Common use of Co-Pays Clause in Contracts

Co-Pays. If Contractor implements co-pays those co-pays shall not exceed the Department’s Fee for Service co-pays. The Contractor shall report on the Members usage and co-payments, including recognition of the accumulation indicators for maximum out-of-pocket co-payments and cost sharing capitations per period that are shared through system files transmissions. The co-payment requirements for the Medicaid Program can be found in 907 KAR 1:604. Any cost sharing imposed by the Contractor shall be in accordance with 42 CFR §§447.50 through 447.82. Whether the Contractor imposes such co-pays or not, the actuarial value of the co- pays will be reflected in the Capitation Rate. The Department may, at its discretion, mandate the imposition or collection of co- pays with at least ninety (90) days written notice to the Contractor.

Co-Pays. If Contractor implements co-pays those co-pays shall not exceed the Department’s Fee for Service co-pays. The Contractor shall report on the Members usage and co-payments, including recognition of the accumulation indicators for maximum out-of-pocket co-payments and cost sharing capitations per period that are shared through system files transmissions. The co-payment requirements for the Medicaid Program can be found in 907 KAR 1:604. Any cost sharing imposed by the Contractor shall be in accordance with 42 CFR §§447.50 through 447.82. Whether the Contractor imposes such co-pays or not, the actuarial value of the co- co-pays will be reflected in the Capitation Rate. The Department may, at its discretion, mandate the imposition or collection of co- pays with at least ninety (90) days written notice to the Contractor.