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 $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) 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.
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 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.
History: 1Sp2003 c 14 art 12 s 37; 2005 c 56 s 1; 1Sp2005 c 4 art 8 s 41,42