Section 7 AAC 105.610 - Recipient cost-sharing(a) Except as provided in (b) of this section, a person eligible for Medicaid under 7 AAC 100 shall pay the following cost-sharing amounts: (1) $50 per day up to a maximum of $200 per discharge for inpatient hospital services;(2) five percent of allowable charges for outpatient hospital services;(3) $3 per day for physician services;(4) for a covered outpatient drug described in 7 AAC 120.110(b), $0.50 for each prescription that is filled or refilled with a payment for service of $50 or less, or $3.50 for each prescription that is filled or refilled with a payment for service of greater than $50; however, a cost-sharing amount is not required for (A) a prescription for a covered outpatient drug for a recipient eligible under 7 AAC 48.560 (chronic and acute medical assistance; limited reimbursement for prescribed drugs and medical supplies); or(B) a vaccine administered by a pharmacist under 7 AAC 120.110(d).(b) The following services are not subject to recipient cost-sharing requirements under this section: (1) a service provided to a recipient under 18 years of age at the time of delivery of the service;(2) a service provided to a recipient in a long-term care facility;(3) a service provided to a pregnant woman, including a service provided to a woman during the postpartum period under 7 AAC 100.304;(4) a family planning service or supply;(5) an emergency service;(6) a hospice care service;(7) a service provided to an American Indian or an Alaska Native by a tribal health program;(8) a service provided to an individual who is eligible for both Medicaid and Medicare, if Medicare is the primary payer for that service;(9) adult preventive and screening services under 7 AAC 110.800.(c) A provider shall collect the amount of cost-sharing from the recipient and otherwise comply with AS 47.07.042(a) concerning cost-sharing.(d) The department will reduce payment to the provider by the amount of cost-sharing required under this section for the service provided to that recipient.(e) In this section, "emergency service" means (1) inpatient hospital care provided to a recipient admitted into the hospital from the emergency room of that hospital; and(2) outpatient hospital services and physician services provided to a recipient in response to the sudden and unexpected onset of an illness or accidental injury that requires immediate medical attention to safeguard the recipient's life; in this paragraph "immediate medical attention" means medical care that the department determines cannot be delayed for 24 hours or more after the onset of the illness or occurrence of the accidental injury.Eff. 2/1/2010, Register 193; am 5/18/2014, Register 210, July 2014; am 3/3/2023, Register 245, April 2023; am 2/1/2024, Register 249, April 2024Authority:AS 47.05.010
AS 47.07.020
AS 47.07.042