Section He-W 606.89 - In and Out Medically Needy Medical Assistance(a) When requested to do so by the district office in accordance with He-W 678.01, the client shall provide documentation of the following: (1) Incurred current medical expenses and obligated prior medical debts, including those of individuals and family members living in the same household as described in He-W 601.72 and He-W 601.74, 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) District office 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 district office 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.N.H. Admin. Code § He-W 606.89
(See Revision Note at Chapter Heading 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