Family and Children's Medicaid MA-3430 NOTICE AND HEARINGS PROCESS
III. Authorized Representatives Entitled to notice.
A. Hierarchy of Representatives
Authorized Representative, power of attorney and guardian information must be keyed on the DSS-8125 so that this individual receives Medicaid and Special Assistance notices. Separate fields have been created on the DSS-8125 to allow for entry of PACE Agency or CAP case manager data in addition to Authorized Representative information. Key PACE Agency or CAP Manager information in the designated fields.
The following list of representatives is ordered by the highest priority representative first and the lowest last. When there is more than one type of representative, always choose the one with the higher priority.
1. Legal Guardian (includes DSS with custody or guardianship; if individual has a Guardian of the Person and a Guardian of the Estate, choose the Guardian of the Person).
2. Power of Attorney.
3. Health Care Power of Attorney.
4. Department of Social Services (placement responsibility only).
5. Spouse (Not separated).
6. Parent (for children under 21, a parent who is not the casehead but who lives in the home).
7. Authorized Representative (An individual designated in writing by the applicant/recipient to assist with eligibility issues and who can have access to the information in the case file).
8. Authorized Representative as designated by SSA on SDX.
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B. Representative Information for Applications
1. Contact the applicant and ask if he has any of the representatives listed in the hierarchy of representatives by reviewing the list with them. For LIS and mail-in applications, obtain the representative information during the phone interview. The individual may have more than one representative, therefore do not stop the inquiry when the individual provides one name. An individual can also have more than one power of attorney; if he has more than one ask him to choose one to receive notices. Document the applicant’s response. If the individual is incapable of choosing, use the name of the Power of Attorney who has been helping with the case.
2. Ask the language preference for each representative named. Document the applicant’s response.
3. Guardianship and/or power of attorney papers
a. Request a copy of the guardianship and/or power of attorney document using the DMA-5097/5097S.
b. If the individual does not respond to the initial request, send a second request.
c. If the individual does not respond to the second request and all other necessary information has been received, process the application within the normal time frame.
d. If the individual has more than one representative and has supplied documentation for only one, enter the information for the one that has been verified, even if the unverified representative has a higher priority.
C. Hospital as Authorized Representative
A hospital may be an Authorized Representative for an applicant, but the authorization may be limited to the application process, the application process and any hearing and appeal following a denial, or for another specified time (See VII.B.7. below for limited circumstances under which information can be released to a hospital which is not an authorized representative).
1. The hospital must identify an individual to serve as the Authorized Representative. If an individual’s name and contact number are not on the Authorized Representative form, contact the hospital and obtain this information.
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2. If the individual has a representative of a higher priority than the hospital, enter the higher priority representative in the representative field. Enter the hospital Authorized Representative information in the PACE Agency/CAP Manager field on the DSS-8124, provided there is no PACE Agency or CAP Manager. If the individual has a representative of a higher priority and there is a PACE Agency or CAP Manager, the hospital Authorized Representative information cannot be entered. If there is a higher priority representative and a PACE Agency or CAP Manager, send copies of all notices to the hospital.
3. If the application is approved and the hospital is listed as Authorized Representative for the application process only, remove the hospital from the Representative Field or PACE Agency/CAP Manager field the day after approval (See III.D).
4. If the application is denied, maintain the hospital Authorized Representative information on the DSS-8124.
D. Representative Information for Redeterminations
1. No representative information in file
a. Ask the individual if he has a representative by reviewing the hierarchy of representatives list with him.
b. If the individual now has a legal guardian and/or power of attorney, request a copy of the guardianship and/or power of attorney document.
2. Representative information in file
a. Verify that the individual listed is still the current representative.
b. Ask the individual whether he has any new representatives. Review the hierarchy of representatives list with the recipient in making the inquiry.
c. If the individual has one or more new representatives, find out the language preference of each representative.
3. Guardianship and/or power of attorney documents
a. If there is a guardian or power of attorney document in the file, determine if it is still valid. If the document has expired or will expire during the redetermination process, request new document.
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b. If the individual has a new legal guardian and/or power of attorney, request a copy of the guardianship and/or power of attorney document using the DMA-5097/DMA-5097s.
c. If the individual does not respond to the request for information, complete the redetermination within the normal time frame. If the individual provides the information after the redetermination is completed, key the information when received.
E. SSI Cases
1 If there is no Authorized Representative information in EIS, Authorized Representative information from the SDX will automatically populate to the DSS-8125.
2. If there is Authorized Representative information in EIS, Authorized Representative information from SDX will not overlay the existing information. The Authorized Representative information from SSA is written to a report on NCXPTR (See V.A).
a. If the Authorized Representative information in XPTR is the same as that contained in EIS, no change is needed.
b. If the Authorized Representative information in XPTR conflicts with that in EIS, contact the recipient and ask which Authorized Representative is current. If the Authorized Representative has changed, request a copy of the new Authorized Representative document from the recipient. Key the new information into the DSS-8125 when the documentation is received.
F. Keying Authorized Representative, PACE Agency and CAP Manager Information
1. AUTHREP Field on the DSS-8124
If the a/b has an Authorized Representative, PACE Agency or CAP Manager, enter a “Y” indicator in the “AUTHREP” field on the DSS-8124. If not, enter an “N”. Note that in AAF, RRF and SCD cases the system defaults to “N”. If a “Y” is entered, the system requires the entry of Authorized Representative/PACE/CAP data prior to the disposition of the application (See EIS2240, Authorized Representative).
2. The PF12 key on the DSS-8124 takes you to the “AUTH REP – PACE/CAP AGENCY DATA” screen where this data is entered.
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3. For the Authorized Representative, required fields are the name, address, relationship code of the representative to the applicant, and the language preference of the representative. Use the existing language preference codes found in EIS 4000.