SECTION .0300 ‑ ELIGIBILITY PROCEDURES

 

10A NCAC 45A .0301       INCOME DOCUMENTATION

(a)  Documentation of earned income of the

patient's family is required before services can be authorized in the following

circumstances:

(1)           Whenever the applicant is requesting

payment program benefits for inpatient services, even when outpatient services

have been previously authorized.

(2)           Whenever medical expense

deductions from income exceed three thousand dollars ($3,000).

(3)           Whenever eligibility

personnel have reason to believe information given may be inaccurate.

(4)           Whenever the Department

requests documentation for quality control purposes.

(b)  Documentation of income is not required

for patients financially eligible pursuant to Rule .0202(g) of this Subchapter.

(c)  For purposes of this Rule, earned income

means salaries, wages, and self‑employment income.

(d)  Eligibility personnel may require

documentation of any component used in computing a patient's annual net family

income.

(e)  Notwithstanding the provisions of

Subparagraph (a)(2), eligibility personnel are not required to demand

documentation of information concerning the earned income of the patient's

family when reimbursement for inpatient services is requested through local

health department delivery funds, 10A NCAC 43C .0200 or perinatal program high

risk maternity clinic reimbursement funds, 10A NCAC 43C .0300.

 

History Note:        Authority G.S. 130A‑5(3); 130A‑124;

130A‑127; 130A‑129; 130A‑205;

Eff. July 1, 1981;

Amended Eff. July 1, 1983; April 1, 1982; January 1,

1982;

Transferred and Recodified from 10 NCAC 4C .0301 Eff.

April 4, 1990;

Amended Eff. January 1, 1996; October 1, 1994; December

1, 1990;

Pursuant to G.S. 150B-21.3A, rule is necessary without

substantive public interest Eff. January 13, 2015.