Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	

		MassHealth
		Eligibility Letter 95
		September 1, 2002

TO:	Division Staff

FROM:	Wendy E. Warring, Commissioner

RE:	Authorized Representative Changes for Volumes I and II and Begin Date Changes for Volume II

This letter transmits revised regulations changing the name, description, and function of the terms, “authorized representative” and “representative.”  The Division will no longer use the terms, “authorized representative” and “representative,” to describe a person who acts on behalf of a MassHealth applicant or member.  As part of our efforts to comply with the Healthcare Insurance Portability and Accountability Act (HIPAA) of 1996, we are establishing the following two types of representatives who may act on behalf of the applicant or member.

•	Appeal Representative
•	Eligibility Representative

An eligibility representative acts on behalf of an applicant or member during the eligibility process, and an appeals representative acts on behalf of an appellant during the appeals process.  They can be the same person.  The definitions of these two types of representatives are the same, with one exception.  Either type of representative can be:

•	designated as such, in writing, by the applicant or member for an eligibility representative, or by the appellant for an appeal representative; or
•	appointed under applicable law to act on behalf of the applicant, member, or appellant.

In addition, an eligibility representative (but not an appeal representative) can be established when the eligibility representative certifies that he or she is acting responsibly on behalf of the applicant or member when the applicant or member is not able to responsibly make a written designation, and when no one has been appointed under other applicable law to represent the applicant or member.

This letter also transmits revised regulations regarding denials due to failure to provide requested information, the date of reapplication, and the begin date for MassHealth Standard, Basic, and Limited coverage for Volume II.  These revised regulations clarify, but do not change, current policy.

Minor editorial changes were also made to these regulations for purposes of consistency.

These emergency regulations are effective September 1, 2002.

	MANUAL UPKEEP

Insert	Remove	Trans. By

501.001 (1 of 6)	501.001 (1 of 5)	E.L. 88
501.001 (2 of 6)	501.001 (2 of 5)	E.L. 88
501.001 (3 of 6)	501.001 (3 of 5)	E.L. 88
501.001 (4 of 6)	501.001 (4 of 5)	E.L. 88
501.001 (5 of 6)	501.001 (5 of 5)	E.L. 88
501.001 (6 of 6)	-----	-----
501.007			501.007	E.L. 92
501.009			-----	-----
501.010			501.010	E.L. 92
501.014 (1 of 2)	501.011	E.L. 51
501.014 (2 of 2)	501.014	E.L. 53

502.001			502.001	E.L. 81
502.008			502.008	E.L. 81

515.001 (1 of 8)	515.001 (1 of 7)	E.L. 72
515.001 (2 of 8)	515.001 (2 of 7)	E.L. 72
515.001 (3 of 8)	515.001 (3 of 7)	E.L. 63
515.001 (4 of 8)	515.001 (4 of 7)	E.L. 63
515.001 (5 of 8)	515.001 (5 of 7)	E.L. 63
515.001 (6 of 8)	515.001 (6 of 7)	E.L. 63
515.001 (7 of 8)	515.001 (7 of 7)	E.L. 63
515.001 (8 of 8)	-----	-----
515.005			515.005	E.L. 63
515.008			515.008	E.L. 92
MANUAL UPKEEP

Insert	Remove	Trans. By

515.009			515.009	E.L. 92

516.001			516.001	E.L. 41
516.004			516.004	E.L. 41
516.008			516.008	E.L. 41

519.007 (1 of 4)	519.007 (1 of 4)	E.L. 72

520.006			520.006	E.L. 63
520.016 (1 of 2)	520.016 (1 of 2)	E.L. 91

610.000 (1 of 2)	610.000 (1 of 2)	E.L. 38
610.000 (2 of 2)	610.000 (2 of 2)	E.L. 38
610.001			610.001	E.L. 64
610.004 (1 of 3)	610.004 (1 of 2)	E.L. 64
610.004 (2 of 3)	610.004 (2 of 2)	E.L. 64
610.004 (3 of 3)	-----	-----
610.015 (1 of 2)	610.015 (1 of 2)	E.L. 90
610.015 (2 of 2)	610.015 (2 of 2)	E.L. 90
610.016			610.016	E.L. 90
610.028			610.028	E.L. 90
610.029			610.029	E.L. 90
610.030			610.030	E.L. 90
610.031			610.032	E.L. 90
610.033			610.033	E.L. 90
610.034			610.035	E.L. 80
610.036			610.036	E.L. 38
610.046			610.046	E.L. 38
610.047			610.047	E.L. 38
610.049			610.049	E.L. 38
610.061			610.061	E.L. 38
610.063			610.063	E.L. 38
610.071			610.071	E.L. 38
610.073			610.074	E.L. 38
610.083			610.083	E.L. 38
610.093			610.093	E.L. 75