Subsection 144-101-II-60.11 - CO-PAYMENTCo-payment dispute resolution procedures are described in Chapter I of the MaineCare Benefits Manual.
60.11-1Co-payment amountA. A co-payment will be charged to each MaineCare member who receives Medical Supplies or DME. The amount of the co-payment shall not exceed $3.00 per day for equipment or supplies, according to the following schedule: MaineCare Payment for Service | Member Co-payment |
$10.00 or less | $ .50 |
$10.01 - 25.00 | $1.00 |
$25.01 - 50.00 | $2.00 |
$50.01 or more | $3.00 |
B. The member shall be responsible for co-payments up to $30.00 per month whether the co-payment has been paid or not. After the $30.00 cap has been reached the member shall not be required to make additional co-payments and the provider shall receive full MaineCare reimbursement.C. Members shall not be charged more than $3.00 per month for any rental service.D. No provider may deny services to a member for failure to pay a co-payment. Providers must rely upon the member's representation that he or she does not have the cash available to pay the co-payment. A member's inability to pay a copayment does not, however, relieve him/her of liability for a co-payment.E. Providers are responsible for documenting the amount of co-payments 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 co-payments.60.11-2Co-payment exemptions. No co-payment may be imposed with respect to the following services: A. All exemptions listed in Chapter I; andB. All oxygen and oxygen equipment services. C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-60, subsec. 144-101-II-60.11