(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.