Subsection 144-101-II-109.11 - COPAYMENTS109.11-1Copayment AmountA. A copayment will be charged to each MaineCare member receiving speech pathology services, with the exception of those exempt, as specified in the MaineCare Eligibility Manual, such as children. The amount of the copayment shall not exceed $2.00 per day for services provided, according to the following schedule: MaineCare Payment for Service | Member Copayment |
$10.00 or less | $ .50 |
$10.01 - 25.00 | $1.00 |
$25.01 or more | $2.00 |
B. The member shall be responsible for copayments up to $20.00 per monthwhether the copayment has been paid or not. After the $20.00 cap has been reached, the member shall not be required to make additional copayments and the provider shall receive full MaineCare reimbursement for covered services.C. No provider may deny services to a member for failure to pay a copayment. Providers must rely upon the member's representation that he or she does not have the cash available to pay the copayment. A member's inability to pay a copayment does not, however, relieve his/her liability for a copayment. Providers are responsible for documenting the amount of copayments 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 copayments.
109.11-2Copayment Exemptions and Dispute ResolutionsSee Chapter I of this Manual for information on copayment exemptions and dispute resolutions.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-109, subsec. 144-101-II-109.11