Cost Sharing Amounts. Except for anti-psychotic drugs for which no copayment is required, Adult MinnesotaCare Enrollees shall pay copayments of twenty dollars ($20.00) per prescription for brand name drugs and six dollars ($6.00) per prescription for generic drugs, with a combined maximum of sixty dollars ($60.00) per month. Adult MinnesotaCare Enrollees shall pay copayments of twenty-five dollars ($25.00) per pair of eyeglasses. Non-preventive visit: Except for mental health or chemical dependency services which are exempt from this copayment, MinnesotaCare Enrollees shall pay a copayment of fifteen dollars ($15.00) per visit. For the purposes of this paragraph, a “visit” means an episode of service which is required because of an Enrollee’s symptoms, diagnosis, or established illness; and delivered in an ambulatory setting by a physician (including physician ancillary services visits billed under the physician’s NPI), chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist. Emergency department visit: Fifty dollars ($50.00), per visit. Emergency department visits resulting in an inpatient admission will be charged only the inpatient admission copayment. Inpatient hospital, one hundred and fifty dollars ($150.00), per admission. Outpatient hospital visit, twenty-five dollars ($25.00) per visit. Ambulatory surgery, fifty dollars ($50.00) per visit. If ambulatory surgery is performed in an outpatient hospital setting, no additional outpatient hospital visit copayment described in (6) above will apply. Radiology service, twenty-five dollars ($25.00), one copayment per visit regardless of the number of procedures. The MCO agrees to waive the family deductible for MinnesotaCare Enrollees. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting.
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