Mont. Admin. R. 37.85.204 - MEMBER REQUIREMENTS, COST SHARING
(1) Effective for claims paid on or after
January 1, 2020, members covered under Medicaid or Medicaid Expansion will not
be assessed a copayment, as defined in ARM
37.84.102, for any covered
service.
(2) The total of Medicaid
or Medicaid Expansion cost share, as defined in ARM 37.84.102, incurred by a
Medicaid or Medicaid Expansion household may not exceed an aggregate limit of
five percent of the family's income applied quarterly. There may not be further
cost sharing applied to the household members in a quarter once a household has
met the quarterly aggregate cap.
(3) Providers may directly charge members
only for the following services if the member signs an Advanced Beneficiary
Notice for the specific service prior to the service being provided:
(a) noncovered services;
(b) experimental services;
(c) unproven services;
(d) services performed in an inappropriate
setting;
(e) services that are not
medically necessary;
(f)
investigational services; or
(g)
dental treatment expenses that exceed the annual dental treatment cap.
Notes
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-6-101, 53-6-113, 53-6-141, MCA
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