Sec. 47.07.042. Recipient cost-sharing.

432 words·~2 min read·/ak/title-47/chapter-7/47-07-042

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)Except as provided in

(b)—

(d)of this section, the state plan developed under AS 47.07.040 shall impose deductible, coinsurance, and copayment requirements on persons eligible for assistance under this chapter to the maximum extent allowed under federal law and regulations. The plan must provide that health care providers shall collect the allowable charge. The department shall reduce payments to each provider by the amount of the allowable charge. A provider may not deny services because a recipient is unable to share costs, but an inability to share costs imposed under this section does not relieve the recipient of liability for the costs.

(b)The state plan developed under AS 47.07.040 shall impose a copayment requirement for inpatient hospital services in an amount that is the lesser of

(1)$50 a day, up to a maximum of $200 per discharge; or

(2)the maximum allowed under federal law and regulations.

(c)If the department has clear and compelling reason to believe that application of the maximum allowable charges under

(a)of this section to a specific service would not reduce state expenditures or would generate savings to the state that are insignificant in relation to the total cost containment possible, then the department may waive the charges otherwise required under

(a)of this section as to that specific service.

(d)In addition to the requirements established under

(a)and

(b)of this section, the department may require premiums or cost-sharing contributions from recipients who are eligible for benefits under AS 47.07.020 (b)(13) and whose household income is between 150 and 175 percent of the federal poverty line. If the department requires premiums or cost-sharing contributions under this subsection, the department

(1)shall adopt in regulation a sliding scale for those premiums or contributions based on household income;

(2)may not exceed the maximums allowed under federal law; and

(3)shall implement a system by which the department or its designee collects those premiums or contributions.

(e)Except as provided in

(c)of this section and notwithstanding

(b)of this section, the department may require premiums and other cost-sharing contributions from recipients who are eligible for assistance under AS 47.07.020 (b)(15) to the maximum extent allowed by federal law. If the department requires premiums or other cost-sharing contributions under this subsection, the department shall

(1)adopt in regulation a sliding scale for those premiums or contributions based on household income; and

(2)implement a system by which the department or its designee collects the premiums or other cost-sharing contributions.

(f)[Repealed, § 3 ch 48 SLA 2007.]