C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA › Subpart J—Eligibility in the States and District of Columbia

42 C.F.R. § 435.923

Authorized representatives

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(a)(1) The agency must permit applicants and beneficiaries to designate an individual or organization to act responsibly on their behalf in assisting with the individual's application and renewal of eligibility and other ongoing communications with the agency. Such a designation must be in accordance with paragraph (f) of this section, including the applicant's signature, and must be permitted at the time of application and at other times.

(2) Authority for an individual or entity to act on behalf of an applicant or beneficiary accorded under state law, including but not limited to, a court order establishing legal guardianship or a power of attorney, must be treated as a written designation by the applicant or beneficiary of authorized representation.

(b) Applicants and beneficiaries may authorize their representatives to—

(1) Sign an application on the applicant's behalf;

(2) Complete and submit a renewal form;

(3) Receive copies of the applicant or beneficiary's notices and other communications from the agency;

(4) Act on behalf of the applicant or beneficiary in all other matters with the agency.

(c) The power to act as an authorized representative is valid until the applicant or beneficiary 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 he or she no longer is acting in such capacity, or there is a change in the legal authority upon which the individual or organization's authority was based. Such notice must be in accordance with paragraph (f) of this section and should include the applicant or authorized representative's signature as appropriate.

(d) The authorized representative—

(1) Is responsible for fulfilling all responsibilities encompassed within the scope of the authorized representation, as described in paragraph (b)(2) of this section, to the same extent as the individual he or she represents;

(2) Must agree to maintain, or be legally bound to maintain, the confidentiality of any information regarding the applicant or beneficiary provided by the agency.

(e) The agency must require that, as a condition of serving as an authorized representative, a provider or staff member or volunteer of an organization must affirm that he or she will adhere to the regulations in part 431, subpart F of this chapter and at 45 CFR 155.260(f) (relating to confidentiality of information), § 447.10 of this chapter (relating to the prohibition against reassignment of provider claims as appropriate for a facility or an organization acting on the facility's behalf), as well as other relevant State and Federal laws concerning conflicts of interest and confidentiality of information.

(f) For purposes of this section, the agency must accept electronic, including telephonically recorded, signatures and handwritten signatures transmitted by facsimile or other electronic transmission. Designations of authorized representatives must be accepted through all of the modalities described in § 435.907(a).

