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    v1.0.28
    OpenPayerPolicy UpdatesAlabama MedicaidAlabama Medicaid representative authorization Poli…
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    CurrentAlabama MedicaidPolicy N/A

    Rules of Practice and Authority of Representatives before the Alabama Medicaid Agency

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    Sets rules for who may represent Medicaid applicants/recipients before the Agency, required authorization forms and content, representative responsibilities, and restrictions on suspended representatives.

    Policy Summary
    PayerAlabama Medicaid
    PolicyRules of Practice and Authority of Representatives before the Alabama Medicaid Agency
    Policy CodePolicy N/A
    Change TypeInformational / no material coverage changes
    Effective DateApr 20, 2015
    Last ReviewApr 20, 2015
    Next Review DateN/A
    Key ActionEnsure any person appearing on behalf of an applicant/recipient has written authority and, when possible, use the Agency's Appointment of Representative form.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    3named rules in Chapter 26 (sections)
    ≥5types of eligible representatives
    written requiredauthorization form requirement
    confidentiality & federal regsconfidentiality & regs
    Policy Summary
    PayerAlabama Medicaid
    PolicyRules of Practice and Authority of Representatives before the Alabama Medicaid Agency
    Policy CodePolicy N/A
    Change TypeInformational / no material coverage changes
    Effective DateApr 20, 2015
    Last ReviewApr 20, 2015
    Next Review DateN/A
    Key ActionEnsure any person appearing on behalf of an applicant/recipient has written authority and, when possible, use the Agency's Appointment of Representative form.
    SourceLink
    On This Page
    Representative Authorization CriteriaAuthorization Form Content (Form Elements)Actions and Restrictions for RepresentativesKey Definitions: Authorized Individual / Organization / Form

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    suspension prohibits representation
    suspension prohibits representation

    Representative Authorization Criteria

    Representative authorization criteria

    Authorization form must meet the following content criteria when not using the Agency form:

    Organization appointments: When the appointment is made by an organization, the appointment must name specific individual(s) who will represent the organization or otherwise narrowly define the class of persons authorized; broadly stated classes are not acceptable, and named individuals must complete the appointment form or acceptable alternative and will receive notices and may act on behalf of the applicant/recipient until authorization is revoked or changed.

    Authorization Form Content (Form Elements)

    Authorization form contentmixed
    (a)expressly authorizes the representative to receive notices in the person's stead
    (b)expressly authorizes the receipt of confidential Medicaid information
    (c)contains the person's typed or printed name and Medicaid number (or Social Security number, if there is no Medicaid number)
    (d)the representative expressly agrees to maintain the confidentiality of any information regarding the applicant or beneficiary provided by the Agency
    (e)if the representative is a provider or staff member or volunteer of an organization, or any agent thereof, the representative affirms that he or she will adhere to federal regulations regarding confidentiality of information (45 C.F.R. 155.260(f), 42 C.F.R. part 431, Subpart F), prohibitions against reassignment of provider claims (42 C.F.R. § 447.10), as well as other relevant State and Federal laws concerning conflicts of interest and confidentiality of information

    Actions and Restrictions for Representatives

    Prior Authorization

    Require written appointment of representative (use Agency form preferred)

    Any person appearing on behalf of a Medicaid applicant or recipient must have written authority to do so. The Agency's 'Appointment of Representative' form is available and preferred; however, the Agency will accept other typed or written authorizations that meet the specified content requirements (e.g., expressly authorize receipt of notices and confidential Medicaid information, include the person's printed name and Medicaid or SSN, and include the representative's confidentiality agreement). If the person represented cannot sign, the authorization must be signed by their legal guardian, agent under Power of Attorney, a member of immediate family (preferably sponsor), or, if deceased, the Executor/Administrator of the estate.

    • Use Agency 'Appointment of Representative' form when possible.
    • Alternative written or typed authorization must: expressly authorize receipt of notices; expressly authorize receipt of confidential Medicaid information; contain the person's printed name and Medicaid number or SSN; include the representative's agreement to maintain confidentiality; and, if applicable, affirm adherence to federal confidentiality and conflict rules.
    Documentation Required

    Organizations must name specific representatives and complete appointment forms

    Organizations must identify at least one specific individual or a narrowly defined class who will act as the organization's authorized representative; broadly stated classes (e.g., all employees) are not accepted. The named individual(s) must be listed on the organization's appointment form or on a signed attachment and must complete an appointment of representative form or submit a signed statement meeting the Agency's alternative authorization requirements. The authorization remains valid until revoked by the applicant/recipient, the representative resigns, or legal authority changes.

    • Organization must name specific individual(s) or narrowly defined class (e.g., Business Office Manager, attorneys with Specific Law Firm).
    • Named individual(s) must be identified on the organization's appointment form or a separate signed statement and must complete their own appointment form or acceptable alternative.
    • Authorization continues until revoked by the applicant/recipient, the representative resigns, or legal authority changes; revocation should include a signature.
    Denial Risk

    Suspended or revoked attorneys/accountants prohibited from representing

    Any attorney or public accountant whose license is suspended or revoked may not represent any person before the Agency until the license is restored; the sole exception is representation of members of the suspended individual's immediate family.

    • Representation is prohibited during suspension or revocation of the license.
    • Exception: may represent immediate family members only, until license is restored.

    Key Definitions: Authorized Individual / Organization / Form

    Properly authorized individual — definition entry
    DefinitionA person over 18 years of age who has completed an Appointment of Representative form as described in Rule 560-X-26-.02(1).
    Examples includedAttorneys; Accountants; Officers or employees of a provider; An adult friend or relative of a recipient or applicant; The Legal Guardian of a recipient or applicant.
    Authority requirementMust have completed the Appointment of Representative form (Agency form preferred) or an acceptable alternative authorization that meets the content criteria in Rule 560-X-26-.02(2).
    Properly authorized organization — definition entry
    DefinitionAn organization where the Medicaid recipient/applicant is residing or applying for admission, or an independent organization assisting with application or eligibility, that has completed an Appointment of Representative form as described in Rule 560-X-26-.02(1).
    Naming requirementThe organization must name at least one specific individual or a narrowly defined class (e.g., Business Office Manager, attorneys with a specific law firm) who will represent the organization; broadly stated classes (e.g., all employees) are not accepted.
    Individual identification and form linkageNamed individual(s) must be identified on the organization's appointment form or on a separate signed statement, and each named individual must complete an Appointment of Representative form or submit a signed statement that fulfills the alternative form requirements; the organization's appointment form and supporting statements must be attached to the named individual's form to be valid.
    Appointment of Representative — form definition / reference
    Form name and availabilityThe Agency's form is entitled 'Appointment of Representative' and is available from the Medicaid Agency, contained in Chapter 28 of the code and on the Agency's website.
    Who may sign if applicant cannotIf the person being represented cannot sign, the authorization must be signed by the Legal Guardian, the agent through Power of Attorney, or if none, by a member of the immediate family (preferably the sponsor); if the applicant/recipient is deceased, only the Executor/Administrator of the decedent's estate may sign.
    Acceptable alternative authorizations — required contentIf not using the Agency form, an authorization must: expressly authorize the representative to receive notices; expressly authorize receipt of confidential Medicaid information; contain the person's typed/printed name and Medicaid number (or SSN if none); include the representative's agreement to maintain confidentiality; and, if the representative is a provider/organization staff/volunteer or agent, affirm adherence to applicable federal confidentiality regulations and prohibitions on reassignment of provider claims.