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(a) Except as provided in (b) of this section, a person eligible for Medicaid under 7 AAC 43.020 shall pay the following cost-sharing amounts:
(1) $50 per day up to a maximum of $200 per discharge for inpatient hospital services;
(2) five percent of allowable charges for outpatient hospital services;
(3) $3 per day for physician services; and
(4) $2 for each prescription for prescribed drugs that is filled or refilled.
(b) The following services are not subject to recipient cost-sharing requirements under this section:
(1) a service provided to a recipient under the age of 18 at time of delivery of the service;
(2) a service provided to a recipient of a long-term care facility, or an intermediate care facility for the mentally retarded;
(3) a service provided to a pregnant woman, including a service provided during the postpartum period;
(4) family planning services and supplies;
(5) emergency services; and
(6) hospice services.
(c) A provider shall collect the amount of cost-sharing from the recipient and otherwise comply with AS 47.07.042 (a) concerning cost-sharing.
(d) The division shall reduce payment to the provider by the amount of cost-sharing required under this section for the service provided to that recipient.
(e) For purposes of this section, "emergency services" means
(1) inpatient hospital care provided to a recipient admitted into the hospital from the emergency room of that hospital; and
(2) outpatient hospital services and physician services provided to a recipient in response to the sudden and unexpected onset of an illness or accidental injury that requires immediate medical attention to safeguard the recipient's life; immediate medical attention is medical care that the division determines cannot be delayed for 24 hours or more after the onset of the illness or occurrence of the accidental injury.
History: Eff. 10/15/94, Register 132; em am 10/15/94 - 2/11/95, Register 132
Authority: AS 47.05.010
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Last modified 7/05/2006