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Office of the Revisor of 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, and before January 1, 2009:
    (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 $12 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) 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 January 1,
2009:
    (1) $6 for nonemergency visits to a hospital-based emergency room; and
    (2) $3 per brand-name drug prescription and $1 per generic drug prescription, subject to
a $7 per month maximum for prescription drug co-payments. No co-payments shall apply to
antipsychotic drugs when used for the treatment of mental illness.
    (c) 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 developmentally disabled;
(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. (a) 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 $12 per month maximum or the $7 per month
maximum effective January 1, 2009, for prescription drug co-payments.
    (b) The provider collects the co-payment from the recipient. Providers may not deny services
to recipients who are unable to pay the co-payment.
    (c) Medical assistance reimbursement to fee-for-service providers and payments to managed
care plans shall not be increased as a result of the removal of the co-payments effective January 1,
2009.
    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.
History: 1Sp2003 c 14 art 12 s 37; 2005 c 56 s 1; 1Sp2005 c 4 art 8 s 41,42; 2007 c 147 art
5 s 10,11
NOTE:Subdivision 4 is repealed by Laws 2007, chapter 147, article 5, section 41, effective
January 1, 2009. Laws 2007, chapter 147, article 5, section 41, paragraph (d).