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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL When a public guardian is appointed to manage the affairs of an individual by Court Order, the Order of Guardianship is acceptable as a designation of authorized representation. Any deputy public guardian acting on behalf of the public guardian may contact the Division and request or give information to any DWSS case worker or customer service representative without being required to complete Form 2525 (Designation of Authorized Representative). For Medical Assistance cases, all authorized representatives are considered a primary A/R. They receive all requests for information along with any attachments plus all notices. They hold the same responsibility as the customer in securing information for determining eligibility, reporting responsibilities and they are the only one authorized to sign on behalf of the customer. Primary representatives have the same access to case information as a customer. Legal guardians are always considered primary representatives. There will be only one primary representative. NOTE: If an applicant lists an individual on the application as an A/R, they will automatically be entered as a primary representative. Having more than one authorized representative (A/R) on a Medical Assistance case is allowable under certain circumstances. Customers who have the need for more than one A/R must select a single A/R as the primary A/R. Any additional A/R(s) must be entered as a Non-Primary authorized representative(s). Those who are a Non-Primary A/R’(s) receive the same requests for information and notices as the customer but are not responsible for securing or reporting information; however, if they choose to, they may secure and report the requested information to the Division. A Non-primary A/R has the same access to case information as a customer, but cannot sign on behalf of the customer. NOTE: If an applicant lists an organization or facility as an A/R on the application, they will automatically be entered as the primary representative unless another primary already exists. An individual representative of the organization or facility must be designated on the application. If a designated representative from the organization or facility is not listed on the application then obtain a completed form 2525. Exception: Department of Health and Human Services (DHHS) divisions administering home and community-based waiver programs are automatically entered as secondary authorized representatives to ensure they receive all notifications and are able to assist customers in completing necessary paperwork. Form 2525 is not required for DHHS divisions. This exception includes but not limited to the following DHHS division/departments:  Aging and Disability Services Division (ADSD)  Department of Health Care and Finance Policy (DHCFP)  Department of Public Behavioral Health (DPBH)  Department of Child and Family Services (DCFS) When applicants are unable to designate an A/R AND there are no family members or the existing family members do not wish to assist the applicant, the hospital, nursing home or county agency social service staff may designate themselves as an A/R. The hospital, nursing home or county agency must make good faith efforts to contact family members of the applicant for information to help determine eligibility. The hospital, nursing home or county agency must provide the names and addresses of family members they contacted or tried to contact. A-120 Division of Welfare and Supportive Services MEDICAL ASSISTANCE OVERVIEW Medical Assistance Manual AUTHORIZED REPRESENTATIVE (A/R) 24 Sept MTL 07/24