13 CSR 40-7.040 - Verification Procedures
(1) The division shall verify all eligibility
factors, through available means, including information obtained through the
electronic data hub, a participant's statements, or other information the
division has obtained. Verification shall occur upon application and
recertification, and at any other time necessary to verify continued
eligibility.
(A) The division shall verify
eligibility information of a participant through the electronic data
hub.
(B) If the information
obtained through the electronic data hub is reasonably compatible with
information provided by or on behalf of the participant, the division shall use
the participant's information as verification for eligibility.
(C) If reasonably compatible standards are
not met, secondary verification is required. Secondary verification may include
the following:
1. Other electronic data
sources available;
2. Other
information, including paper documentation; or
3. A written statement which reasonably
explains the discrepancy.
(2) If verification cannot be obtained by the
division through the electronic data hub, or if the information is not
reasonably compatible with other information provided, the division shall ask
for any additional information from or on behalf of the participant needed in
order to verify the information.
(A) The
participant shall provide the required verification within ten (10) days from
the date that the division requests the information in writing.
(B) A participant may request additional time
to provide the information. The additional time shall be granted if the
participant is making a reasonable effort to obtain the information.
(C) If a participant fails to provide the
requested verification within ten (10) days from the date of the written
request or fails to obtain additional time to provide the information, the
division shall issue an adverse action notice to the participant notifying them
that their coverage is denied or their coverage shall terminate ten (10) days
from the date of the adverse action notice.
(D) The participant shall be given the right
to request a hearing on the issue pursuant to section
208.080, RSMo. Failure on the
part of the participant to request a hearing shall result in termination of
coverage upon expiration of the adverse action notice.
(3) This rule shall be effective for all
eligibility decisions made on January 1, 2014, and any date after.
Notes
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