409.9081 Copayments.
409.9081 Copayments.
(1) The agency shall require, subject to federal regulations and limitations, each Medicaid recipient to pay at the time of service a nominal copayment for the following Medicaid services:
(a) Hospital outpatient services: up to $3 for each hospital outpatient visit.
(b) Physician services: up to $2 copayment for each visit with a physician licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 463.
(c) Hospital emergency department visits for nonemergency care: 5 percent of up to the first $300 of the Medicaid payment for emergency room services, not to exceed $15.
(d) Prescription drugs: a coinsurance equal to 2.5 percent of the Medicaid cost of the prescription drug at the time of purchase. The maximum coinsurance shall be $7.50 per prescription drug purchased.
(2) The agency shall, subject to federal regulations and any directions or limitations provided for in the General Appropriations Act, require copayments for the following additional services: hospital inpatient, laboratory and X-ray services, transportation services, home health care services, community mental health services, rural health services, federally qualified health clinic services, and nurse practitioner services. The agency may only establish copayments for prescribed drugs or for any other federally authorized service if such copayment is specifically provided for in the General Appropriations Act or other law.
(3) In accordance with federal regulations, the agency shall not require copayments of the following Medicaid recipients:
(a) Children under age 21.
(b) Pregnant women when the services relate to the pregnancy or to any other medical condition which may complicate the pregnancy up to 6 weeks after delivery.
(c) Any individual who is an inpatient in a hospital, long-term care facility, or other medical institution if, as a condition of receiving services in the institution, that individual is required to spend all but a minimal amount of her or his income required for personal needs for medical care costs.
(d) Any individual who requires emergency services after the sudden onset of a medical condition which, left untreated, would place the individual’s health in serious jeopardy.
(e) Any individual when the services or supplies relate to family planning.
(f) Any individual who is enrolled in a Medicaid prepaid health plan or health maintenance organization.
(4) No provider shall impose more than one copayment for any encounter upon a Medicaid recipient.
(5) The agency shall develop a mechanism by which participating providers are able to identify those Medicaid recipients from whom they shall not collect copayments.
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(6) This section does not require a provider to bill or collect a copayment required or authorized under this section from the Medicaid recipient. If the provider chooses not to bill or collect a copayment from a Medicaid recipient, the agency must still deduct the amount of the copayment from the Medicaid reimbursement made to the provider.
History. s. 48, ch. 93-129; s. 6, ch. 95-393; s. 5, ch. 96-280; s. 5, ch. 96-387; s. 1022, ch. 97-103; s. 12, ch. 2003-405; s. 14, ch. 2006-28.
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Note. As created by s. 5, ch. 96-280. This version is published as the last expression of legislative will. Subsection (6) was also created by s. 5, ch. 96-387, and that version reads:
(6) This section does not require a provider to bill or collect from the Medicaid recipient any copayment authorized by subsection (1). Regardless of whether the provider bills or collects the copayment, the agency shall deduct the amount of the copayment from the Medicaid reimbursement to the provider.