Indiana Administrative Code
Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES
Article 1 - MEDICAID PROVIDERS AND SERVICES
Rule 8 - Hospital and Ambulatory Surgical Center Reimbursement for Outpatient Services
Section 8-4 - Client copayment
Current through March 20, 2024
Authority: IC 12-15-21-2; IC 12-15-21-3
Affected: IC 12-15-6-3; IC 12-15-6-4
Sec. 4.
(a) Except for those categories of individuals and services specifically exempted in subsection (e), Medicaid members shall be responsible for paying directly to providers a set portion of the payment for nonemergency services provided in an emergency room setting. Services defined as nonemergency shall be determined by the office.
(b) The amount of copayment to be charged shall be three dollars ($3) for nonemergency services provided in emergency room settings.
(c) The provider shall be responsible for collecting the appropriate copayment amount from the member.
(d) Participating providers may not deny services to any eligible individual on account of the individual's inability to pay the copayment amount. This services guarantee does not apply to an individual who is able to pay, nor does an individual's inability to pay eliminate the individual's liability for the copayment.
(e) The following categories of members and services are exempt from the copayment requirements:
(f) The copayment shall be made by the members and collected by the provider. Medicaid reimbursement shall be adjusted to reflect the copayment amount.
