450 Verification of Deductible Expenses at Initial Certification (A)
Medical Expenses The amount of allowable medical expenses, including the amount of reimbursement (for example, by a third-party insurer), must be verified before the initial certification, if use of the expenses would result in a deduction. Additional verifications relevant to the claimed medical expenses, such as whether the services provided are allowable, are not required unless the information provided by the applicant or recipient is questionable pursuant to 106 CMR 361.620. (B) Other Expenses Other deductible expenses must be verified before initial certification only when questionable and use of the expense claimed by the household would actually result in a deduction. If a deductible expense must be verified, but obtaining the verification would delay the household’s certification, the worker must inform the household that it may elect to be certified without receiving the deduction for the unverified expense. If the household subsequently provides the missing verification, the case manager shall treat the information as a reported change and provide increased benefits, if any, in accordance with the timeliness standards for reported changes. The household is not entitled to lost benefits unless the expense could not be verified within the 30-day application processing standard because the worker did not allow the household at least 10 days from the date of the initial request to provide the verification or because the worker did not provide the household assistance when required. Households ineligible because a claimed, but unverified expense is disallowed must be sent a Notice of Pending/Denial on the 30th day following the date of application.
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(A) Medical Expenses. The amount of allowable medical expenses, including the amount of reimbursement (for example, by a third-party insurer), must be verified before the initial certification, if use of the expenses would result in a deduction. Additional verifications relevant to the claimed medical expenses, such as whether the services provided are allowable, are not required unless the information provided by the applicant or recipient is questionable pursuant to 106 CMR 361.620: Questionable Information. (B) Other Expenses. Other deductible expenses must be verified before initial certification only when questionable and use of the expense claimed by the household would actually result in a deduction. If a deductible expense must be verified, but obtaining the verification would delay the household's certification, the worker must inform the household that it may elect to be certified without receiving the deduction for the unverified expense. If the household subsequently provides the missing verification, the case manager shall treat the information as a reported change and provide increased benefits, if any, in accordance with the timeliness standards for reported changes. The household is not entitled to lost benefits unless the expense could not be verified within the 30-day application processing standard because the worker did not allow the household at least ten days from the date of the initial request to provide the verification or because the worker did not provide the household assistance when required. Households ineligible because a claimed, but unverified expense, is disallowed must be sent a Notice of Pending/Denial on the 30 day following the date of application. th