Rule-Making Standards and Procedures s34

(10 CCR 2506-1)

4.502 VERIFICATION REQUIREMENTS AT APPLICATION, REDETERMINATION, AND PERIODIC REPORT

B. Verification Requirements at Redetermination and Periodic Report

1. Eligibility factors not verified by the Income and Eligibility Verification System (IEVS) should be verified at redetermination only if they are incomplete, inaccurate, questionable, inconsistent, or outdated and would affect a household's eligibility or benefit level. Unchanged information shall not be verified unless the information is outdated.

2. A change in total monthly earned income of one hundred dollars ($100) or more for each member must be verified at redetermination.

3. At redetermination, all households shall verify the following information if the source has changed or the amount has changed by more than twenty-five dollars ($25) since the last time they were verified:

a. Changes in unearned income;

b. Allowable medical expenses. SEE SECTION 4.407.61(B).

c. Legally-obligated child support;

d. Dependent care expenses;

4.407.6 Excess Medical Deduction

A household shall receive a deduction for total medical expenses in excess of thirty-five dollars ($35) per month, incurred by any household member(s) who is elderly or disabled as defined in Section 4.304.41. Other household members who are not elderly or disabled, including spouses and dependents, cannot claim costs of their medical treatment and services.

A. The following medical costs, less the cost of reimbursements from another source, are allowable:. IN CASES WHEN THE HOUSEHOLD CLAIMS A DEDUCTION FOR BILLED MEDICAL EXPENSES AND THE HOUSEHOLD IS UNABLE TO VERIFY WHETHER OR NOT ANY REIMBURSEMENT WILL BE RECEIVED, NO MEDICAL EXPENSE DEDUCTION SHALL BE ALLOWED UNTIL THE HOUSEHOLD EITHER RECEIVES REIMBURSEMENT FOR ALL OR PART OF THE EXPENSE OR IS ABLE TO VERIFY THAT REIMBURSEMENT WILL NOT BE PROVIDED. WHEN SUCH REIMBURSEMENT IS RECEIVED AND/OR VERIFIED, THE NON-REIMBURSED PORTION OF THE CLAIMED MEDICAL EXPENSE IS ALLOWED.

1. Medical and dental care including psychotherapy and rehabilitation services provided by a licensed practitioner or other qualified health professional.

2. Hospitalization or outpatient treatment, nursing care, and nursing home care including payments by the household for an individual who was a household member immediately prior to entering a hospital or nursing home provided by a facility recognized by the Colorado Department of Public Health and Environment.

3. Prescription drugs when prescribed by a licensed practitioner authorized under state law and other over-the-counter medication (including insulin) when approved by a licensed practitioner or other qualified health professional. Costs of medical supplies, sickroom equipment (including rental), or other prescribed equipment may also be allowable.

4. Health and hospitalization insurance policy premiums, Medicare premiums, and any cost-sharing expenses incurred by medical recipients.

5. Dentures, hearing aids, prosthetics, and eyeglasses prescribed by a physician skilled in eye disease or by an optometrist.

6. Securing and maintaining a service animal, such as a seeing-eye or hearing dog, including cost of food and veterinarian fees. The costs of caring for these animals may be deducted only when the animal has received special training to provide a service to the client.

7. Reasonable transportation and lodging to obtain medical treatment or services. Mileage expenses shall be calculated based on the prevailing Internal Revenue Service (IRS) mileage rate used for medical purposes.

8. Wages to an attendant, homemaker, home health aide, child care services, or a housekeeper necessary due to age, infirmity, or illness. In addition, an amount equal to the maximum allotment for one (1) person is allowed if the household furnishes the majority of the attendant's meals. The allotment shall be the one in effect at the time of certification with an appropriate adjustment at the next certification.

If attendant care costs qualify under both medical and dependent care deduction, the costs shall be allowed as a medical expense.

B. Non-allowable medical costs include, but are not limited to:

1. Special diet expenses;

2. Premiums for health and accident policies, such as those payable in lump sum settlements for death or dismemberment, or policies for income maintenance such as those that continue mortgage or loan payments while the beneficiary is disabled;

3. Medical expenses that are reimbursable by insurance or other public or private sources;

4. Medical marijuana shall not be an allowable medical deduction; and

5. Vitamins and supplements unless prescribed by a physician; AND.

6. MEDICAL EXPENSES CARRIED FORWARD FROM PAST BILLING PERIODS UNLESS ONE OF THE FOLLOWING CONDITIONS IS MET:

a.  THE AMOUNT IS BEING CARRIED FORWARD PENDING REIMBURSEMENT INFORMATION; OR,

b.  THE HOUSEHOLD HAS MADE ARRANGEMENTS TO MAKE MONTHLY INSTALLMENTS ON THE PAST DUE BILLS. THE PAST DUE AMOUNT MUST BE DUE TO MISSED PAYMENTS UNDER A PREVIOUS REPAYMENT AGREEMENT WITH THE MEDICAL PROVIDER, AND THE PAYMENT PLAN IS NOW BEING RENEGOTIATED WITH THE PROVIDER. THE NEGOTIATION OF A PAYMENT PLAN WITH A COLLECTION AGENCY WILL NOT BE ACCEPTED AS A RENEGOTIATED PAYMENT PLAN; OR,

