1322.2 Mandatory Verification That Affects the Amount of Program Benefits

The following information shall be verified prior to a determination of the benefit amount for households initially applying or when an ongoing recipient reports a change. Failure to provide verification of these items is not grounds for denial or discontinuance, rather the determination would be completed without considering the reported information.

Reserved

Medical expense allowed in the medical assistance programs. The amount of any medical expenses shall be verified prior to being applied toward the applicant/recipient’s share of cost. Reserved All medical expenses used against spenddown, client obligation or patient liability are to be verified including responsibility and amounts of third party payments. Expenses direct billed to the fiscal agent by the medical provider are considered verified but are subject to review by KDHE-DHCF. In addition, non-medical household expenses used to determine the excess shelter deduction for spousal impoverishment income allocation 8144.2 (1) (b) and 8244.2 (2) shall be verified.

Community Spouse Resource Assessment (CSRA) - Verification of all resources shall be requested to determine the Community Spouse Resource Assessment (CSRA). See 8144.1 (2) and 8244.1 (2) . The CSRA shall be calculated based on the resources actually verified. Unverified resources shall not be included in the determination. When verification of resources is requested, the agency shall also provide notification that information not provided will not be included in the CSRA determination. In addition, the agency is also responsible for notifying the individual of any unverified resources not included in the CSRA once the allowance has been established. Applicants have until the later of 45-days from the date of application or 12-days from the date notification of the outcome of the CSRA was sent to provide unverified resource verification. NOTE: Information provided in this section does not absolve the individual from the responsibility to provide verification of any resources owned at the time the long term care arrangement began when the information is being used to determine eligibility. The information provided in this section only allows the eligibility worker to complete the CSRA. Any other reason for the eligibility determination, such as the determination that a transfer of property occurred, a determination of whether the resource is producing income, or the determination of the countable or exempt status of the resource, would require verification of the resources.