Common use of Co-Payments Clause in Contracts

Co-Payments. A. The Contractor may submit service claims to Participants' private insurance carriers and/or to Medicare/Medicaid (if the Contractor is a Medicare/Medicaid provider) for co- payment reimbursement. Upon the insurance/Medicare/Medicaid payment exceeding the allowed co-payment amounts (as defined in Sections G.4.3.B-D), the Participant is no longer eligible for subsidy, pursuant to Section G.4.4. The Contractor is responsible for knowing and understanding the terms and requirements set forth by Medicare/Medicaid with regard to reimbursement. B. For Participants who have demonstrated an ability to pay a co-payment per Section C.6 toward evaluation Services but whose evaluation is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each Participant and Department’s subsidy Payment per evaluation. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from Department (Section B.2). C. For Participants receiving treatment in a group setting who have demonstrated an ability to pay a co-payment per Section C.6 toward treatment Services but whose treatment is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each group Participant and Department’s subsidy Payment per group session. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from the Department (Section B.2). D. For Participants receiving treatment in an individual setting who have demonstrated an ability to pay a co-payment per Section C.6 toward individual treatment Services but whose treatment is subsidized, the Contractor shall establish a MAXIMUM payment which the Contractor may collect from each individual-therapy Participant and Department’s subsidy Payment per individual treatment session. The Contractor shall provide the maximum payment amount which shall include the maximum co-payment expected to receive from the Participant plus (+) the maximum subsidized Payment expected to be received from the Department (Section B.2). E. Collection of co-payments shall be in accordance with the following requirements. The Contractor shall: 1. Not employ Participants in any manner to "work off" the fee; 2. Not terminate Participants or exclude Participants from treatment for failure to pay their established and agreed-upon fee, unless this decision is jointly agreed upon by the Contractor, Treatment Provider, and the supervising parole officer; 3. Not withhold treatment reports to include evaluation reports for failure to pay; and 4. Furnish a receipt to the Participant and maintain a copy of the receipt for review by the Department.