Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-308-4

Verification of Eligibility and Information Exchange

Notice of Proposed Rule

(Amendment)

DAR File No.: 34049
Filed: 09/01/2010 10:19:24 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to include verification requirements for the electronic match system that the Department uses to verify an applicant's citizenship and identity.

Summary of the rule or change:

This amendment adds verification requirements for the electronic match system that the Department uses to verify an applicant's citizenship and identity.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 18
• 42 U.S.C. 1396a(ee)(1)(B)

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any new costs or savings to the state budget because Medicaid applicants who declare United States Citizenship will continue to receive Medicaid services during the verification process.

local governments:

There is no impact to local governments because they do not determine Medicaid eligibility.

small businesses:

There is no budget impact because this change does not impose any new requirements on small businesses.

persons other than small businesses, businesses, or local governmental entities:

There is no budget impact because this change does not impose any new requirements on Medicaid providers and clients. In addition, Medicaid applicants who declare United States Citizenship will continue to receive Medicaid services during the verification process.

Compliance costs for affected persons:

There are no compliance costs because this change does not impose any new requirements on a single Medicaid provider or client. In addition, a Medicaid applicant who declares United States Citizenship will continue to receive Medicaid services during the verification process.

Comments by the department head on the fiscal impact the rule may have on businesses:

This clarification of the citizenship verification process is not expected to change the reimbursement to any provider.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/15/2010

This rule may become effective on:

10/22/2010

Authorized by:

David Sundwall, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-308. Application, Eligibility Determinations and Improper Medical Assistance.

R414-308-4. Verification of Eligibility and Information Exchange.

(1) Medical assistance applicants and recipients must verify all eligibility factors requested by the eligibility agency to establish or to redetermine eligibility. Medical assistance applicants and recipients must provide identifying information that the eligibility agency needs to meet the requirements of 42 CFR 435.945, 435.948, 435.952, 435.955, and 435.960.

(a) The eligibility agency will provide the client a written request of the needed verification[s].

(b) The client has at least 10 calendar days from the date the eligibility agency gives or mails the verification request to the client to provide verification[s].

(c) The due date for returning verification[s], forms or information requested by the eligibility agency is the close of business on the date the eligibility agency sets as the due date in a written request to the client, but not less than 10 calendar days from the date such request is given to or mailed to the client.

(d) The eligibility agency shall allow[s] the client additional time to provide verification[s] if the client requests additional time by the due date. [The agency will set a new due date that is at least 10 days from the date the client asks for more time to provide the verifications, forms or information.]The eligibility agency shall set a new due date based on what the client needs to do to obtain the verification and whether the client shows a good faith effort to obtain the verification.

(e) If a client has not provided required verification[s] by the due date, and has not contacted the eligibility agency to ask for more time to provide verification[s], the eligibility agency shall den[ies]y the application, [re-certification]review, or end[s] eligibility.

(f) If the eligibility agency receives all necessary verification[s] during the 30 days after denying an application for lack of verification[s], the date the eligibility agency receives all the verification[s] is the new application date. If the eligibility agency receives verification[s] more than 30 days after the application has been denied, the client will need to reapply for medical assistance.

(2) The eligibility agency must receive verification of an individual's income, both unearned and earned. To be eligible under [Section 1902(a)(10)(A)(ii)(XIII),] the Medicaid Work Incentive program, the eligibility agency may require proof such as paycheck stubs showing deductions of FICA tax[;], self-employment tax filing documents[;], or for newly self-employed individuals who have not filed tax forms yet, a written business plan and verification of gross receipts and business expenses, to verify that the income is earned income.

(3) If an applicant's citizenship and identity do not match through the Social Security electronic match process and the eligibility agency cannot resolve this consistency, the agency shall request the applicant to provide verification of his citizenship and identity in accordance with 42 U.S.C. 1396a(ee)(1)(B).

(a) The applicant must provide verification to resolve the inconsistency or provide original documentation to verify his citizenship and identity within 90 days of the request.

(b) The eligibility agency shall continue to provide medical assistance during the 90-day period if the individual meets all other eligibility criteria.

(c) If the applicant fails to provide verification, eligibility ends within 30 days after the 90-day period. The eligibility agency cannot extend or repeat the verification period.

(d) An individual who provides false information to receive medical assistance is subject to investigation of Medicaid fraud and penalties as outlined in 42 CFR 455.13 through 455.23.

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [January 1], 2010

Notice of Continuation: January 31, 2008

Authorizing, and Implemented or Interpreted Law: 26-18