[78 FR 42303, July 15, 2013]
Notes of Decisions
Cited in 15 cases (3 in the last 5 years), 2015–2025 · leading case: Tiggs c/o Indian hills Healthcare Grp., Inc. v. Ohio Dept. of Job & Fam. Servs., 2018 Ohio 3164 (Ohio Ct. App. 2018).
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Tiggs c/o Indian hills Healthcare Grp., Inc. v. Ohio Dept. of Job & Fam. Servs., 2018 Ohio 3164 (Ohio Ct. App. 2018). · cites it 14× “An authorized representative’s duties are derived from 42 C.F.R. 435.923(b) and its Ohio counterpart Ohio Adm.”
Turner v. Md. Dept. of Health, 226 A.3d 419 (Md. Ct. Spec. App. 2020). · cites it 17× “Health—General Medical Assistance Program Authorized Representative 42 C.F.R. § 435.923 allows an applicant to personally designate an authorized representative.”
Cowan v. Ohio Dept. of Jobs & Fam. Servs., 2021 Ohio 1798 (Ohio Ct. App. 2021). “However, we note that Tiggs affirmed a trial court’s decision that “relied solely upon a recent federal court decision, Doctors Nursing & Rehab.”
Juanita Fowler Life Care Ctrs. of Am., Inc. v. Dept. of Job & Fam. Servs., 2019 Ohio 1238 (Ohio Ct. App. 2019). “35(A)(2) and 42 C.F.R. 435.923(B). As [LCCW] filed this appeal on behalf of the applicant, Ms.”
Evangelical Good Samaritan Soc'y v. North Dakota Dep't of Human Servs., 2015 ND 96 (N.D. 2015). · cites it 6× “The new regulation, 42 C.F.R. § 435.923 , provides in part: (a)(1) The agency must permit applicants and beneficiaries to designate an individual or organization to act responsibly on their behalf in assisting with the individual’s application and renewal of eligibility and…”
J.C. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 5× “A-4265-16T1 3 with 42 C.F.R. § 435.923 (c) 2 and state law, it had no obligation to respond to CRNC's request for a hearing because CRNC's DAR "extinguished on [J.”
D.T. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 3× “DMAHS, for the first time on appeal, argues that in accordance with 42 C.F.R. § 435.923 (c) 1 and state law, it reasonably declined to transmit D.”
L.m Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2020). · cites it 3× “' 42 C.F.R. § 435.923 (c)." The Director agreed with the ALJ that R.”
Ncrnc, LLC v. Angona, 2022 NY Slip Op 06041 (N.Y. App. Div. 2022). · cites it 3× “2 [d] [1]; see also 42 CFR 435.923 [a] [1]). Here, the July 2016 application was signed by plaintiff's Medicaid coordinator, purportedly acting as Lehtinen's "authorized representative" and submitted "pending legal guardianship.”
Frances Lynch v. Bedford Cnty. DSS & VA Dept. of Med. Assistance Servs. (Va. Ct. App. 2019). · cites it 2× “” 42 CFR § 435.923 (a)(1). Under this section, [a]pplicants and beneficiaries may authorize their representatives to— (1) Sign an application on the applicant’s behalf; (2) Complete and submit a renewal form; (3) Receive copies of the applicant or beneficiary’s notices and other…”
J.G. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 2× “203 and 42 C.F.R. § 435.923 as a unified and harmonious whole" so as to permit FCC to prosecute J.”
M.F. Vs. Div. of Med. Assistance & Health Servs. (Div. of Med. Assistance & Health Servs.) (N.J. Super. Ct. App. Div. 2019). · cites it 2× “42 C.F.R. § 435.923 (c) states: The power to act as an authorized representative is valid until the applicant or beneficiary modifies the authorization or notifies the agency that the representative is no longer authorized to act on his or her behalf, or the authorized…”
Show all 15 citing cases →
— 42 C.F.R. § 435.923(B) — 1 case
Juanita Fowler Life Care Ctrs. of Am., Inc. v. Dept. of Job & Fam. Servs., 2019 Ohio 1238 (Ohio Ct. App. 2019). “35(A)(2) and 42 C.F.R. 435.923(B). As [LCCW] filed this appeal on behalf of the applicant, Ms.”
— 42 C.F.R. § 435.923(a)(1) — 1 case
Turner v. Md. Dept. of Health, 226 A.3d 419 (Md. Ct. Spec. App. 2020). “Health—General Medical Assistance Program Authorized Representative 42 C.F.R. § 435.923 allows an applicant to personally designate an authorized representative.”
— 42 C.F.R. § 435.923(a)(2) — 1 case
Turner v. Md. Dept. of Health, 226 A.3d 419 (Md. Ct. Spec. App. 2020). “Health—General Medical Assistance Program Authorized Representative 42 C.F.R. § 435.923 allows an applicant to personally designate an authorized representative.”
— 42 C.F.R. § 435.923(b) — 1 case
Tiggs c/o Indian hills Healthcare Grp., Inc. v. Ohio Dept. of Job & Fam. Servs., 2018 Ohio 3164 (Ohio Ct. App. 2018). “An authorized representative’s duties are derived from 42 C.F.R. 435.923(b) and its Ohio counterpart Ohio Adm.”
— 42 C.F.R. § 435.923(b)(4) — 3 cases
Tiggs c/o Indian hills Healthcare Grp., Inc. v. Ohio Dept. of Job & Fam. Servs., 2018 Ohio 3164 (Ohio Ct. App. 2018). “An authorized representative’s duties are derived from 42 C.F.R. 435.923(b) and its Ohio counterpart Ohio Adm.”
Cowan v. Ohio Dept. of Jobs & Fam. Servs., 2021 Ohio 1798 (Ohio Ct. App. 2021). “However, we note that Tiggs affirmed a trial court’s decision that “relied solely upon a recent federal court decision, Doctors Nursing & Rehab.”
Peck c/o Legacy Health Servs v. Dept. of Job & Fam. Servs., 2018 Ohio 2353 (Ohio Ct. App. 2018).
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