5.02 Authorized representatives84

In general An individual may designate another person or organization to accompany, assist, and represent or to act responsibly on their behalf in assisting with the individual's application and renewal of eligibility and other ongoing communications with AHS. These include: (i) Guardians and people with powers of attorney (§ 5.02(i)); and (ii) Any other person of the individual’s choice. AHS may permit an applicant or enrollee to authorize a representative to perform fewer than all of the activities described in paragraph (b)(1) of this subsection, provided that AHS tracks the specific permissions for each authorized representative. Except as provided in paragraph (h) of this subsection, and consistent with current state policy and practice, designation of an authorized representative must be in writing, including the individual’s signature, or through another legally binding format subject to applicable authentication and data security standards. Designation will be permitted at the time of application and at other times. Legal documentation of authority to act on behalf of an individual under state law, such as a court order establishing legal guardianship or a power of attorney, shall serve in the place of written authorization by the individual. In such cases AHS may recognize an individual as an authorized representative before the 82 All Programs Rule 2030. 83 42 USC § 18116; 45 CFR §§ 92.2 and 155.120(c)(1); 9 VSA § 4502. 84 42 CFR §§ 435.908(b) and 435.923; 45 CFR § 155.227. General Provisions and Definitions Part 1 – Page 29 (Sec.5.00, Sub.5.02) legal documentation is provided to AHS. When an individual dies before applying for retroactive Medicaid coverage, the administrator or executor of the individual’s estate, a surviving relative or responsible person may act as the individual’s representative. Scope of authority Representatives may be authorized to do any or all of the following: (i) Assist the individual in completing and submitting any health-benefits application, verification, or other documentation with AHS; (ii) Give and receive information regarding the individual’s application or enrollment; (iii) Sign an application on the individual’s behalf; (iv) Receive copies of the individual’s notices and other communications. A person who receives authority to only receive copies of communications is referred to as an “alternate reporter”; (v) Request a fair hearing or file a grievance; and (vi) Act on behalf of the individual in any other matters with AHS. The kinds of information that may be shared may include the following: (i) Information or proofs needed to complete the application or redetermination of eligibility; (ii) The status of the application including the program or programs the household members are enrolled in and the effective dates of enrollment; (iii) The reason the individual or household is not eligible for a benefit, if the application is denied or benefits end; and (iv) The effective date of redetermination and any outstanding information or verifications needed to complete a redetermination. Duration of authorization The power to act as an authorized representative is valid with AHS until: (i) The individual modifies the authorization or notifies AHS, using one of the methods available for the submission of an application, as described in § 52.02(b)(2), that the representative is no longer authorized to act on their behalf; (ii) The authorized representative informs AHS that they no longer are acting in such capacity; or (iii) There is a change in the legal authority upon which the individual or organization's authority was based. General Provisions and Definitions Part 1 – Page 30 (Sec.5.00, Sub.5.02) Any notification described in (c)(1) of this subsection, except as stated in (c)(1)(i), must be in writing and should include the individual’s or authorized representative's signature as appropriate. Duties of the authorized representative. The authorized representative: Is responsible for fulfilling all responsibilities encompassed within the scope of the authorized representation, as described in paragraph (b) of this subsection, to the same extent as the individual they represent; and Must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the individual provided. Condition of representation The authorized representative must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or enrollee provided by AHS. When an organization is designated as an authorized representative, as a condition of serving, staff members or volunteers of that organization must sign an agreement that they will adhere to the regulations in § 4.08 (relating to confidentiality of information), federal regulations relating to the prohibition against reassignment of provider claims as appropriate for a health facility or an organization acting on the facility's behalf, as well as other relevant state and federal laws concerning conflicts of interest and confidentiality of information. Form of authorization. For purposes of this subsection, electronic, including telephonically recorded, signatures and handwritten signatures transmitted by facsimile or other electronic transmission will be accepted. Designations of authorized representatives will be accepted through all of the modalities described in § 52.02(b). Disclosures. The authorization form or the AHS call center representative (if the authorization is made over the telephone) shall advise that: The individual need not give permission to share information. If the individual decides not to give permission, that will not affect eligibility for, or enrollment in, benefits; If the individual does not give permission, the information will not be released unless the law otherwise allows it; AHS is not responsible for what an unrelated authorized representative does with the individual’s information after it is shared pursuant to a valid authorization; The individual may change or stop this authorization at any time by notifying AHS by telephone or in writing. However, doing so will not affect previously shared information; If the individual does not change or stop the authorization, it will remain in effect as long as the individual (or household) continues to receive health-care benefits; and General Provisions and Definitions Part 1 – Page 31 (Sec.5.00, Sub.5.03) The individual will be provided with a copy of the authorization upon request. Minors and incapacitated adults.85 If the individual is a minor or an incapacitated adult, no authorization is required; someone acting responsibly for the individual may assist in the application process or during a redetermination of eligibility. Such person may also sign the initial application on the applicant’s behalf. Judicially-appointed legal guardian or representative.86 Upon presentment of a valid document of appointment, a judicially-appointed legal guardian or representative may act on an individual’s behalf.