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, Medical Assistance Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs and one dollar ($1.00) 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, Medical Assistance Enrollees shall pay copayments of three dollars ($3) per non- preventive visit. For the 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; Medical Assistance 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 Medical Assistance Enrollees. 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. For Medical Assistance, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income.

Medicaid Cost-Sharing Amounts. ‌  Except for anti-psychotic drugs for which no copayment is required, Medical Assistance Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs drugs, and one dollar ($1.001) 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, Medical Assistance Enrollees shall pay copayments of three dollars ($33.00) per non- non-preventive visit. For the 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; Medical Assistance  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, deductible for Medical Assistance Enrolleesboth 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. For Medical Assistance, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income.

Medicaid Cost-Sharing Amounts. ‌  Except for anti-psychotic drugs for which no copayment is required, Medical Assistance Enrollees shall pay copayments of three dollars ($3.00) per prescription for brand name drugs drugs, and one dollar ($1.001) 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, Medical Assistance Enrollees shall pay copayments of three dollars ($33.00) per non- non-preventive visit. For the 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; Medical Assistance 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, deductible for Medical Assistance Enrolleesboth 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. For Medical Assistance, Enrollees’ total monthly cost-sharing must not exceed five percent (5%) of family income.