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.

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 or substance use disorder 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.

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.