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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 29

8.2.2. Deductibles: N/A 8.2.3. Coinsurance or copayments:

• A participant who seeks care at a hospital emergency department for a condition that is not an emergency medical condition may be required to pay a co-payment to the provider. The determination that the participant does not have an emergency medical condition is made by the emergency room physician conducting the medical screening and using the prudent layperson standard. • A participant who accesses emergency transportation services for a condition that is not an emergency medical condition may be required to pay a co-payment to the provider of the service. The determination that the participant did not have an emergency medical condition is made by Idaho Medicaid. • Beginning on February 1, 2007, the nominal fee amount required to be paid by the participant as a co-payment is three dollars ($3.00). This nominal amount will be adjusted annually as determined by the Secretary of Health and Human Services.

8.2.4. Other: N/A

8.3. Describe how the public will be notified, including the public schedule, of this cost sharing (including the cumulative maximum) and changes to these amounts and any differences based on income. (Section 2103(e)((1)(B)) (42CFR 457.505(b))

Changes to cost-sharing requirements are communicated through the public legislative process. DHW also adheres to a public rules promulgation process in order to communicate cost-sharing and other program changes.

In addition, the public is made aware of cost-sharing requirements through the following communication methods. • Publication on the State’s Medicaid website. • Program information materials including brochures and applications. • Program notices to participants at eligibility determination and redetermination. • Public hearings held in conjunction with Administrative rules promulgation.