5101:1-37-55.1 Medicaid: authorized representative responsibilities.

(A) This rule describes the responsibilities of an authorized representative who is appointed in writing by the individual to stand in the place of the individual and act with authority on behalf of the individual. These responsibilities do not apply to people or organizations who merely help or assist an individual with portions of the application, verification, or redetermination process, unless the individual or organization is granted authority to act on behalf of the individual.

(B) Assistance from individuals who are not authorized representatives. A person may accompany and assist an individual without being an individual's authorized representative.

(1) The administrative agency must not reveal safeguarded information, as described in rule 5101:1-37-51.1 of the Administrative Code, or send notices or correspondence to a person who is assisting an individual, unless the person is designated in writing as an authorized representative.

(2) A person who is assisting an individual must provide accurate information, to the best of his or her knowledge, regardless of whether the person is an authorized representative.

(C) Appointment of an authorized representative.

(1) Any person at least eighteen years old, or a business or other legal entity, may be appointed an authorized representative by an individual.

(2) An authorized representative must be appointed by an individual in order to act on the individual's behalf or have access to the individual's medicaid information. The document appointing an authorized representative must identify what duties the individual is authorizing the representative to perform.

(3) If the appointed authorized representative is unwilling or unable to accept the responsibility of being an authorized representative, the authorized representative must inform the administrative agency and the individual of the refusal or withdrawal.

(D) Responsibilities of an authorized representative. If a person or organization is designated as an individual's authorized representative, the authorized representative:

(1) Must present proper identification, if requested by the administrative agency, prior to representation of the individual by or disclosure of medicaid information to the authorized representative.

(2) Will receive copies of notices and correspondence sent to the individual by the administrative agency.

(3) Stands in the place of the individual. Any responsibility of the individual is a responsibility of the authorized representative. Any action taken by the authorized representative or failure to act will be accepted as the action or lack of action of the individual.

(4) Shares all responsibilities set out in rule 5101:1-37-55 of the Administrative Code.

(E) The administrative agency may contact the individual to clarify or verify information provided by an authorized representative if the authorized representative provides information that seems contradictory, unclear, or unrealistic.

Effective: 10/01/2013
R.C. 119.032 review dates: 10/01/2018
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011 , 5111.012
Rule Amplifies: 5111.01 , 5111.011 , 5111.012 , 2913.401 , 3501.01 , 3503.10 , 5101.58 , 329.051