1322.4 Special Verification Provisions - The following special provisions apply to the Medical Assistance programs. See also 7123(2) (Reasonable Compatibility) and 7123(3) (Budgeting Method).
1. Tiered Verification - The medical assistance programs will use a four-tiered approach to verifying information needed to determine eligibility. This method means the agency will try to verify reported information as much as possible before contacting the consumer for the information. The verification process will proceed in order from Tier 1 through Tier 4. It is acceptable to return to a prior Tier to verify information when a new self-attestation is received or when an administrative error is made. For example, when a Reasonable Compatibility test has already been completed in Tier 2, staff may return to Tier 2 to repeat the RC test when the consumer has clarified information or provides new information.
a. Tier 1 - Reported information is verified through the use of a payer source interface (Federal Hub, Social Security, Unemployment Compensation, KPERS). Since this data comes directly from the source of the reported information, it is considered verified. Note: If there is a difference between the reported SSA or SSI amount and the amount verified through the Federal HUB, the Social Security interface (EATSS) may be accessed to resolve the discrepancy. Reported unearned income not verifiable through a payer source interface shall be verified as indicated in 1321 and subsections.
b. Tier 2 -Reported information is verified through the use of a secondary non-payer source interface (i.e., The Work Number (TALX), Kansas Department of Labor (KDOL), the Asset Verification Solution (AVS)). This data does not come directly from the source of the reported information, but may be used for verification. Use of Tier 2 interfaces to verify earned income for Working Healthy (WKH) and Long Term Care (LTC) is not appropriate. See (c) and (d) below.
Note: See 1322.4(2) for more information about using the AVS as a verification source.
c. Tier 3 -Manual research by the eligibility worker is required. This may include review of the Medical and Non-Medical case files, reconciling information received from Tier 2 interfaces, checking other available program information, and making collateral contacts. Any decision to verify reported information at this level must be thoroughly documented.
In addition, the manual research shall progress through the following steps in the order listed:
i. The Work Number - When The Work Number data is not successful in establishing reasonable compatibility for reported or no reported earned income in Tier 2, the interface data is used as outlined in 7123.2. If Work Number data is not available, proceed to researching the medical case file.
ii. Medical Case File - The medical case file shall be searched for hard copy verification of the reported information. If no hard copy information is found in the medical case file, proceed to the DCF images.
iii. Department for Children and Families (DCF) Images - A manual search of the DCF case records shall be completed for usable images to satisfy verification requirements if a consumer was part of a DCF case for a relevant time period. If verification cannot be obtained from DCF images, proceed to collateral contact.
iv. Collateral Contact – Collateral contact shall be made to verify the reported information, when deemed appropriate. If verification cannot be made via collateral contact, proceed to Tier 4 level verification.
d. Tier 4 - As a last resort when the reported information cannot be verified through any other means, contact with the consumer is required. Normally a formal request for information will be sent to the consumer to provide verification. However, in some instances, a phone contact with the consumer may be sufficient.
2. Resource Verification - There are no payer interface sources for verification of resources.
a. At application, all resources for resource-tested medical assistance programs shall be verified as described in 1322.1(9) and 1322.3(3).
b. When processing a Pre-Populated Review, the Asset Verification Solution (AVS) shall be used to verify bank account information as described in 1322.3(3) and 9333.
3. Expense Verification - Since there are no interface sources for verification of medical expenses (i.e., health insurance premiums, medical bills) or household expenses used to determine the excess shelter expense for spousal impoverishment income allocation [8144.2(1)(b) and 8244.2(2)], those expenses shall be verified as described in 1322.2(2).
4. Prior Medical Period Verification - For all medical assistance programs except long term care (LTC), verification of income and resources in a prior medical assistance period shall proceed as follows:
a. No Change Reported - If an individual requesting prior medical assistance reports that there has been no change in income or resources in the prior months from the application month, income and resources verified in the current period are considered verified in the prior period as well and will be budgeted for each of those months.
b. Change Reported - If the individual reports that there has been a change in income and/or resources in the prior period, verification of actual income and/or resources for each of the prior months must be obtained as indicated above. The verified actual income and/or resource amounts will be budgeted for each month of the prior period.