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Rule Title: MENTAL HEALTH SERVICES PLAN, APPLICATION FORMS, INCOME VERIFICATION
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Department: PUBLIC HEALTH AND HUMAN SERVICES, DEPARTMENT OF
Chapter: MEDICAID PRIMARY CARE SERVICES
Subchapter: Physician Services
 
Latest version of the adopted rule presented in Administrative Rules of Montana (ARM):

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37.86.108    MENTAL HEALTH SERVICES PLAN, APPLICATION FORMS, INCOME VERIFICATION

(1) Application forms and information regarding eligibility for the plan are available at all local county human services departments.

(2) The applicant must submit with the application form a completed and signed income statement and the necessary documentation to verify the income reported.

(3) For purposes of (2), necessary income verification may include one or more of the following or other appropriate and persuasive documentation:

(a) pay stubs or other pay statements;

(b) employee's W-2 forms;

(c) state or federal income tax returns and associated forms and schedules;

(d) union records;

(e) check copies;

(f) self-employment bookkeeping records;

(g) sales and expenditure records;

(h) employer's wage or payroll records;

(i) award notices or award letters;

(j) correspondence specifying a benefit;

(k) records of any government payer;

(l) court records or correspondence from attorneys;

(m) financial institution records;

(n) insurance company correspondence or records; or

(o) college or university financial aid correspondence or records.

History: 41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA; IMP, 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA; NEW, 2001 MAR p. 27, Eff. 1/12/01.


 

 
MAR Notices Effective From Effective To History Notes
1/12/2001 Current History: 41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA; IMP, 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA; NEW, 2001 MAR p. 27, Eff. 1/12/01.
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