Subsection 144-101-II-45.11 - CO-PAYMENT FOR INPATIENT SERVICES, OUTPATIENT HOSPITAL CLINIC SERVICESA. A co-payment will be charged to each MaineCare member receiving either inpatient or outpatient hospital services. Two separate co-payments will be charged if the member receives both inpatient and outpatient services. The amount of the co-payment shall not exceed three dollars ($3.00) per day for either category of hospital services provided, according to the following schedule: MaineCare Payment for Service | Maximum Member Co-payment Per Day |
$10.00 or less | $ .50 |
$10.01 - 25.00 | $1.00 |
$25.01 - 50.00 | $2.00 |
$50.01 or more | $3.00 |
B. The member shall be liable for co-payments up to a maximum of thirty dollars ($30.00) per calendar month for each category: inpatient or outpatient service, and regardless of whether there are multiple hospital service providers within the same month. After the maximum thirty dollar ($30.00) monthly cap(s) has been charged to the member, the member shall not be liable for additional co-payments and the provider(s) shall receive full MaineCare reimbursement.C. No provider may deny services to a member for failure to pay a co-payment. Providers must rely upon the member's representation that he or she does not have the cash available to pay the co-payment. A member's inability to pay a co-payment does not, however, relieve him/her of liability for a co-payment.D. Providers are responsible for documenting the amount of co-payments charged to each member (regardless of whether the member has made payment) and shall disclose that amount to other providers, as necessary, to confirm previous co-payments. Co-payment exemptions and dispute resolution procedures are contained in Chapter I.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-45, subsec. 144-101-II-45.11