DPSS ePolicy

To convert existing policy to new webpage – No content changes

Revision of existing policy and/or form(s)

What changed?

1. Provides instructions on accepting telephonic signatures; and
2. Adds a Questions and Answers (Q&A).

An applicant/beneficiary may appoint an individual or organization as their Medi-Cal (MC) Authorized Representative (AR) at any time to act responsibly on the applicant’s/beneficiary’s behalf.  ARs can only be appointed by a competent MC applicant/beneficiary.  Any attempt by an individual to appoint themselves as an AR due to the applicant’s/beneficiary’s incompetent state is invalid.  To finalize an AR appointment, the applicant’s/beneficiary’s signature must be captured by telephone, mail, fax, or in person.  If the signature is captured telephonically, the audio recording must include the individual's sworn statement about the information they agree to and acknowledgment of their rights and responsibilities.

Applicant/Beneficiary Responsibilities:

• Designate AR(s) to act on their behalf;
• Define the scope of duties of the AR(s); and
• Specify the notices or correspondence that can be sent to the AR(s).

AR Appointment

Any individual from an appointed organization must have a signed agreement to adhere to AR rights and responsibilities in order to act on behalf of the applicant/beneficiary.

An applicant/beneficiary may appoint an AR through:

1. MC 382, Appointment of Authorized Representative form;
2. MC application, e.g., Single Streamlined Application (SSApp);
3. Statewide Automated Welfare System (SAWS) 2 PLUS, Application for CalFresh, Cash Aid, and/or Medi-Cal/Health Care Programs;
4. Covered California (CoCA);
5. Legal documentation of authority to act on behalf of the applicant/beneficiary under State law (e.g., conservatorship documents, power of attorney, or court documents designating guardianship);
6. Any type of written statement provided by the applicant/beneficiary;
7. MC 306, Appointment of Representative form; and
   
   Note:  The MC 306 must no longer be provided to an applicant/beneficiary to designate an AR; however, if the form is submitted by the applicant/beneficiary, it must be accepted.
   
   
8. DPA 19, State Hearing Authorized Representative, for the appeals process only.

An AR designation may be submitted by telephone, mail, fax, or in person at any time.  When completing an AR form telephonically, the applicant/beneficiary must be present to designate an AR and a telephonic signature must be captured.  In addition:

• The appointment of an AR remains in effect until a change is requested by the applicant/beneficiary;
• Applicant/beneficiary may modify the scope of duties of an AR telephonically, in person, or in writing.  An AR may not modify their own appointment duties at any time; and
• Applicant/beneficiary and AR(s) may cancel an AR appointment telephonically, in person, or in writing at any time.

The AR appointment is valid for 90 calendar days following a denial or discontinuance of benefits unless:

• Canceled by either party;
• “Good Cause” exists for the AR appointment to continue beyond 90 calendar days because it is in the best interest of the applicant/beneficiary; and
• A fair hearing is filed, at which time the appointment will continue through the hearing process.

An AR appointment is not needed to provide case information to:

• An applicant’s/beneficiary’s spouse if the spouse is on the MC case; or
• The parent of a minor child if the parent is on the child’s MC case.

AR Duties

When an individual or organization is appointed as an AR, they must adhere to the AR rights and responsibilities outlined on the MC 382 – Appointment of Authorized Representative and MC 383 – Authorized Representative Standard Agreement for Organizations accordingly.  When an AR appointment is completed, the AR is considered to have full authority in all matters related to MC eligibility.

The following are examples of the duties that can be performed by an AR under full authority:

• Act on behalf of the applicant/beneficiary on the duties (full or limited) related to their MC eligibility or enrollment, as defined by the applicant/beneficiary;
• Complete and sign the application;
• Complete and sign annual renewal forms;
• Provide Department of Public Social Services (DPSS) requested information;
• Report changes;
• Choose a health plan; and
• Help with fair hearings and appeals.

Full authority does not include authorization to receive duplicate copies of notices/correspondence sent to the applicant/beneficiary; however, an applicant/beneficiary can designate that an AR receives copies of notices/correspondence by indicating this on the MC 382.

AR duties do not include AR authority to request or view case privileged or confidential information, nor should an AR be given an applicant’s/beneficiary’s:

• Benefits Identification Card (BIC);
• Client Index Number (CIN); or
• Social Security Number (SSN).

Title 42 of the Code of Federal Regulations (CFR) Section 435.923 states that MC applicants/beneficiaries must be permitted to designate an individual(s) or organization to act responsibly on their behalf to assist with the individual’s application, renewal of eligibility, and other ongoing communications with the department.

