilling or unavailable, then 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 chief executive officer (CEO) (see section 635-99.1 of this Part) of the agency operating the person’s residential facility or sponsoring the family care home, or a designee of the CEO, may enroll the person or act in the FIDA-IDD review process. 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. For the purposes of this subsection only, if the person’s residential facility is operated by OPWDD, the CEO of the agency is the director of the DDSOO that operates the residential facility.

(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.

(f) If the 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;

(2) the person’s Medicaid service coordinator, or other person identified as that person’s care coordinator;

(3) the DDRO director for the region encompassing the person’s residence.

14 CRR-NY 635-11.4

Current through June 30, 2021

End of Document

IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.