MO HealthNet for the Aged, Blind, and Disabled

0803.020.10 Appointment of an Authorized Representative

IM-175, December 16, 2019; IM# 79, December 28, 2018, IM#010 January 09, 2018, IM#33 April 20, 2015

At the time of application or at any other time, an applicant/participant may elect to appoint an authorized representative to:

  • Assist and/or represent them in the MO HealthNet application process, or the re-determination or review of eligibility;
  • Act on behalf of the applicant/participant in other actions on the MO HealthNet case; and
  • Receive copies of the applicant/participant’s notices and other communications between the participant and FSD.

The applicant/participant may use an authorized representative to perform only the following:

NOTE: Do not release participant information to another person until a valid designation of authorized representative, including HIPAA authorization has been signed and received by the Division. This does not apply to a request for release of participant information from the participant’s attorney, spouse, attorney-in-fact, guardian, conservator, or court appointed public administrator.

  • Access information regarding online interactions between the participant and FSD after the participant’s death only if:
    • the participant has granted access during his or her lifetime; or
    • the individual is a court appointed personal representative, administrator or executor of the estate; or
    • the individual is a surviving spouse who has obtained a refusal of letters or who has filed a valid small estate affidavit

The appointment of an authorized representative does not preclude FSD staff from contact with the applicant/participant as needed to conduct the business of the agency with regard to the application, review, or other agency action.

An applicant/participant:

  • Cannot appoint an authorized representative if the applicant/participant is determined incompetent by a court. (In those cases, the Guardian or Conservator would appoint the authorized representative.)
  • Must willingly and knowingly appoint an authorized representative. If the designation of an authorized representative was created under duress or undue influence, or was induced by fraud, it is considered void.

NOTE: A parent may not represent an MHABD participant who turns age 18 or a MAGI participant who turns age 19, unless that participant:

  • appoints the parent as an authorized representative; or
  • the parent produces documents that show the parent is appointed by the court as guardian and/or conservator; or
  • the parent has the participant’s power of attorney.

EXAMPLE:  Beverly has MHABD program coverage.  Her mother, Brenda, completed her reinvestigation in March 2017.  Beverly turned age 18 in May 2017.  Brenda cannot complete the March 2018 reinvestigation because Beverly is now age 18 and there is no paperwork on file to appoint Brenda as Beverly’s authorized representative.  Beverly contacts FSD and would like Brenda to continue to act on her behalf.  An authorized representative form is mailed to Beverly so she can appoint her mother as her authorized representative.

  • Will be financially and legally responsible for all information provided or omitted, and all actions taken or omitted by the authorized representative.
  • Must sign an IM-6AR or other designation form to appoint an authorized representative. The signature can be handwritten, stamped, electronic, telephonically recorded (when available), or by any other method accepted by the FSD. An unsigned IM-6AR or designation form is not a valid appointment of an authorized representative.
    • The IM-6AR or other designation form must include the name, address and telephone number of the authorized representative or organization designated to serve as the authorized representative.
    • The IM-6AR or other designation form can be accepted by mail, fax or any other commonly available electronic means.
    • If an IM-6AR is not used, the other designation form must include:
      • The name of the person or organization designated to serve as the authorized representative;
      • The address of the authorized representative and the mailing address of the authorized representative (if different);
      • A phone number for the authorized representative; and
      • An attestation substantially in the following format: “In appointing my authorized representative, I understand that I will be legally bound and responsible for the actions of my appointed representative with respect to my application for or participation in the MO HealthNet program.” The attestation shall also contain or be accompanied by a signed authorization compliant with the Health Insurance Portability and Accountability Act (HIPAA) for the Department of Social Services to release protected health information to the authorized representative.”
    • The authorized representative is effective with the date the completed IM-6, IM-6AR or other designation form is received by the FSD. The FSD may contact the applicant/participant or other individuals signing the IM-6AR or other designation form on behalf of the applicant/participant to verify the appointment of an authorized representative.

NOTE: For applications/cases in Family Assistance Management Information System (FAMIS), upon receipt of a completed IM-6, IM-6AR, IM-6ARO or other designation form add Authorized Representative information on the Representative List screen (AUTHREP/FMJ1) and Representative Detail screen (FMJG).

For applications/cases in Missouri Eligibility Determination and Enrollment System (MEDES), upon receipt of a completed IM-6AR, IM-6ARO or other designation form add a comment to the client’s Person Page, under Notes. List the authorized representatives name, address and telephone number as well as the date the IM-6AR, IM-6ARO or other designation form was signed and received (at this time the authorized representative evidence is not functioning in MEDES so manual notices must be sent to the authorized representative).

  • Can appoint an individual or an organization as an authorized representative.
    • If an individual is appointed as an authorized representative, the individual must be 18 years of age or older.
    • If an organization is appointed as an authorized representative, the organization must provide in writing the name, address and phone number of an individual within the organization serving as a contact person for the FSD within ten (10) days of appointment of the organization as the authorized representative. The organization must notify the FSD in writing of any change in the name and contact information for the designated contact person within 10 days of the change. The IM-6ARO is the preferred method to notify the FSD of the contact person and any subsequent changes.
  • May appoint more than one individual or organization to serve as the authorized representative at any given time.

NOTE: If there is conflicting information or instructions from more than one authorized representative, the FSD must consult with the applicant/participant and/or the authorized representatives to resolve the conflict.

EXCEPTION: When the applicant/participant is represented by an attorney the FSD will consult with the attorney before consulting with the applicant/participant if conflicting information is received.

  • Must notify the FSD of any change in the address and phone number of the authorized representative within 10 days of the known change. (The authorized representative may provide this information on behalf of the applicant/participant.)

Do NOT require an IM-6AR or other authorized representative designation form when the applicant/participant is represented by:

  • A public administrator or other individual appointed by the court as guardian and/or conservator. Obtain documentation of the court appointment.
    • An authorized representative cannot represent an applicant/participant who has a Guardian and/or Conservator recognized by Missouri law, unless the Guardian and/or Conservator appointed the authorized representative.
  • A person acting as attorney-in-fact or agent under a Power of Attorney (POA), when the applicant/participant has given that person written authorization to act on their behalf in financial, business or legal matters. Review the POA document to determine if the POA is currently in effect and if the applicant/participant has given their attorney-in-fact/agent the authority to act in this capacity.
    • The attorney-in-fact/agent may appoint an authorized representative when allowed to act in that capacity.
  • An attorney at law licensed by the State of Missouri. The attorney must file a written entry of appearance with the FSD.

NOTE: Attorneys who do not file a written entry of appearance, but wish to act on an applicant/participant’s behalf must provide other appropriate documentation of their capacity as representative.

  • An individual or organization to whom a court of competent jurisdiction has issued letters of administration or testamentary on behalf of the deceased participant or a surviving spouse when a valid court order or valid small estate affidavit has been received.
    • The individual, organization or surviving spouse may appoint an authorized representative

The authorized representative must not:

  • Make a willfully false statement,
  • Misrepresent,
  • Willfully conceal,
  • Fail to report, or fail to disclose any fact or event required to be reported by any law, regulation, or rule of this State or the United States.
  • Transfer the appointment or re-delegate his or her authority to represent the applicant/participant to another individual or organization.

An appointment of authorized representative is only valid with the DSS. It does not permit an authorized representative to represent or appear for the applicant/participant in any court of law in the State of Missouri.