New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-W - Former Division of Human Services
Chapter He-W 500 - MEDICAL ASSISTANCE
Part He-W 512 - ALTERNATIVE BENEFIT PLAN (ABP) AND PREMIUM ASSISTANCE PROGRAM
Section He-W 512.06 - Co-payments

Universal Citation: NH Admin Rules He-W 512.06

Current through Register No. 40, October 3, 2024

(a) Except as prohibited by 42 USC § 1396o-1(b) (3) (B) , newly eligible individuals who have an income greater than 100 percent of the FPL and are PAP participants shall be subject to the following co-payments:

(1) A co-payment in the amount of $8.00 for each non-preferred drug prescription and refill dispensed;

(2) A co-payment in the amount of $4.00 for each preferred drug prescription and refill dispensed;

(3) A co-payment in the amount of $5.00 for each primary care provider visit to treat illness or injury;

(4) A co-payment in the amount of $125.00 for each inpatient mental health admission, inpatient substance use disorder treatment admission or hospital admission, excluding maternity admissions;

(5) A co-payment in the amount of $50.00 for high-cost imaging such as CT/PET scans, and MRIs;

(6) A co-payment in the amount of $5.00 for each mental health outpatient visit;

(7) A copayment in the amount of $5.00 for each substance use disorder outpatient visit;

(8) A co-payment in the amount of $8.00 for each physical therapy visit;

(9) A co-payment in the amount of $8.00 for each occupational therapy visit;

(10) A co-payment in the amount of $8.00 for each speech therapy visit;

(11) A co-payment in the amount of $5.00 for each chiropractor visit;

(12) A co-payment in the amount of $8.00 for each specialty physician visit;

(13) A co-payment in the amount of $5.00 for each visit to other medical professionals such as an advanced practice registered nurse or a physician's assistant; and

(14) A co-payment in the amount of $5.00 for each laboratory outpatient visit.

(b) Co-payment obligations shall be suspended for the remainder of the calendar year quarter when the total co-payments made out of pocket by the newly eligible individual reach 5 percent of the individual's household income for that quarter. Co-payment obligations shall resume at the beginning of the next quarter. "Quarter" means one of 4 calendar periods ending March 31, June 30, September 30, and December 31.

#10656, eff 8-15-14

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