405 Ind. Admin. Code 5-30-2

Current through October 31, 2024

Section 405 IAC 5-30-2 - Copayments for transportation services

Authority: IC 12-15-1-10; IC 12-15-6-5; IC 12-15-21-2; IC 12-15-21-3

Affected: IC 12-13-7-3; IC 12-15-6

Sec. 2.

In accordance with IC 12-15-6, a copayment will be required for transportation services as follows:

(1) The copayment shall be made by the member and collected by the provider at the time the service is rendered. Medicaid reimbursement to the provider shall be adjusted to reflect the copayment amount for which the member is liable.

(2) In accordance with 42 CFR 447.15, effective October 1, 1991, not including tertiary citations therein, the provider may not deny services to any eligible individual on account of the individual's inability to pay the copayment amount. Under this federal requirement, this service guarantee does not apply to an individual who is able to pay, nor does an individual's inability to pay eliminate his or her liability for the copayment.

(3) The provider shall collect from the member a copayment amount equal to the following:

(A) Fifty cents ($0.50) for services for which Medicaid pays ten dollars ($10) or less.

(B) One dollar ($1) for services for which Medicaid pays ten dollars and one cent ($10.01) to fifty dollars ($50).

(C) Two dollars ($2) for services for which Medicaid pays fifty dollars and one cent ($50.01) or more.

(D) No copayment will be required for an accompanying adult traveling with a minor member or for an attendant.

(4) The following transportation services are exempt from the copayment requirement:

(A) Emergency ambulance services.

(B) Services furnished to individuals less than eighteen (18) years of age.

(C) Services furnished to pregnant women.

(D) Services furnished to individuals who are inpatients in hospitals, nursing facilities, intermediate care facilities for individuals with intellectual disabilities, or other medical institutions.

405 IAC 5-30-2

Office ofthe Secretary of Family and Social Services; 405 IAC 5-30-2; filed Jul 25, 1997, 4:00p.m.: 20 IR 3358; readopted filed Jun 27, 2001, 9:40 a.m.: 24 IR 3822; readopted filed Sep 19, 2007, 12:16 p.m.: 20071010-IR-405070311RFA; readopted filed Oct 28, 2013, 3:18 p.m.: 20131127-IR-405130241RFA

Filed 8/1/2016, 3:44 p.m.: 20160831-IR-405150418FRA

Readopted filed 7/28/2022, 2:21 p.m.: 20220824-IR-405220205RFA

Readopted filed 5/30/2023, 11:54 a.m.: 20230628-IR-405230292RFA