1. (a) When requested to do so by the department in accordance with He-W 878.01, the client shall provide documentation of the following:

   1. (1) Incurred current medical expenses and obligated prior medical debts, including those of individuals of a family, as defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for whom the client is liable;
   2. (2) Medical services and amounts that are subject to third party reimbursement or insurance coverage; and
   3. (3) The relationship between the client and the individual for whom medical expenses are claimed.

2. (b) Acceptable documentation of the above criteria shall include, but not be limited to:

   1. (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. (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. (3) Department collateral verification by letter or telephone with the insurance or medical provider of the charges and allowances toward medical services;
   4. (4) Historical data previously received by the department which documents the amount of the charges and allowances toward recurring medical services; and
   5. (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.

Source. (See Revision Note #1 at Chapter heading for 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; ss by #10743, eff 12-12-14 (See Revision Note at Part heading for He-W 806)