Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-55 - Laboratory Services
Subsection 144-101-II-55.08 - COPAYMENT

A. A copayment will be charged to each Medicaid recipient receiving services. According to the following schedule, the amount of the copayment shall not exceed $1.00 per day for services provided,

B. The recipient shall be responsible for copayments up to $10.00 per month whether the copayment has been paid or not. After the $10.00 cap has been reached, the recipient shall not be required to make additional copayments and the provider shall receive full Medicaid reimbursement for covered services.

C. No provider may deny services to a recipient for failure to pay a copayment. Providers must rely upon the recipient's representation that he or she does not have the cash available to pay the copayment. A recipient's inability to pay a copayment does not, however, relieve him/her of liability for a copayment.

D. Providers are responsible for documenting the amount of copayments charged to each recipient (regardless of whether the recipient has made payment) and shall disclose that amount to other providers, as necessary, to confirm previous copayments.

A. Family planning services and supplies;

B. Services furnished to individuals under twenty-one (21) years of age;

C. Services furnished to any individual who is an inpatient in a hospital, skilled nursing facility, nursing facility, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID), or other medical institution, if that individual is required, as a condition of receiving services in that institution, to spend for costs of medical care all but a minimal amount of his or her income required for personal needs;

D. Services furnished to pregnant women, including services provided during the three months following the end of a pregnancy;

E. Emergency services, i.e.: when failure to provide the service could reasonably be expected to:

F. Services furnished to an individual of a Health Maintenance Organization in which he or she is enrolled.

G. Recipients in State custody.

H. Recipients living in a Boarding Home or Foster Home.

Medicaid recipients exempt from copayment requirements are identified by a "NO" in the copay column on the recipient's Medical Eligibility Card.

See Section 55.09 for billing instructions for copayment exemptions.