Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Effective July 1, 2010, federal regulations at 42 CFR 447.78 place aggregate limits on cost- sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, member debt collected and/or other cost-sharing information available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.
Member Cost-Sharing. 4.6.15.1 The Contractor shall ensure that Providers collect Member co-payments as specified in Attachment K.
Member Cost-Sharing. As specified in OAC rules 5101:3-26-05(D) and 5101:3-26-12, MCPs are permitted to impose the applicable member co-payment amount(s) for dental services, vision services, non-emergency emergency department services, or prescription drugs, other than generic drugs. MCPs must notify ODJFS if they intend to impose a co-payment. ODJFS must approve the notice to be sent to the MCP’s members and the timing of when the co-payments will begin to be imposed. If ODJFS determines that an MCP’s decision to impose a particular co-payment on their members would constitute a significant change for those members, ODJFS may require the effective date of the co-payment to coincide with the “Annual Opportunity” month. Notwithstanding the preceding paragraph, MCPs must provide an ODJFS-approved notice to all their members 90 days in advance of the date that the MCP will impose the co-payment. With the exception of member co-payments the MCP has elected to implement in accordance with OAC rules 5101:3-26-05(D) and 5101:3-26-12, the MCP’s payment constitutes payment in full for any covered services and their subcontractors must not charge members or ODJFS any additional co-payment, cost sharing, down-payment, or similar charge, refundable or otherwise. Appendix G
Member Cost-Sharing. As specified in Appendix A, Section 3.3 of the Three-Way, the MCOP may elect to implement co-payments for Medicaid-covered drugs but shall not charge cost sharing to members above levels established under the Medicare Part D Low Income Subsidy. Pursuant to Appendix C, Section 3.3(C) of the Three-Way, members who reside in a nursing facility or are enrolled in the MyCare 1915(c) waiver may be required to contribute to the cost of care the amount of patient liability established by the County Department of Job and Family Services.
Member Cost-Sharing. As specified in OAC rules 5160-26-05 and 5160-26-12, the MCP is permitted to impose the applicable member co-payment amount for dental services, vision services, non-emergency emergency department services, or prescribed drugs, the MCP shall notify ODM if they intend to impose a co-payment. ODM shall approve the notice to be sent to the MCP’s members and the timing of when the co-payments will begin to be imposed. If ODM determines the MCP’s decision to impose a particular co-payment on their members would constitute a significant change for those members, ODM may require the effective date of the co-payment to coincide with the “Open Enrollment” month. Notwithstanding the preceding paragraph, the MCP shall provide an ODM-approved notice to all their members 90 calendar days in advance of the date that the MCP will impose the co- payment. With the exception of member co-payments the MCP has elected to implement in accordance with OAC rules 5160-26-05 and 5160-26-12, the MCP’s payment constitutes payment in full for any covered services and their subcontractors shall not charge members or ODM any additional co-payment, cost sharing, down-payment, or similar charge, refundable or otherwise.
Member Cost-Sharing. A. Any applicable Deductibles, Copayments and/or Coinsurance will be waived for services provided by a CCC, an HCC, an LCC, or a Care Coordination Team that are Designated Providers in connection with the service provided in Section 14.2 when the Qualified Individual participates in one of the programs described in this section. However, if the Qualified Individual’s Agreement is compatible with a federally-qualified Health Savings Account, then the Qualified Individual will be responsible for any associated costs for Covered Services provided when the Qualified Individual participates in one of these programs until the annual Deductible has been met.
Member Cost-Sharing. 4.5.11.1 The CONTRACTOR is responsible for implementation of copayments as directed by HSD.
Member Cost-Sharing. The Contractor shall adhere to State and Federal law, the State Plan and the requirements set forth in 42 CFR 447.50 through 447.57 when imposing any cost sharing charges on members. Federal regulations at 42 CFR 447.78 place aggregate limits on cost-sharing and prohibit total member cost-sharing per family from exceeding five percent (5%) of the family’s income, as determined by the State, in a monthly or quarterly period. To ensure a family’s total cost-sharing does not exceed five percent (5%) of the family’s income in a calendar quarter, the Contractor shall accept family income data from the State’s fiscal agent and track the copayments, premiums, member debt collected, and/or other cost-sharing information EXHIBIT 1.C SCOPE OF WORK available to the Contractor against the total family income data provided by the State. Any service not specifically listed as a covered benefit in the applicable benefit plan may not be applied against the member’s five percent (5%) contribution calculation. The time period for tracking data shall be defined by the State. When a family’s total cost-sharing expenditures come close to exceeding five percent (5%) of the family’s income in the quarterly period, the Contractor shall coordinate with the State and shall notify providers and the family that additional cost sharing during the period is reduced or waived. In monitoring the quarterly 5% member cost-sharing limit, the Contractor shall comply with the policies and procedures set forth in this section, as well as the additional policies and procedures included in the Hoosier Care Connect MCE Policies and Procedures Manual.
Member Cost-Sharing. Notwithstanding any provision in the Medicaid fee-for-service program which permits cost-sharing by Medicaid consumers, including provisions specific to the pharmacy benefit, MCPs must ensure compliance with OAC rule 5101:3-26-05(D)(10) which prohibits subcontracting providers from charging members any copayment, cost sharing, down-payment, or similar charge, refundable or otherwise. Appendix G
Member Cost-Sharing. Provider is responsible for the collection of co-payments, co-insurances, and deductibles, if any, from Members. Provider agrees to bill Members and collect such cost-sharing amounts from Members.
