Participant Verification

PURPOSE: This rule outlines how the Department of Social Services will verify participant information in order to administer the Family MO HealthNet programs and Children’s Health Insurance Program (CHIP). (1) Scope: This regulation specifies how the Department of Social Services shall verify participant information in order to administer the Family MO HealthNet programs and CHIP to prevent fraud and insure the integrity of the Family MO HealthNet programs and CHIP. (2) The “Federally Facilitated Marketplace” is created under section 1321(c)(1) of the Patient Protection and Affordable Care Act of 2010 (Public Law No. 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law No. 111-152). (3) The Department of Social Services shall access the electronic data hub, as defined in 13 CSR 40-7.010, to verify information provided by the participant as part of the application process for Family MO HealthNet programs and CHIP. The department shall only verify the following: (A) Citizenship; (B) Immigration status; (C) Income using Internal Revenue Service information; (D) Income from Title II benefits information from the Social Security Administration; (E) The number of work quarters from Social Security Administration; (F) Employment information; and (G) Confirm current enrollment in a MO HealthNet program. (4) The Department of Social Services shall also use the electronic data hub to send information on participants who are not eligible for Family MO HealthNet programs and CHIP to the Federal Facilitated Marketplace to verify if the participants qualify for advance payment of premium tax credit; cost-sharing reductions or qualified health plans. The Federally Facilitated Marketplace will use the electronic data hub to send information to the Department of Social Services to verify if participants qualify for Family MO HealthNet programs or CHIP or to verify if a participant is already enrolled in Family MO HealthNet programs or CHIP. (5) The Department of Social Services will not use, duplicate, or disclose any information used or obtained under this rule to any individual, organization, state or federal agency for any purpose not related to the public assistance benefits administered in whole or in part by the Department of Social Services as that phrase is defined in section 205.967.1(1), RSMo. All applicable state and federal laws and regulations governing the confidentiality of public assistance programs, health information, and taxpayer information shall govern the use or disclosure of information shared with or obtained from the electronic data hub. (6) All information used or obtained under this rule, unless otherwise prohibited by this rule, shall be destroyed in accordance with section 208.125, RSMo, unless otherwise required by law. AUTHORITY: section 208.990, RSMo Supp. 2013.* Original rule filed April 8, 2014, effective Oct. 30, 2014. *Original authority: 208.990, RSMo 2013.