Furthermore, Welfare and Institutions Code (WIC) Section 14100.2 requires that all types of information, whether written or oral, concerning an applicant/beneficiary, must be kept confidential and shall not be open to examination other than for purposes directly connected with their MC application and/or retention of benefits.

AR Appointment

• When appointing an AR using the MC 382, the MC 380 must also be completed.
• When appointing an AR using options 2-8 in the AR Appointment Section, the MC 382, MC 380, and MC 383 (if organization is designated AR) must also be completed.
  

AR Forms

MC 380

The MC 380, Notice of Authorized Representative Appointment form (6/18) is used to notify an applicant/beneficiary and newly appointed AR of their appointment and responsibilities.  Additionally, the notice informs the applicant/beneficiary and the AR of the following information:

1. Overview of their (applicant/beneficiary and AR) rights and responsibilities;
2. Ability to cancel/modify the scope of the AR appointment; and
3. Notifies the AR that by accepting the appointment, they agree to abide by all State and federal laws governing an AR.

Refer to Form Instructions Release (FIR) 5716 for additional information.

MC 381

The MC 381, Cancellation or Change to a Medi-Cal Authorized Representative Appointment form (6/18) is used to notify the applicant/beneficiary and the AR of a:

1. Cancellation to the AR appointment; or
2. Change to the duties of an AR.

The MC 381 is required whenever a change or cancellation is made to an AR’s scope of duties or appointment.  Applicant/beneficiary may cancel the appointment of the AR or change the scope of duties of the AR at any time.  This may be done by telephone, mail, fax, or in person. 

An AR may not modify their own scope of duties.  Only the applicant/beneficiary can modify the duties; however, the AR can cancel their appointment as an AR at any time.

Refer to FIR 5717 for additional information.

MC 382

The MC 382, Appointment of Authorized Representative form (6/18) is provided to an MC applicant/beneficiary to designate, in writing, an individual or organization as an AR.  The form must be signed by the applicant/beneficiary in order for the AR appointment to be valid.  The MC 382:

1. Captures applicant/beneficiary information;
2. Captures AR information;
3. Allows applicant/beneficiary to specify any limitations to AR duties;
4. Allows applicant/beneficiary to specify if the AR can receive copies of notices and correspondence provided to the applicant/beneficiary; and
5. Captures the applicant’s/beneficiary’s signature.

If the MC 382 is completed by eligibility staff on behalf of the applicant/beneficiary, a valid signature of the applicant/beneficiary must be captured. 

However, a signature is not required on the copies that will be mailed to the applicant/beneficiary or AR.  These copies also do not need to be returned.  The intent for sending copies of the MC 382 is the following:

• Document the applicant’s/beneficiary’s request, inform all affected parties of the AR’s scope of duties; and
• Inform the AR that their acceptance of the appointment demonstrates their agreement to abide by all State and federal laws governing ARs.
  

Refer to FIR 5718 for additional information.

MC 383

The MC 383, Authorized Representative Standard Agreement for Organizations form (6/18) must be completed by an organization when an MC applicant/beneficiary designates an organization as an AR.

The form must be completed and signed by each individual who will be acting on behalf of the organization as the applicant/beneficiary’s AR.  Up to three individuals from an organization may be added on the MC 383.  Additional individuals may be added on separate MC 383 forms if necessary.

Only individuals who have signed the MC 383 within the organization may act as an AR.  The MC 383 must not be issued or given to an applicant/beneficiary to complete.

Refer to FIR 5719 for additional information.

N/A

Authorized Representative Questions and Answers

Question:  Are we required to send the MC 383 “Standard Agreement” to organizations when an organization is appointed as the AR?

Answer:  Yes, send the MC 383. Also, the form is required to be in the case record when the AR is part of an organization. 

Question:  If we receive a “Release of Information” request (such as the ABCDM 228), should we follow the AR process detailed in this Administrative Release?

Answer:  No.  A "Release of Information" request does not follow the AR process.

Question:  If an AR appears in the MEDS INQD, should we use this as current AR information?

Answer:  No.  Do not use the MEDS INQD screen as verification of current AR information. 

If we are contacted by an AR listed in the MEDS INQD screen and that AR is not known to CalSAWS as a Medi-Cal AR, we must contact the applicant/beneficiary to confirm if they would like the individual or organization listed in the MEDS INQD screen to act as their AR for Medi-Cal purposes.  We must document the response on the CalSAWS Journal page per normal processes.  If the applicant/beneficiary wishes to appoint that individual or organization as their Medi-Cal AR, we must follow the process outlined in this Administrative Release. 

Question:  What is the process when an AR cannot be reached?  Is the AR appointment still valid?  Should we take action on the case?