c.  HOUSEHOLDS THAT BECOME CATEGORICALLY ELIGIBLE FOR FOOD ASSISTANCE BY REASON OF BECOMING A PURE SSI HOUSEHOLD SHALL BE ENTITLED TO EXCESS MEDICAL EXPENSES FOR THE PERIOD FOR WHICH THEY ARE AUTHORIZED TO RECEIVE SSI OR FROM THE DATE OF THE FOOD ASSISTANCE APPLICATION, WHICHEVER IS LATER. RESTORED BENEFITS SHALL BE ISSUED IF APPROPRIATE; OR,

d.  MEDICAL EXPENSES THAT OCCUR AFTER THE DATE AN APPLICATION IS FILED AND REPORTED AT THE SUBSEQUENT APPLICATION FOR REDETERMINATION OR PERIODIC REPORT SHALL BE CONSIDERED IF THE MEDICAL EXPENSE HAS NOT PREVIOUSLY BEEN REPORTED AND ALLOWED AS A MEDICAL DEDUCTION. IF AT RECERTIFICATION THE HOUSEHOLD PROVIDES PREVIOUSLY UNREPORTED MEDICAL EXPENSES THAT OCCURRED PRIOR TO THE LAST CERTIFICATION PERIOD THAT ARE PAST DUE, THE COUNTY DEPARTMENT SHALL REVIEW THE MEDICAL EXPENSES UNDER PROVISIONS A THROUGH C OF THIS SUBSECTION.

4.407.61 Determining Monthly Medical Expenses

A. In cases when the household claims a deduction for billed medical expenses, which the household can verify will neither be paid directly nor reimbursed by an insurance company government program or private individual, a deduction for the total amount over thirty-five dollars ($35) shall be allowed. A HOUSEHOLD THAT CONTAINS A MEMBER WHO IS ELIGIBLE FOR A MEDICAL EXPENSE DEDUCTION IS ELIGIBLE FOR A DEDUCTION USING EITHER THE STANDARD MEDICAL EXPENSE DEDUCTION (SMED) OR USING ACTUAL MEDICAL EXPENSES. BEGINNING OCTOBER 1, 2016, THE SMED IS ONE HUNDRED SIXTY FIVE DOLLARS ($165).

THE SMED IS USED IF THE TOTAL VERIFIED MEDICAL EXPENSES ARE GREATER THAN THIRTY FIVE DOLLARS ($35) AND LESS THAN OR EQUAL TO THE SMED. THE HOUSEHOLD MAY CLAIM ACTUAL EXPENSES IF THE TOTAL VERIFIED EXPENSES, AFTER DEDUCTING THE FIRST THIRTY FIVE DOLLARS (35$), EXCEED THE SMED.

B. Non-allowable medical costs include, but are not limited to:

1. Special diet expenses;

2. Premiums for health and accident policies, such as those payable in lump sum settlements for death or dismemberment, or policies for income maintenance such as those that continue mortgage or loan payments while the beneficiary is disabled;

3. Medical expenses that are reimbursable by insurance or other public or private sources;

4. Medical marijuana shall not be an allowable medical deduction; and

5. Vitamins and supplements unless prescribed by a physician.

C B. Expenses incurred weekly or biweekly shall be converted to a monthly amount using exact dollars and cents and the conversion method outlined in Section 4.402, A. The excess over thirty-five dollars ($35) per month is allowed as a monthly deduction.

D C. At the time of application and recertification, the household may elect to have one-time-only costs deducted in one month as a lump sum or averaged over the certification period to obtain a monthly amount. If the household elects to average the expenses over the certification period, the thirty-five dollar ($35) deduction shall be taken for each month of the certification period.

When a one-time-only medical expense is reported during a certification period, the amount may be deducted in a lump sum or averaged over the remainder of the certification period. Averaging would begin the month the change would be effective. If the household elects to average the expenses over the remainder of the certification period, the thirty-five dollar ($35) deduction shall be taken for each remaining month of the certification period.

WHEN AVERAGING THE MEDICAL EXPENSES, THE SMED IS BUDGETED FOR EACH MONTH OF THE CERTIFICATION PERIOD, AS LONG AS THE HOUSEHOLD’S ALLOWABLE AVERAGED MONTHLY MEDICAL EXPENSE IS GREATER THAN $35. IF THE EXPENSE RECURS MONTHLY OR MORE OFTEN, AND THE MEDICAL EXPENSE EXCEEDS $35 AND IS LESS THAN OR EQUAL TO THE SMED EACH MONTH, THE SMED IS BUDGETED FOR EACH MONTH OF THE CERTIFICATION PERIOD. WHEN ALLOWABLE MEDICAL EXPENSES FOR THE HOUSEHOLD EXCEED THE SMED AFTER DEDUCTING THE FIRST $35, THE ACTUAL MEDICAL EXPENSES ARE BUDGETED. THE FOLLOWING CHART IS USED TO DETERMINE WHEN TO BUDGET THE SMED OR ACTUAL MEDICAL EXPENSES.

4