42 C.F.R. § 447.54 Maximum allowable charges.
Title 42 - Public Health
(a) Non-institutional services. Except as specified in paragraph (b), for non-institutional services, the plan must provide that— (1) Any deductible it imposes does not exceed $2.00 per month per family for each period of Medicaid eligibility. For example, if Medicaid eligibility is certified for a 3-month period, the maximum deductible which may be imposed on a family for that period of eligibility is $6.00; (2) Any coinsurance rate it imposes does not exceed 5 percent of the payment the agency makes for the services; and (3) Any co-payments it imposes do not exceed the amounts shown in the following table: (b) Waiver of the requirement that cost sharing amounts be nominal. Upon approval from CMS, the requirement that cost sharing charges must be nominal may be waived, in accordance with section 431.55(g) for nonemergency services furnished in a hospital emergency room. (c) Institutional services. For institutional services, the plan must provide that the maximum deductible, coinsurance or co-payment charge for each admission does not exceed 50 percent of the payment the agency makes for the first day of care in the institution. (d) Cumulative maximum. The plan may provide for a cumulative maximum amount for all deductible, coinsurance or co-payment charges that it imposes on any family during a specified period of time. [48 FR 5736, Jan. 8, 1983]
Title 42: Public Health
PART 447—PAYMENTS FOR SERVICES
Subpart A—Payments: General Provisions
deductible, coinsurance, co-payment or similar cost-sharing charge
§ 447.54 Maximum allowable charges.
------------------------------------------------------------------------ Maximum copayment States payment for the service chargeable to recipient------------------------------------------------------------------------$10 or less................................................. $.50$10.01 to $25............................................... 1.00$25.01 to $50............................................... 2.00$50.01 or more.............................................. 3.00------------------------------------------------------------------------
