(a) The State must make available to the groups in paragraph (b) of this section a public schedule that contains the following information:
(1) Current premiums, enrollment fees, or similar fees.
(2) Current cost sharing charges.
(3) The aggregate limit on premiums and cost sharing or just cost sharing.
(4) Mechanisms for making payments for required premiums and charges.
(5) The consequences for an applicant or recipient who does not pay a premium or charge.
(6) A list of hospitals charging alternative cost sharing for non-emergency use of the emergency department.
(7) Either a list of preferred drugs or a method to obtain such a list upon request.
(b) The State must make the public schedule available to the following:
(1) Beneficiaries, at the time of their enrollment and reenrollment after a redetermination of eligibility, and when premiums, cost sharing charges, or aggregate limits are revised.
(2) Applicants, at the time of application.
(3) All participating providers.
(4) The general public.
(c) Prior to submitting to the Centers for Medicare & Medicaid Services for approval a State plan amendment (SPA) to establish alternative premiums or cost sharing under section 1916A of the Act or an amendment to modify substantially an existing plan for alternative premiums or cost sharing, the State must provide the public with advance notice of the amendment and reasonable opportunity to comment with respect to such amendment in a form and manner provided under applicable State law, and must submit documentation with the SPA to demonstrate that this requirement was met.
[73 FR 71851, Nov. 25, 2008, as amended at 75 FR 30264, May 28, 2010]
Title 42 published on 2012-10-01
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