5111.0112 Copayment program.
5111.0112 Copayment program.
(A) The director of job and family services shall institute a cost-sharing program under the medicaid program. In instituting the cost-sharing program, the director shall comply with federal law. In the case of an individual participating in the children’s buy-in program established under sections 5101.5211 to 5101.5216 of the Revised Code, the cost-sharing program shall be consistent with sections 5101.5213 and 5101.5214 of the Revised Code if the children’s buy-in program is a component of the medicaid program. The cost-sharing program shall establish a copayment requirement for at least dental services, vision services, nonemergency emergency department services, and prescription drugs, other than generic drugs. The cost-sharing program shall establish requirements regarding premiums, enrollment fees, deductions, and similar charges. The director shall adopt rules under section 5111.02 of the Revised Code governing the cost-sharing program.
(B) The cost-sharing program shall, to the extent permitted by federal law, provide for all of the following with regard to any providers participating in the medicaid program:
(1) No provider shall refuse to provide a service to a medicaid recipient who is unable to pay a required copayment for the service.
(2) Division (B)(1) of this section shall not be considered to do either of the following with regard to a medicaid recipient who is unable to pay a required copayment:
(a) Relieve the medicaid recipient from the obligation to pay a copayment;
(b) Prohibit the provider from attempting to collect an unpaid copayment.
(3) Except as provided in division (C) of this section, no provider shall waive a medicaid recipient’s obligation to pay the provider a copayment.
(4) No provider or drug manufacturer, including the manufacturer’s representative, employee, independent contractor, or agent, shall pay any copayment on behalf of a medicaid recipient.
(5) If it is the routine business practice of the provider to refuse service to any individual who owes an outstanding debt to the provider, the provider may consider an unpaid copayment imposed by the cost-sharing program as an outstanding debt and may refuse service to a medicaid recipient who owes the provider an outstanding debt. If the provider intends to refuse service to a medicaid recipient who owes the provider an outstanding debt, the provider shall notify the individual of the provider’s intent to refuse services.
(C) In the case of a provider that is a hospital, the cost-sharing program shall permit the hospital to take action to collect a copayment by providing, at the time services are rendered to a medicaid recipient, notice that a copayment may be owed. If the hospital provides the notice and chooses not to take any further action to pursue collection of the copayment, the prohibition against waiving copayments specified in division (B)(3) of this section does not apply.
(D) The department of job and family services may work with a state agency that is administering, pursuant to a contract entered into under section 5111.91 of the Revised Code, one or more components of the medicaid program or one or more aspects of a component as necessary for the state agency to apply the cost-sharing program to the components or aspects of the medicaid program that the state agency administers.
Effective Date: 09-26-2003; 09-29-2005; 06-30-2006; 2007 HB119 09-29-2007