Kan. Admin. Regs. § 30-5-71 - Copayment requirements
(a) Except as set
forth in subsection (b) of this regulation, program recipients shall be
obligated to the provider for the following copayment charges.
(1) The copayment for inpatient general
hospital and freestanding psychiatric facility services shall be $48.00 per
admission.
(2) The copayment for
outpatient general hospital services shall be $1.00 per non-emergency visit in
place of a doctor's office visit.
(3) The copayment for other medical services
subject to copayment shall be based upon the following ranges:
average medicaid/medikan payment for services maximum copayment chargeable to recipient
$10.00 or less $.50
$10.01 to $25.00 $1.00
$25.01 to $50.00 $2.00
$50.01 or more $3.00
(4) The copayment for other medical services
subject to copayment shall be a standard amount based upon the average medicaid
payment for the services, calculated on an annual basis. The average medicaid
payment shall be calculated by dividing the cost of the services in aggregate
by the total number of claims paid in the previous fiscal year. Any change in
copayment shall be published in the Kansas Register on or before December
fifteenth to be effective January first of each year.
(5) Other medical services subject to
copayment shall include the following:
(A)
Ambulatory surgical center services, for each date of service;
(B) audiological services, excluding
batteries, for each date of service;
(C) community mental health center services,
for each individual psychotherapy visit;
(D) durable medical equipment, prosthetics,
and orthotics, for each claim, excluding the rental of durable medical
equipment;
(E) home health
services, for each skilled nursing visit, excluding the rental of durable
medical equipment;
(F)
non-emergency ambulance services, for each date of service;
(G) optometric or opthalmologist services,
for each date of service;
(H)
outpatient general hospital surgery, for each date of service;
(I) prescribed drugs, for each new or
refilled prescription;
(J)
physician or physician extender services, for each office visit;
(K) podiatric services, for each office
visit;
(L) psychological services,
for each office visit;
(M)
dietician services, for each date of service;
(N) dental services, for each date of
service;
(O) federally qualified
health center services, for each encounter; and
(P) rural health clinic services, for each
encounter.
(b) The provisions of subsection (a) shall
not apply to services provided as follows:
(1) To residents in nursing facilities,
including swing beds, intermediate care facilities for the mentally retarded,
nursing facilities for mental health, and to recipients participating in the
home-and community-based services programs;
(2) to inpatients in a state psychiatric
hospital who meet both of the following conditions:
(A) Have reached the age of 18 but are not
yet 22 years of age; or
(B) are at
least 65 years of age;
(3) to recipients under age 18;
(4) to recipients in the custody of the
juvenile justice authority or secretary of social and rehabilitation services
who are at least 18 years old but under age 21 and who are in out-of-home
placements;
(5) to recipients
enrolled in a medicaid-funded health maintenance organization;
(6) for family planning purposes;
(7) for medical services relating to an
injury incurred on the job during a community work experience project;
(8) for services related to
pregnancy; and
(9) for emergency
services.
Notes
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