Md. Code Regs. 14.35.11.14

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.11.14 - Authorized Representatives

A. Definitions.

(1) "Authorized representative" means an individual or organization acting responsibly on behalf of the applicant in accordance with this regulation, in assisting with an applicant's application, renewal of eligibility, appeals, and other ongoing communications with the Exchange.

(2) "Signature" includes electronic, including telephonically recorded, signatures and handwritten signatures transmitted by facsimile or other electronic transmissions.

B. Designating an Authorized Representative.

(1) An applicant may designate any individual or organization to serve as authorized representative.

(2) An authorized representative may be designated either:

(a) In writing, including the applicant's signature; or

(b) By providing proof of legal authority to act on behalf of an applicant

(3) Legal authority includes, but is not limited to the:

(a) Applicant's parent, if the applicant is a minor;

(b) Applicant's legal guardian, if one has been appointed, or a person who has in good faith filed an application to be appointed the applicant's legal guardian but who has not yet been appointed the applicant's legal guardian;

(c) Applicant's healthcare surrogate as defined in Health-General Article, §5-605, Annotated Code of Maryland;

(d) Personal representative of applicant's estate, or a person who has in good faith filed an application to be appointed the personal representative of the applicant's estate but who has not yet been appointed the personal representative of the applicant's estate;

(e) Individual appointed to make legal or medical decisions on behalf of the applicant pursuant to a validly executed power of attorney; or

(f) Attorney or paralegal retained by the applicant.

(4) For individuals who lack the capacity to designate an authorized representative and for whom no other individual or organization has the legal authority to act under §B(2) of this regulation, an authorized representative can be any individual or organization acting responsibly on behalf of the applicant who:

(a) In good faith, is acting in the best interest of the applicant; and

(b) Declares the applicant lacks legal capacity, and for organizations, declares that its directors, employees, officers or employers, if any, do not have a direct financial interest in the outcome of the fair hearing.

(5) For individuals who lack the capacity to designate an authorized representative, for whom no other individual or organization has the legal authority to act under §B(2) of this regulation, and on behalf of whom no individual or organization covered by §B(4) of this regulation is willing and able to act, an authorized representative can be any individual or organization with a direct financial interest in the outcome of the hearing or whose employer has a direct financial interest in the outcome of the hearing who:

(a) In good faith is acting in the best interest of the applicant;

(b) Declares that the applicant lacks legal capacity; and

(c) Declares that to the best of the authorized representative's belief, no other individual or organization is willing and able to act on the applicant's behalf.

C. Time for Authorization. Designation of an authorized representative, or the declarations by an individual or organization required under §B(4) or (5) of this regulation to become an authorized representative, can take place at any time, including, but not limited to, the time of application, upon redetermination, upon filing an appeal, and at the appeal hearing.

D. Duration of Representation. The power to act as an authorized representative is valid until the applicant modifies the authorization or notifies the Exchange that the representative is no longer authorized to act on his or her behalf, there is a change in the legal authority upon which the individual or organization's authority was based, or the authorized representative informs the Exchange, as required by 45 CFR § 155.227(d)(2), that the representative no longer has legal authority to act on behalf of the applicant. Such notice shall be in writing and shall include the applicant's signature or the authorized representative's signature, as appropriate.

E. Powers of Authorized Representative. Authorized representatives may be authorized to perform all, or fewer than all, of the following:

(1) Sign an application on the applicant's behalf;

(2) Complete and submit an update or a renewal form or respond to a request for redetermination;

(3) Receive copies of the applicant's notice and other communications from the Exchange; and

(4) Act on behalf of the applicant in all matters with the Exchange including appeals.

F. Obligations of Authorized Representative. An authorized representative:

(1) Is responsible for fulfilling all the responsibilities encompassed within the scope of the authorized representation as described in §E of this regulation to the same extent as the individual the representative represents;

(2) Shall agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant provided by the Exchange.

G. Authorized Representatives Through an Organization. A provider, staff member, or volunteer of an organization shall sign an agreement to adhere to the federal regulations governing authorized representatives as laid out in 42 CFR § 435.923 or 45 CFR § 155.227, as applicable, as well as relevant State and federal laws concerning conflicts of interest and confidentiality of information.

Md. Code Regs. 14.35.11.14

Regulation .14 adopted effective 42:11 Md. R. 726, eff.6/8/2015