1. (1) Medicaid and Medicare/Medicaid related recipients are required to pay and Provider-Based Rural Health Clinics are required to collect the established copayment amount for each clinic visit.

2. (2) The cost-sharing requirement 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 on account of the individual's inability to pay the copayment amount.

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

Statutory Authority: 42 C.F.R. Section 447.50; Section 447.53; Section 447.55; State Plan, Attachment 4.18-A and 4.19-B.

History: Emergency rule effective October 1, 1993. Permanent rule effective December 14, 1993. Amended: Filed January 19, 2011; effective February 23, 2011.