Md. Code Regs. 10.01.04.12 : MARYLAND DEPARTMENT OF HEALTH —Part 1 — PROCEDURES — Fair Hearing Appeals Under the Maryland State Medical Assistance Program — Authorized Representatives

A. Definitions.
(1) Authorized representative means an individual or organization acting responsibly on behalf of the applicant or recipient in accordance with §§B, C, D, and E of this regulation, in assisting with an applicant or recipient's application, renewal of eligibility, appeals, and other ongoing communications with the agency.
(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 or recipient may designate any individual or organization to serve as an authorized representative.
(2) An authorized representative may be designated either:
(a) In writing, including the applicant or recipient's signature; or
(b) By providing proof of legal authority to act on behalf of an applicant or recipient.
(3) Legal authority includes, but is not limited to those who are the:
(a) Applicant or, if applicant or recipient is a minor, recipient's parent;
(b) Applicant or recipient's legal guardian, if one has been appointed, or a person who has in good faith filed an application to be appointed the applicant or recipient's legal guardian but who has not yet been appointed the applicant or recipient's legal guardian;
(c) Applicant or recipient's healthcare surrogate as defined in Health General Article, § 5-605, Annotated Code of Maryland;
(d) Personal representative of the applicant or recipient's estate, or a person who has in good faith filed an application to be appointed the personal representative of the applicant or recipient's estate but who has not yet been appointed the personal representative of the applicant or recipient's estate;
(e) Individual appointed to make legal or medical decisions on behalf of the applicant or recipient pursuant to a validly executed power of attorney; or
(f) Attorney or paralegal retained by the individual.
(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 or recipient who:
(a) In good faith, is acting in the best interest of the applicant or recipient; and
(b) Declares the applicant or recipient 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 or recipient;
(b) Declares that the applicant or recipient lacks legal capacity; and
(c) Declares that to the best of his or her belief, no other individual or organization is willing and able to act on the applicant or recipient's behalf.
C. Time for Authorization. Designation of an authorized representative or the declarations by an individual or organization required under §B(4) and (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. Validity of Representation. The power to act as an authorized representative is valid until the applicant or recipient modifies the authorization or notifies the agency that the representative is no longer authorized to act on his or her behalf, or the authorized representative informs the agency that the authorized representative is no longer acting in such capacity, or there is a change in the legal authority upon which the individual or organization's authority was based. This notice shall be in writing and shall include the applicant or recipient's signature or the authorized representative's signature as appropriate.
E. Powers of Authorized Representative. Authorized representatives may be authorized to:
(1) Sign an application on the applicant's behalf;
(2) Complete and submit an update, a renewal form, or respond to a request for redetermination;
(3) Receive copies of the applicant or recipient's notice and other communications from the agency; and
(4) Act on behalf of the applicant or recipient in all matters with the agency including appeals.
F. Obligations of the 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 individuals the authorized representative represents; and
(2) Shall agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or recipient provided by the agency.
G. Authorized Representatives Through an Organization. A provider, staff member or volunteer of an organization shall sign an agreement that he or she will adhere to the federal regulations governing authorized representatives as laid out in 42 CFR § 435.923 or 45 CFR § 155.227, or both, as well as relevant State and federal laws concerning conflicts of interest and confidentiality of information.

Md. Code Regs. 10.01.04.12

Regulation .12 effective March 19, 2012 (39:5 Md. R. 382); adopted as an emergency provision effective October 1, 2013 (40:22 Md. R. 1871); adopted permanently effective January 6, 2014 (40:26 Md. R. 2162)