Policy                                                                           Issuance Number: MS 06-06

Medical Services Policy Manual                           Issuance Date: July 1, 2006

From: Joni Jones, Director                                       Expiration Date: Until Superseded

Subj: ARKids B 5% Co-pay Cap 

Sections to be Deleted                   Dated                      Sections to be Added                   Dated

16000 - 16020                              04-15-02                    16000 - 16020                             04-15-02

                                                        04-04-04                                                                          07-01-06

16020 - 16040                              04-01-04                    16020 - 16040                             07-01-06 

16040 - 16045                              04-01-04                    16040 - 16045                             07-01-06

                                                        04-15-02                       

16045 - 16048                              04-15-02                    16045 - 16048                             07-01-06

                                                        04-01-04                                                                           04-01-04

 Summary of Changes 

MS 16020 and MS 16045 have been revised to state that the worker will process a reported change when it is a decrease in income. Effective July 1, 2006, ARKids B families will have an annual cumulative cost-sharing (co-payments and coinsurance) maximum of 5% of the family’s gross annual income.  The annual period is the state fiscal year (SFY) of July 1 through June 30.  The annual cost-sharing maximum will be recalculated and the cumulative cost-sharing counter will be reset each July 1.  The co-pay will be recalculated at fiscal year and whenever reported decreases of income have been entered in ANSWER.  Income increases do not cause the co-pay to be recalculated.  

The new change will not affect the amount the ARKids B participant currently pays for their services.  This change only means that co-payments and coinsurance will be tracked by EDS until the cost-sharing maximum is reached, at which point, the ARKids B family’s cost-sharing for the year will end the following July 1.  Once the gross income has been entered in ANSWER, EDS will use this information to calculate the 5% SFY cap.  The cap will be recalculated at each change of income entered in ANSWER.  Once the cap has been met, the provider will receive a message on their claims transaction and on their eligibility verifications that the co-pay is no longer applied for the current SFY.  

EXAMPLE:  A family of four (4) has an annual gross income of $24,000 per year.  $24,000 multiplied by 5% = $1,200 (the family’s annual cumulative cost-sharing maximum). Once the total cost sharing reaches $1,200, the family will not have any co-payments until the following July 1.  

MS 16040(#3) has been revised to include a statement regarding verification of citizenship.  

Inquiries to:  Judy Key, 682-8259

                         Carmen Banks, 682-8258

                         Carla Droughn,. 682-8254

                         Dona Young , 682-1562