Common use of Medicaid Cost-Sharing Amounts Clause in Contracts

Medicaid Cost-Sharing Amounts. Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, and one dollar ($1) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.00) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting Cost-sharing and Family Income. (a) For MSC+ Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.

Medicaid Cost-Sharing Amounts. (1) Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, drugs and one dollar ($11.00) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. . (2) Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.003) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; ; (3) Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. . (4) The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting reporting. (5) Cost-sharing Sharing and Family Income. (a) . For MSC+ SNBC Medicaid-only Enrollees, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. . (a) For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent (5%) limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.

Medicaid Cost-Sharing Amounts. (1) Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.003) per prescription for brand name drugs, and one dollar ($1) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. . (2) Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments a copayment of three dollars ($3.003) per non-preventive nonpreventive visit. For purposes of this paragraphsubdivision, a “visit” means an episode of service which is required because of an Enrollee’s symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; ; (3) Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. . (4) The MCO agrees to waive the monthly family deductible for of two dollars and fifty-five cents ($2.55) or as updated by CMS. This waiver applies to both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting under section 9.10.3. (5) Cost-sharing and Family Income. (a) . For MSC+ Enrollees’ only, individuals identified by the commissioner with income at or below one hundred percent (100%) of the federal poverty guidelines, total monthly cost-sharing must not exceed five percent (5%) of family income. For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee individual and the Enrolleeindividual’s spouse, if the spouse is enrolled in Medical Assistance medical assistance and also subject to the five percent limit on cost-cost- sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.

Medicaid Cost-Sharing Amounts. ‌ Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, and one dollar ($1) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.00) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting Cost-sharing and Family Income. (a) For MSC+ Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6).a)(6).‌ (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.sharing.‌

Medicaid Cost-Sharing Amounts. ‌ Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, drugs and one dollar ($11.00) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.003) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting reporting. Cost-sharing Sharing and Family Income. (a) . For MSC+ SNBC Medicaid-only Enrollees, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent (5%) limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) . The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.sharing.‌‌ Inability to Pay Cost-Sharing. The MCO must ensure that no Provider deny Covered Services to an Enrollee because of the Enrollee’s inability to pay the cost- sharing pursuant to 42 CFR § 447.52. The MCO must ensure that Enrollees can obtain services from other Providers.‌

Medicaid Cost-Sharing Amounts. (1) Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, and one dollar ($1) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. . (2) Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.00) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; ; (3) Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. . (4) The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting reporting (5) Cost-sharing and Family Income. (a) For MSC+ Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.

Medicaid Cost-Sharing Amounts. ‌ (1) Except for anti-psychotic drugs for which no copayment is required, Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs, drugs and one dollar ($11.00) per prescription for generic drugs, with a combined maximum of twelve dollars ($12.00) per month. . (2) Except for mental health services which are exempt from this copayment, Enrollees shall pay copayments of three dollars ($3.003) per non-preventive visit. For 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 which is delivered in an ambulatory setting by a physician or physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse, audiologist, optician, or optometrist; ; (3) Enrollees shall have a copayment for non-emergency use of the emergency department of three dollars and fifty cents ($3.50) per visit. . (4) The MCO agrees to waive the monthly family deductible for both MSHO and MSC+. The STATE will provide the amount no later than December 1 of the previous calendar year. The MCO must track the amounts for reporting reporting. (5) Cost-sharing Sharing and Family Income. (a) . For MSC+ SNBC Medicaid-only Enrollees, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income. . (a) For purposes of this paragraph, family income is the total earned and unearned income of the Enrollee and the Enrollee’s spouse, if the spouse is enrolled in Medical Assistance and also subject to the five percent (5%) limit on cost-sharing as authorized by Minnesota Statutes, § 256B.0631, subd. 1, (a)(6). (b) The MCO must provide to the Enrollee a notice, within five (5) days of adjudicating the claim that causes the total cost-sharing to exceed five percent (5%), for each month the Enrollee meets the five percent (5%) limit on cost- sharing.