2003 Minnesota Statutes

     256B.0631 Medical assistance co-payments. 

    Subdivision 1.    Co-payments.  (a) Except as provided 
 in subdivision 2, the medical assistance benefit plan shall 
 include the following co-payments for all recipients, effective 
 for services provided on or after October 1, 2003: 

    (1) $3 per nonpreventive visit.  For purposes of this 
 subdivision, a visit means an episode of service which is 
 required because of a recipient'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; 

    (2) $3 for eyeglasses; 

    (3) $6 for nonemergency visits to a hospital-based 
 emergency room; and 

    (4) $3 per brand-name drug prescription and $1 per generic 
 drug prescription, subject to a $20 per month maximum for 
 prescription drug co-payments.  No co-payments shall apply to 
 antipsychotic drugs when used for the treatment of mental 
 illness. 

    (b) Recipients of medical assistance are responsible for 
 all co-payments in this subdivision. 

    Subd. 2.    Exceptions.  Co-payments shall be subject to 
 the following exceptions: 

    (1) children under the age of 21; 

    (2) pregnant women for services that relate to the 
 pregnancy or any other medical condition that may complicate the 
 pregnancy; 

    (3) recipients expected to reside for at least 30 days in a 
 hospital, nursing home, or intermediate care facility for the 
 mentally retarded; 

    (4) recipients receiving hospice care; 

    (5) 100 percent federally funded services provided by an 
 Indian health service; 

    (6) emergency services; 

    (7) family planning services; 

    (8) services that are paid by Medicare, resulting in the 
 medical assistance program paying for the coinsurance and 
 deductible; and 

    (9) co-payments that exceed one per day per provider for 
 nonpreventive visits, eyeglasses, and nonemergency visits to a 
 hospital-based emergency room. 

    Subd. 3.    Collection.  The medical assistance 
 reimbursement to the provider shall be reduced by the amount of 
 the co-payment, except that reimbursement for prescription drugs 
 shall not be reduced once a recipient has reached the $20 per 
 month maximum for prescription drug co-payments.  The provider 
 collects the co-payment from the recipient.  Providers may not 
 deny services to recipients who are unable to pay the 
 co-payment, except as provided in subdivision 4. 

    Subd. 4.    Uncollected debt.  If it is the routine 
 business practice of a provider to refuse service to an 
 individual with uncollected debt, the provider may include 
 uncollected co-payments under this section.  A provider must 
 give advance notice to a recipient with uncollected debt before 
 services can be denied. 

    HIST: 1Sp2003 c 14 art 12 s 37