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.
No material clinical or coverage changes in this revision.
Representative Authorization Criteria
Representative authorization criteria
Authorization form must meet the following content criteria when not using the Agency form:
Authorization Form Content (Form Elements)
| (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
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.
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.
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
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