405 IAC 1-8-4 - Client copayment

Current through March 30, 2022

Authority: IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-15-6-3; IC 12-15-6-4

Sec. 4.

(a) Except for those categories of individuals and services specifically exempted in subsection (e), Medicaid members shall be responsible for paying directly to providers a set portion of the payment for nonemergency services provided in an emergency room setting. Services defined as nonemergency shall be determined by the office.
(b) The amount of copayment to be charged shall be three dollars ($3) for nonemergency services provided in emergency room settings.
(c) The provider shall be responsible for collecting the appropriate copayment amount from the member.
(d) Participating providers may not deny services to any eligible individual on account of the individual's inability to pay the copayment amount. This services guarantee does not apply to an individual who is able to pay, nor does an individual's inability to pay eliminate the individual's liability for the copayment.
(e) The following categories of members and services are exempt from the copayment requirements:
(1) Services provided to children under eighteen (18) years of age.
(2) Services provided to pregnant women.
(3) Family planning services.
(4) Services provided by a health maintenance organization (HMO) to members enrolled in an HMO.
(5) Medicaid members residing in participating long term care facilities.
(f) The copayment shall be made by the members and collected by the provider. Medicaid reimbursement shall be adjusted to reflect the copayment amount.


405 IAC 1-8-4
Office of the Secretary of Family and Social Services; 405 IAC 1-8-4; filed Dec 2, 1993, 2:00 p.m.: 17 IR 736; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

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