42 C.F.R. § 457.555 Maximum allowable cost-sharing charges on targeted low-income children in families with income from 101 to 150 percent of the FPL.
Title 42 - Public Health
(a) Non-institutional services. For targeted low-income children whose family income is from 101 to 150 percent of the FPL, the State plan must provide that for non-institutional services, including emergency services— (1) Any copayment or similar charge the State imposes under a fee-for-service delivery system does not exceed the following amounts: (2) Any copayment that the State imposes for services provided by a managed care organization may not exceed $5.00 per visit; (3) Any coinsurance rate the State imposes may not exceed 5 percent of the payment the State directly or through contract makes for the service; and (4) Any deductible the State imposes may not exceed $3.00 per month, per family for each period of eligibility. (b) Institutional services. For targeted low-income children whose family income is from 101 to 150 percent of the FPL, the maximum deductible, coinsurance or copayment charge for each institutional admission may not exceed 50 percent of the payment the State would make under the Medicaid fee-for-service system for the first day of care in the institution. (c) Institutional emergency services. Any copayment that the State imposes on emergency services provided by an institution may not exceed $5.00. (d) Nonemergency use of the emergency room. For targeted low-income children whose family income is from 101 to 150 percent of the FPL, the State may charge up to twice the charge for non-institutional services, up to a maximum amount of $10.00, for services furnished in a hospital emergency room if those services are not emergency services as defined in §457.10. (e) Standard copayment amount. For targeted low-income children whose family income is from 101 to 150 percent of the FPL, a standard copayment amount for any service may be determined by applying the maximum copayment amounts specified in paragraphs (a), (b), and (c) of this section to the State's average or typical payment for that service.
Title 42: Public Health
PART 457—ALLOTMENTS AND GRANTS TO STATES
Subpart E—State Plan Requirements: Enrollee Financial Responsibilities
§ 457.555 Maximum allowable cost-sharing charges on targeted low-income children in families with income from 101 to 150 percent of the FPL.
------------------------------------------------------------------------ Maximum amount Total cost of services provided during a visit chargeable to enrollee------------------------------------------------------------------------$15.00 or less............................................. $1.00$15.01 to $40.............................................. 2.00$40.01 to $80.............................................. 3.00$80.01 or more............................................. 5.00------------------------------------------------------------------------
