CD-PASS Designation of Authorized Representative form update
The CD-PASS service option has updated and retitled the Designation of Guardianship, Power of Attorney, and Designation of Authorized Representative form, version 7/20/09. The new form is titled the CD-PASS Designation of Authorized Representative form, draft version 6/9/16, and is available with this bulletin, as well as on the Public Partnerships website: www.publicpartnerships.com .
The purpose of this update is to bring this form into compliance with DHS standards for accessibility and to address long-standing deficiencies within this form. This form is intended to allow ADvantage Members to appoint a person to assist with CD-PASS services and to identify the level of authority that person has been granted. This form is required with Service Plan addendums transitioning Members to CD-PASS, and for all CD-PASS Service Plan reassessments.
Key form updates:
- Definitions of roles are presented on page 1.
- Sections for Legal Guardian, Power of Attorney, and Authorized Representative have been combined to reduce confusion.
- Space has been created to define specific activities that the representative will perform.
- Signature line for Case Manager has been added.
- The previous version of this form (version 7/20/09) will be phased out according to the following timeline:
- 7/5/16 – Updated form (version 6/9/16) released for immediate use.
- 7/5/16 – 8/31/16 - Informational conditions only will be placed on T1016 service lines (no authorizations will be impacted).
- 9/1/16 to 9/30/16 – S5125, S5125TF, T2025, and T1016 service lines will be conditionally authorized for 30 days, requiring submission of form version 6/9/16.
- 10/1/16 - Full implementation of the updated form: All CD-PASS and Case Management service lines will be Not Authorized pending receipt of the Designation of Authorized Representative form, version 6/9/16.
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