Rights and Responsibilities of a Representative

270.1.4 - Rights and Responsibilities of a Representative (Rev. 4278, Issued: 04-12-19, Effective: 06-13-19, Implementation: 06-13-19) In representing an appellant before a MAC, the representative has certain rights and responsibilities. A. Authority of an Appointed Representative A representative may represent a party in an appeal of a claim. An appointed representative may, on behalf of the party; obtain appeal information about the claim to the same extent as the party, submit evidence, make statements about facts and law, and make any request, or give or receive, any notice about the appeal proceedings. When a MAC takes action or issues a redetermination, it shall send notice to only the appointed representative. Notice shall not be sent to the party if there is an appointed representative. The MAC shall send any requests for information or evidence regarding an appeal only to the appointed representative. See also, §270.3 for MSP specific requirements. B. Responsibilities of an Appointed Representative An appointed representative must- • Inform the party of the scope and responsibilities of the representation; • Inform the party of the status of the appeal and the results of actions taken on behalf of the party such as notification of appeal determinations, decisions, and further appeal rights; • Disclose to a beneficiary any financial risk and liability of a non-assigned claim that the beneficiary may have; • Not act contrary to the interest of the party; and • Comply with all laws and CMS regulations, CMS Rulings, and instructions. The appointment of a representative by a party must be made freely and without coercion. The MAC should assume that a representative is not making false or misleading statements, representations, or claims about any material fact affecting any person’s rights. However, if the MAC has reason to believe that the representative is making false or misleading statements, representations or claims about any material fact affecting any person’s rights, it should refer the matter to the Unified Program Integrity Contractor (UPIC), which were formerly known as Zone Program Integrity Contractors. A representative will have access to personal and confidential medical and other information about a beneficiary. The MAC may assume that the representative will not disclose personal or confidential information about a beneficiary except as necessary to pursue an appeal on behalf of the party represented. Further, it may assume that a representative is not disclosing any personal or confidential medical or other information about a beneficiary(ies) outside of the appeals process. Unless otherwise directed by the party making the appointment, the MAC need not keep the represented party informed of the purpose of the appointment, the scope of the appointment, and exactly when/under what circumstances the appointment will be exercised, since it may assume the representative has taken on this responsibility. It is the responsibility of the representative to keep the party informed on the progress of an appeal. C. Delegation of Appointment by Appointed Representative An appointed representative may delegate the appointment if the following conditions are met; • The appointed representative provides written notice to the party of the appointed representative’s intent to delegate to another individual. The notice must include the name of the designee and the designee’s acceptance to be obligated and comply with the requirements or representation under this subpart. • The party accepts the designation by signing a written statement to that effect. This signed statement is not required when the appointed representative and designee are attorneys in the same law firm or organization.