Section He-W 512.06 - Co-payments(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.N.H. Admin. Code § He-W 512.06
Amended by Volume XXXVI Number 01, Filed January 7, 2016, Proposed by #11012, Effective 1/1/2016, Expires 6/29/2016.Amended by Volume XXXVI Number 28, Filed July 14, 2016, Proposed by #11119, Effective 6/29/2016, Expires 6/29/2026.Amended by Volume XXXVIII Number 02, Filed January 11, 2018, Proposed by #12438, Effective 1/1/2018, Expires 1/1/2028.