Answer:  If we are unable to reach the AR after reasonable attempts have been made, then we should contact the applicant/beneficiary via their preferred contact method to notify them of the County’s inability to reach the AR and the reason that the County is contacting the AR (for example, verification needed by the County) and work directly with the applicant/beneficiary to obtain the necessary information. 

When contacting the AR, we should use the AR’s preferred method of contact. In instances where the County is not able to reach the AR, the AR’s appointment would continue and would not terminate unless requested by the AR or applicant/beneficiary.  The AR may still act on behalf of the applicant/beneficiary, but we must request updated contact information if the AR contacts the County.  Follow existing procedures to request required information from the applicant/beneficiary, including taking denial or discontinuance action if the applicant/beneficiary fails to respond to the required County contacts. 

Even when ARs have full authority, all correspondences must be sent to the applicant/beneficiary, with copies sent to the AR (if authorized).

Question:  What should we do when an applicant/beneficiary becomes incompetent or deceased after appointing someone as an AR?

Answer:  If an applicant/beneficiary loses competence or dies after appointing an AR, we must honor the AR appointment made during the time of competency.  However, a spouse or any individual with legal documentation (such as a power of attorney, executor of the deceased person’s estate, or the incompetent person’s guardian/conservator) will have ultimate authority for the deceased or incompetent applicant/beneficiary’s Medi-Cal case and may cancel an AR appointment.

Question:  Is a Certified Enrollment Counselor (CEC)/application assistor/insurance agent considered an AR? 

Answer:  No.  A CEC, application assistor or insurance agent is not automatically considered an AR.  To be considered an AR, they must be appointed as one by the applicant/beneficiary. 

If the CEC, application assistor, or agent wishes to act on behalf of the applicant/beneficiary in any other matter, the applicant/beneficiary must appoint them as an AR following the processes detailed in the Administrative Release. 

Question:  ARs are now allowed to sign on behalf of the applicant/beneficiary, including the SSApp.  How do we ensure an AR is properly appointed to sign on behalf of the beneficiary? 

Answer:  To ensure an AR is appropriately appointed to sign on behalf of an individual, the applicant/beneficiary must sign the Medi-Cal AR appointment form, authorizing such action on their behalf. 

For example, an AR may sign the SSApp on behalf of the applicant/beneficiary; however, the “Authorized Representative” section of the SSApp or another acceptable AR appointment method must still be signed by the applicant/beneficiary utilizing any of the approved signature methods.

Question:  Is an electronic/digital signature acceptable for the MC 382?

Answer:  No.  The MC 382 can only be signed manually (wet) or telephonically (following telephonic signature procedures). 

Question:  Should we send the GEN 1365 with the AR forms? 

Answer:  Yes.  The GEN 1365 is required to be included with all correspondence regardless of the preferred language.

Question:  Do ARs have the same rights as the MC applicant/beneficiary they represent to request Medi-Cal information and forms in a threshold language or in alternative formats such as Braille, Large Font, or an accessible screen-readable electronic format?

Answer:  ARs do have the same rights as the MC applicant/beneficiary they represent to request MC information and forms in the threshold language or accessible format they prefer when authorized to receive notices or other correspondence.

Question:  How do we assess “conflicts of interests” for organizations as described on the MC 383?

Answer:  There are no expectations for counties to evaluate organizations for conflicts of interest.  If we receive information from an applicant/beneficiary that their appointed AR has a conflict of interest not disclosed to them, please contact the Health Care Reform Section through the HCR inbox (HCR@dpss.lacounty.gov). 

Question:  Is there a limit to the number of MC 383 that an organization can submit?

Answer:  No.  There is no limit to the number of MC 383 forms that an organization can submit. 

The MC 383 form provides space for three individuals from an appointed AR Organization to act as ARs for an applicant/beneficiary.  The AR Organization may identify additional individuals by submitting additional MC 383 forms for the applicant/beneficiary.

Question:  Are the AR designation forms required if we receive acceptable legal documentation such as documentation establishing conservatorship, guardianship, and Power of Attorney?

Answer:  No.  They are not required if we receive acceptable legal documentation.  Such legal documentation must be clearly annotated on the CalSAWS Journal page. 

Question:  Should we require an applicant/beneficiary and/or AR to submit a signed MC 382 and/or MC 383 before accepting the AR appointment if a telephonic AR appointment has already been provided?

Answer:  No.  A manual (wet) signature is not required to designate an AR if a telephonic signature has already been captured for the MC 382 and/or MC 383. 

We must also accept handwritten signatures transmitted by facsimile or other electronic transmissions.