37.85.204    MEMBER REQUIREMENTS, COST SHARING

(1) Effective for claims paid on or after January 1, 2020, members covered under Medicaid or Medicaid Expansion will not be assessed a copayment, as defined in ARM 37.84.102, for any covered service.

(2) The total of Medicaid or Medicaid Expansion cost share, as defined in ARM 37.84.102, incurred by a Medicaid or Medicaid Expansion household may not exceed an aggregate limit of five percent of the family's income applied quarterly. There may not be further cost sharing applied to the household members in a quarter once a household has met the quarterly aggregate cap.

(3) Providers may directly charge members only for the following services if the member signs an Advanced Beneficiary Notice for the specific service prior to the service being provided:

(a) noncovered services;

(b) experimental services;

(c) unproven services;

(d) services performed in an inappropriate setting;

(e) services that are not medically necessary;

(f) investigational services; or

(g) dental treatment expenses that exceed the annual dental treatment cap.

 

History: 53-2-201, 53-6-113, MCA; IMP, 53-6-101, 53-6-113, 53-6-141, MCA; NEW, 1983 MAR p. 1197, Eff. 8/26/83; AMD, 1986 MAR p. 677, Eff. 4/25/86; AMD, 1987 MAR p. 895, Eff. 7/1/87; AMD, 1987 MAR p. 1688, Eff. 10/1/87; AMD, 1988 MAR p. 758, Eff. 4/15/88; AMD, 1989 MAR p. 272, Eff. 3/1/89; AMD, 1989 MAR p. 859, Eff. 6/30/89; AMD, 1989 MAR p. 842, Eff. 7/1/89; AMD, 1994 MAR p. 686, Eff. 4/1/94; AMD, 1995 MAR p. 1159, Eff. 7/1/95; AMD, 1997 MAR p. 548, Eff. 3/25/97; AMD, 1997 MAR p. 1208, Eff. 7/8/97; AMD, 1999 MAR p. 1301, Eff. 7/1/99; TRANS, from SRS, 2000 MAR p. 479; AMD, 2002 MAR p. 797, Eff. 3/15/02; EMERG, AMD, 2002 MAR p. 3156, Eff. 11/15/02; AMD, 2016 MAR p. 829, Eff. 5/7/16; AMD, 2017 MAR p. 100, Eff. 1/7/17; AMD, 2017 MAR p. 2326, Eff. 1/1/18; AMD, 2020 MAR p. 95, Eff. 1/18/20.