Mississippi Administrative Code
Title 23 - Division of Medicaid
Part 101 - Coverage Groups and Processing Applications and Reviews Redetermination Processes
Chapter 3 - How to Apply
Rule 23-101-3.3 - Representatives Authorized to Act for an Applicant
Universal Citation: MS Code of Rules 23-101-3.3
Current through September 24, 2024
A. An authorized representative is defined as a person or employee of an organization who is acting responsibly for the applicant with his knowledge and written consent.
1. The MAGI-related application form
allows the head of household to designate an authorized representative with no
separate written authorization required except in cases where the head of
household has a legal representative who is required to act on his/her behalf.
2. ABD applications require the
use of a separate authorization form in order for an applicant or recipient to
appoint an authorized representative.
3. The authorized representative:
a) Has knowledge of the applicant's
circumstances and is usually a relative or close friend, but may be a designee
of an organization if the applicant or recipient permits.
b) Must be authorized in writing by the
applicant to act on his/her behalf and files the application in the name of the
applicant.
c) Can provide
eligibility information and sign the application form and receive all
eligibility notices; however, the applicant or recipient has the right to limit
the authority of their authorized representative.
4. The appointment of an authorized
representative does not prevent the Division of Medicaid from communicating
directly with the applicant or beneficiary as deemed appropriate.
5. When an organization or other individual
assisted with the completion of an application and their primary need is access
to case record information rather than function as an authorized
representative, the "Authorization for the Use and Disclosure of Protected
Health Information" form must be completed.
B. A self-designated representative is defined as a person acting responsibly for an applicant or beneficiary because the physical or mental condition of the applicant/ beneficiary is such that he/she cannot authorize anyone to act for him/her nor can he/she act for himself/herself.
1. Family members or
non-relatives with knowledge of the applicant's or beneficiary's circumstances
are allowed to self-designate in writing with the use of the form designed for
this purpose.
2. A representative
of an organization or a provider cannot self-designate to represent an
applicant or beneficiary, except in cases where the self-designating individual
is an owner, operator or employee of a state-owned long-term care facility.
3. All other individuals
representing an organization or provider must be legally appointed to represent
an individual for health care decisions, in which case the individual becomes
the legal representative of the applicant or beneficiary.
4. A self-designated representative must file
an application or review form in the name of the applicant/beneficiary with the
self-designated representative providing required information to determine or
re-determine eligibility and sign all eligibility-related forms that are
required. The self-designated representative will receive all eligibility
notices and letters.
C. A legal representative is defined as someone legally appointed to act on behalf of an applicant or beneficiary.
1. The legal
representative must complete the Legal Representative Form and provide
documentation of their legal authorization to act for the applicant or
beneficiary, including, but not limited to, one (1) of the following:
a) Power of Attorney document,
b) Legal guardianship decree,
c) Conservatorship decree,
d) Custody decree, or
e) Other type of court order.
2. All such documents must specify
that the legally appointed individual has the right to make health care
decisions for the applicant or beneficiary.
3. If an applicant or beneficiary is
deceased, proof that the individual is the executor or administrator of the
applicant's or beneficiary's estate is required if eligibility is needed in the
month of death and/or retroactive period.
4. The legally appointed representative must
act on behalf of the applicant or beneficiary in all matters with the Division
of Medicaid without limitation.
42 C.F.R. § 435.4; Miss. Code. Ann. § 43-13-121.
Disclaimer: These regulations may not be the most recent version. Mississippi may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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