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 X
Sec2 144-101-X-1 - Benefit for People Living with HIV/AIDS
Subsection 144-101-X-1.07 - COST SHARING

Universal Citation: 144-101-X-1 ME Code Rules § 144-101-X-1.07

Current through 2024-38, September 18, 2024

1.07-1 Co-payments

A. Demonstration enrollees are required to pay a co-pay for physician services, pharmaceuticals, and some other services. Required co-payments for the respective services are as follows:

Services	Co-payment
Prescription Drugs	$10.00 (for 30 day supply)
Physician Visits	$10.00
Outpatient Hospital Services	$3.00
Ambulance Services	$3.00
Physical Therapy Services	$2.00
Occupational Therapy Services	$2.00
Psychologist Services	$2.00
Laboratory Services	$1.00
Mental Health Clinic Services	$2.00
Substance Abuse Services	$2.00
Hospital Inpatient Services	$3.00 per patient day
Federally Qualified Health Center Services	$3.00 per patient day
Rural Health Center Services	$3.00 per patient day

B. If this chapter conflicts with co-payment policies addressed in other chapters of the MBM, this chapter governs.

C. Co-payment dispute policies are in Chapter I of the MBM.

D. No co-payment may be imposed on enrollees with respect to the following services and populations:

1. Family planning;

2. Individuals under 21 years of age;

3. An individual who is an inpatient in a hospital, nursing facility, or other institution, and is required to spend all their income for costs of care, with the exception of a minimal amount for personal needs;

4. Pregnant women and services furnished during the post-partum phase of maternity care to the extent permitted by federal law;

5. Emergency services, as defined by the Department;

6. Services furnished to an individual by a Health Maintenance Organization, as defined in Section 1903(m) of the Social Security Act, in which he/she is enrolled; and

7. Any other service or services required to be exempt under the provisions of the Social Security Act, Title XIX and successors to it.

E. Additional assistance may be available from the Maine CDC, Division of Infectious Disease, with co-payments and premiums through the AIDS Drug Assistance Program (ADAP).

1.07-2 Premiums

Enrollees with an individual income of 150% of FPL or higher are required to pay a monthly premium to receive services under this benefit. Enrollees' cost of premium is dependent on their income level and, when added to other payments made by the enrollee's family to CHIP or Medicaid, will not exceed five percent (5%) of an enrollee's gross annual family income. Premium amounts, exemptions, and collection criteria policies are described in the MaineCare Eligibility Manual.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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