1. (1) Medicaid and Medicare/Medicaid related recipients are required to pay and the FQHCs are required to collect the established copayment amount for each medical encounter.

2. (2) The cost-sharing amount does not apply to services provided for the following:

   1. (a) Recipients under 18 years of age
   2. (b) Emergencies
   3. (c) Pregnancy
   4. (d) Family Planning
   5. (e) Nursing home residents
   6. (f) American Indians
3. (3) A provider may not deny services to any eligible individual based on the individual's inability to pay the copayment amount.

Author: Carol Akin, Associate Director, Clinic/Ancillary Services

Statutory Authority: State Plan, Attachment 4.18-A; Title XIX, Social Security Act; 42 C.F.R. §§447.50, 447.53, 447.55, et seq.

History: Emergency rule effective October 1, 1990. Permanent rule effective January 15, 1991. Amended: Filed January 19, 2011; effective February 23, 2011.