MEMORANDUM

DISCUSSION:

The purpose of this memorandum is to:

• provide clarification of
  • APPLICATION PROCESSING (Excluding Food Stamps and Child Care) and
  • QUESTIONABLE DOCUMENTATION; and to
• introduce NEW MANUAL SECTIONS FOR AUTHORIZED REPRESENTATIVE(S) with policy on the
  • APPOINTMENT OF AUTHORIZED REPRESENTATIVE(S) and
  • Revocation of Authorized Representative(s)

APPLICATION PROCESSING

IM Manual sections 0105.010.00 SIGNING THE APPLICATION,0105.015.00 DATING THE APPLICATION, 0105.040.00 SPECIALIZED APPLICATION PROCEDURES, and 0110.000.00 VERIFICATION REQUIREMENTS FOR MO HEALTHNET AND ADULT CASH ASSISTANCE PROGRAMS have been revised.  The revisions include clarification of:

• who can sign the MO HealthNet (MHN) application for benefits;
• dating the application;
• application procedures for death after application;
• application for deceased persons; and
• questionable documentation.

SIGNING THE APPLICATION

IM Manual section 0105.010.00 SIGNING THE APPLICATION is revised to clarify signing of the application by a legal guardian, conservator, authorized representative, or by a personal representative, administrator, or executor of the estate of a deceased individual.

Use the following to determine who can complete and sign an application for IM programs:

WHO CAN SIGN THE APPLICATION	PROGRAM
Applicant	All Programs
Legal Guardian	All Programs (does not apply if the applicant is deceased)
Conservator	All Programs (does not apply if the applicant is deceased)
Relative  - due to incapacity of applicant	Adult Cash Assistance and MO HealthNet Programs (does not include Temporary Assistance) (does not apply if the applicant is deceased)
Authorized Representative	All MO HealthNet Programs  (does not include Temporary Assistance) (does not apply if the applicant is deceased unless appointed by the personal representative, administrator or executor of the deceased applicant's estate)
Relative or Non-Relative Caretaker	All Family Healthcare Programs  (does not include Temporary Assistance) (does not apply if the applicant is deceased)
Power of Attorney	Adult Cash Assistance and All MO HealthNet Programs (does not include Temporary Assistance) (does not apply if the applicant is deceased)
Personal Representative, Administrator or Executor of Estate of Deceased Person	All MO HealthNet Programs (when MO HealthNet applicant is deceased)

If an unsigned application is received, the application must be returned for signature. Temporary Assistance (TA) and MHN applications must be signed before the application request is entered in the Family Information Management Information System (FAMIS). The Family Support Division (FSD) accepts electronic signatures for MHN applications received from the FSD Program Enrollment portal on the Internet.

DATING THE APPLICATION

IM Manual section 0105.015.00 DATING THE APPLICATION is revised to clarify the application date for TA and MHN. The application date is the date the SIGNED application is received in the FSD office, or additionally for MHN applications the date that the signed application is received by a contracted agency.

If an electronic or dropped off application is received after normal business hours or on a weekend or holiday, the application date is the next working day, unless the application is taken by a FSD contracted agency such as a Federally Qualified Health Center.

QUESTIONABLE DOCUMENTATION

IM Manual section 0110.000.00 VERIFICATION REQUIREMENTS FOR MO HEALTHNET AND CASH ASSISTANCE PROGRAMS is revised to provide clarification on questionable documentation. The FSD is not required to accept documentation that is questionable, but staff must record comments from the Eligibility Unit Member Role (EUMEMROL, FM3Z) screen that provide a detailed explanation of the documentation received and the reasons staff believe the documentation is not true, is inaccurate, or is incomplete. Eligibility specialists should consult with eligibility specialist supervisors when determining that documentation is questionable.

NEW MANUAL SECTIONS FOR AUTHORIZED REPRESENTATIVE(S)

The following new sections have been added to the General Information Manual 0130.000.00 LEGAL ASPECTS regarding appointment of Authorized Representative(s) for MHN programs:

• 0130.020.00 AUTHORIZED REPRESENTATIVE(S) FOR MO HEALTHNET;
• 0130.020.05 Legal Basis;
• 0130.020.10 Appointment of an Authorized Representative;
• 0130.020.15 Appointment of an Authorized Representative when there is a Spouse or Second Parent in the Eligibility Unit;
• 0130.030.00 DURATION OF APPOINTMENT OF REPRESENTATIVE; and
• 0130.040.00 AUTHORIZED REPRESENTATIVE REVOCATION.

These sections include:

• appointed authorized representative's roles, rights and responsibilities for the application, annual review, and agency actions;
• agency roles and responsibilities to the appointed authorized representative;
• duration of appointment of authorized representative;
• revocation of authorized representative; and
• authorization to disclose protected health and other information.

