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Effective: October 1, 2008 |
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07.15.10ar2 - Authorized Representatives (Archive) |
Archived: April 1, 2009 |
Applicants and enrollees may designate an authorized representative. This section provides information on who can be an authorized representative, what their role is and other requirements.
What Is an Authorized Representative?
What Does an Authorized Representative Do?
Who Can Be an Authorized Representative?
Who Cannot Be an Authorized Representative?
Designating an Authorized Representative.
How Long Does the Designation Last?
Disqualification of an Authorized Representative.
Authorized Representative Receipt of Forms and Notices.
Authorization to Release Information.
What Is an Authorized Representative?
An authorized representative is a person or organization authorized by an applicant or enrollee to apply for any of the health care programs and to perform the duties required to establish and maintain eligibility.
Example:
ABC Assistors, an organization that assists people with applications for MA, files an application on behalf of Clara Jones. The application is signed by Ms. Jones and specifies that MedEligibles is her authorized representative.
Action:
Accept MedEligibles as Ms. Jones authorized representative until either Ms. Jones or MedEligibles revoke the designation.
What Does an Authorized Representative Do?
In most cases, authorized representatives have the same responsibilities and rights as applicants or enrollees.
Authorized representatives may have the responsibility and right to:
l Contact the agency, including talking with the worker without additional consent.
l Have access to all information in the applicant's or enrollee's case file.
l Attend interviews.
l Complete forms.
l Sign forms, such as renewals, for the applicant or enrollee.
l Provide documentation.
l Appeal agency decisions.
l Receive forms and notices.
l Pay premiums if the client wishes them to do so.
Who Can Be an Authorized Representative?
Authorized representatives must:
l Be at least 18 years old.
l Have access to required information and ability to verify eligibility factors.
Who Cannot Be an Authorized Representative?
The following people cannot be an authorized representative:
l County and MCRE employees who determine eligibility.
l Regional Treatment Center (RTC) reimbursement officers for MA/GAMC clients.
Designating an Authorized Representative
In most cases, the applicant or enrollee must designate the authorized representative.
If the client is unable to designate an authorized representative, the agency may allow a person who can act responsibly for the client to act as an authorized representative.
This applies to applicants and enrollees who are incapacitated or incompetent, including children who are unable to act on their own behalf.
The agency must appoint a social service professional as the applicant’s or enrollee’s authorized representative if no qualified individual is available to act as an authorized representative.
Potential authorized representatives for children in foster care or pre-adoptive placements include, but are not limited to, social workers or other representatives of the agency that has legal custody and control of the child.
Applicants and enrollees may designate an authorized representative by:
l Filling in the authorized representative’s name, address, and phone number in the appropriate place on the application.
n The authorized representative and the applicant must both sign the application unless the applicant is unable to sign. In that case an explanation of why the client is unable to sign should be included.
n The designation on the application authorizes the exchange of information. An additional consent is not required.
l Providing a written request to designate an authorized representative:
n The written request may be signed by the authorized representative only if it contains a statement that the applicant or enrollee is incapable of signing the request.
The written request may include but is not limited to:
n Providing the form Giving Permission for Someone to Act on My Behalf (DHS-3437).
n Signing the pages of the application at a time other than application.
n Signing externally created statements that designate an authorized representative.
Externally created statements must clearly indicate the client is giving permission for someone to act on the clients behalf and include the name, address and phone number of the authorized representative.
How Long Does the Designation Last?
The authorized representative designation remains in place until revoked by the applicant or enrollee or the authorized representative.
Disqualification of an Authorized Representative
County agencies or MCRE Operations may disqualify authorized representatives who do any of the following:
l Knowingly provide false information.
l Are unable to provide required information.
l Refuse to provide required information.
If you disqualify an authorized representative:
l Allow the applicant or enrollee to designate a new one.
l Determine whether or not a vulnerable adult referral to social services is needed.
Authorized Representative Receipt of Forms and Notices
If the MCRE applicant wants the authorized representative to receive forms, notices, and premium notices, enter a ”r;Y” indicator on the RREP screen in MMIS, along with the authorized representative’s name and address.
MAXIS automatically sends all notices of action to the authorized representative. If clients indicate that they want the authorized representative to receive other forms such as report forms and explanations of medical benefits, enter a "Y" on STAT/AREP in the "Forms to AREP?" field.
A Power of Attorney is a legally binding document that authorizes a person or corporation to act on another person’s behalf in financial matters. The person or corporation acting on another’s behalf is called an Attorney-in-Fact. The powers granted to the person or corporation can be limited to certain activities and to a specific time frame or they can be general and wide in scope.
The person who executes a Power of Attorney must usually indicate if the Power is to continue if he or she becomes incapacitated. Check to see if the Power of Attorney continues to be in effect if the person signing the Power becomes incapacitated.
Accept a designation of Power of Attorney in place of an authorized representative designation if the Power of Attorney does not contain language that would restrict the Attorney-in-Fact from representing the applicant or enrollee in the health care application or eligibility process. The Power of Attorney must be dated, signed by the applicant or enrollee and include the name of the person or corporation who is being appointed to act on the applicant’s or enrollee’s behalf.
Authorization to Release Information
The Permission to Share Information (DHS-5337) and General Consent/Authorization for Release of Information (DHS-3549) allow the agency to share information about the applicant or enrollee with the person or organization specified on the form. These forms do not appoint the person to be an authorized representative.