Verification Requirements for In and Out Medically Needy Medical Assistance

(a) When requested to do so by the department in accordance with He-W 878.01, the client shall provide documentation of the following:

(1) Incurred current medical expenses and obligated prior medical debts, including those of individuals of a family, as defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for whom the client is liable;

(2) Medical services and amounts that are subject to third party reimbursement or insurance coverage; and

(3) The relationship between the client and the individual for whom medical expenses are claimed.

(b) Acceptable documentation of the above criteria shall include, but not be limited to:

(1) Provider bills, reminder notices and collection agency notices which are dated within 30 days of the month to which the debt is expected to be applied;

(2) A statement from the insurance company of the intent to pay covered charges, or the medical service provider's bill showing insurance payment;

(3) D epartment collateral verification by letter or telephone with the insurance or medical provider of the charges and allowances toward medical services;

(4) Historical data previously received by the department which documents the amount of the charges and allowances toward recurring medical services; and

(5) A birth certificate, baptismal record, marriage certificate, or other document that establishes the relationship between the client and the individual for whom medical expenses are claimed.

Source. (See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by #5508, eff 12-1-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14 (See Revision Note at Part heading for He-W 806)