APPOINTMENT OF AUTHORIZED REPRESENTATIVE(S)

The appointment of an authorized representative does not prohibit or prevent 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.

The Appointment of Authorized Representative (IM6-AR) form is revised to comply with applicant/participant confidentiality and HIPPA requirements. Refer to section 0130.005.00 CONFIDENTIALITY for confidentiality requirements. Refer to section 0130.005.10 Health Insurance Portability and Accountability Act for HIPAA requirements.

The Appointment of Authorized Representative (IM6-AR) form is the only form that is accepted by FSD for appointment of an authorized representative(s). Other forms for appointment of an authorized representative will not be accepted after December 1, 2012.

The applicant/participant must designate a person to serve as their authorized representative. The authorized representative may not be an organization or legal entity such as a corporation. The applicant/participant may designate one or more individuals as authorized representatives at any time by completing the IM-6AR for each person. Multiple individuals may serve as authorized representative concurrently.

When more than one person is appointed as an authorized representative, the applicant/participant must designate one person as the primary representative. Additional representatives will be secondary representative(s). The FSD will send correspondence to the primary representative.

An authorized representative can only represent the applicant/participant who signed the IM-6AR. If an applicant and the applicant's spouse apply for MHN benefits and the applicant appoints an authorized representative(s), but the spouse does not, the spouse's information must not be shared with the applicant's authorized representative(s). The authorized representative may only make application for the individual who has appointed the authorized representative.

The second parent or spouse is not required to appoint an authorized representative. However, if the second parent or spouse wants to appoint an authorized representative, he/she must complete a separate IM-6AR. The appointed representative may be the same authorized representative as the applicant/participant or a different authorized representative.

EXAMPLE: If Mrs. A appoints an authorized representative but her spouse, Mr. A, does not, the authorized representative can only make application for Mrs. A, and only receive eligibility information and eligibility notices relating to Mrs. A.

Mr. A. does not have to appoint an authorized representative. If Mr. A does not appoint an authorized representative, and he wants to apply for benefits, he will have to sign an application form. If Mr. A does not appoint an authorized representative and does not want to apply for benefits, the authorized representative must provide information about both Mr. and Mrs. A to complete the eligibility determination.

FAMIS forms and notices contain information on all members in the eligibility unit. When an eligibility unit contains a second parent or spouse who did not appoint an authorized representative, manual forms and notices, such as the Approval Notice (IM-32) form or Notice of Case Action (IM-33) form, must be provided to the primary authorized representative for the applicant/participant. The manual forms and notices must only contain information about the applicant/participant who signed the IM-6AR.

NOTE:  The IM-6AR form only authorizes appointment of an authorized representative.  It does not allow for disclosure of Protected Health and Other Information (PHI) to the person appointed as authorized representative.  If the applicant/participant wants to release protected health information, the 650-2616 (HIPPA) Authorization for Disclosure of Consumer Medical/Health Information form must be completed. Refer to 0130.005.10 Health Insurance Portability and Accountability Act for information and process for disclosure of protected health and other information.

NOTE:  FAMIS does not send notice of case actions to the authorized representative.  The eligibility specialist must manually send a copy of notices to the authorized representative when appropriate by selecting and printing the notice from the Document Queue (DOCQUE, FMVM) screen. The eligibility specialist should enter comments on Eligibility Unit Member Role (EUMEMROL, FM3Z) screen. Comments must include the type of notice and date sent to the authorized representative.

Destroy all previous versions of the IM6-AR and use forms with revision date 11/2012. Provide applicants/participants or persons requesting authorized representative appointment forms with the IM6-AR with revision date 11/2012. The form will be available at https://dss.mo.gov/fsd/massist.htm.

REVOCATION OF AUTHORIZED REPRESENTATIVE

A new manual section 0130.040.00 AUTHORIZED REPRESENTATIVE REVOCATION has been added. This section explains the process to revoke an authorized representative prior to expiration of the appointment.

A new form, Authorized Representative Revocation (IM-6ARR), has been developed to provide a written document for revoking the appointment of an authorized representative. The applicant /participant may revoke the Appointment of Authorized Representative at any time by completing the IM-6ARR form or submitting a signed and dated written statement requesting revocation. The form will be available at https://dss.mo.gov/fsd/massist.htm.

NECESSARY ACTION:

• Review this memorandum with all appropriate staff.
• Effective immediately, begin using clarified signing and dating of application and appointment of authorized representative(s) processes.
• Effective immediately, begin using clarified questionable documentation policy.
• Effective immediately destroy all IM6-AR forms with a revision date prior to 11/2012, and begin using IM6-AR form with revision date 11/2012.
• Effective immediately, begin using the IM6-ARR form or signed and dated written request for revocation.
• Manually send a copy of notices to the authorized representative.

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