HAR §17-1711.1-12. Authorized representatives

(a) An individual applying for medical assistance may designate an individual or organization to be an authorized representative to act on their behalf to assist with an application, a redetermination of eligibility, and other on-going communications with the department. UNOFFICIAL 1711.1-7 (b) The designation of an authorized representative must be in writing and signed by the individual. Legal documentation of authority to act on behalf of an individual under State law, to include a court order establishing legal guardianship, or power of attorney, shall serve in the place of a written authorization. (c) The authority of an authorized representative is valid until: (1) The applicant or beneficiary withdraws the authorization by notifying the department that the representative is no longer authorized to act on the applicant’s or beneficiary’s behalf; (2) There is a change in the legal document of authority to act on the applicant’s or beneficiary’s behalf; or (3) The authorized representative informs the department that he is no longer acting as the individual’s authorized representative. (d) An authorized representative may be authorized to: (1) Sign an application on behalf of an applicant; (2) Receive copies of an individual’s notices and other communications from the department; (3) Act on behalf of the individual in all other matters with the department; and (4) Complete and submit redetermination forms. (e) An authorized representative must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or beneficiary provided by the department. (f) An authorized representative who is a provider, staff member or volunteer of an organization must agree to sign an agreement to comply with regulations relating to: (1) Confidentiality of information (42 C.F.R. part 431, subpart F); (2) Prohibition against reassignment of provider claims as appropriate for a health facility UNOFFICIAL 1711.1-8 or an organization acting on the facility’s behalf (42 C.F.R. §447.10); (3) Other relevant State and federal laws concerning conflicts of interest and confidentiality of information; and (4) Must meet the authentication and data security standards required under State and federal law or otherwise specified by the department. (g) The department shall accept electronic signatures, including telephonically recorded signatures and handwritten signatures transmitted by facsimile or other electronic transmission, and must accept such signatures through all of the methods specified in section 17-1711.1-21. [Eff 09/30/13] (Auth: HRS §§346-14, 346-29; 42 C.F.R. §435.923) (Imp: HRS §346-29, 42 C.F.R. §435.923)