![]() Determine the household’s monthly insurance deductible by dividing the annual deductible by 12 (months).See the example below for an annual insurance deductible of $6,000 and a monthly household income of $1,000: If the applicant’s annual insurance deductible is any amount over $600, they are eligible under this criterion for HHSC FPP.Īnother way to make the comparison is to divide the annual insurance deductible into a monthly amount. Determine 5% of the total annual income by multiplying it by 0.05 (5%).Determine the total household’s annual income by multiplying the monthly income by 12 (months). ![]() Determine the total household’s monthly income.See the example below for a monthly household income of $1,000: To compare an annual deductible with a monthly income, multiply the monthly income by 12 and then determine 5% of that amount. FPP household incomes are figured as a monthly amount. Most insurance deductibles are given as an annual amount. Services may be provided to individuals with third-party insurance if the confidentiality of the person is a concern or if the person’s insurance deductible is 5% or more of their monthly income. Contractors can bill clients for services outside the scope of HHSC FPP allowable services if the service is provided at the individual’s request and the client is made aware of their responsibility for paying for the charges. Signs indicating this policy must be visibly posted at contractor clinic sites.Ĭlients shall not be charged administrative fees for items such as processing and/or transfer of medical records, copies of immunization records, etc.Contractors must have policies and procedures regarding co-pay collection, which must be approved by the contractor’s governing body and.Co-pays collected by the contractor are considered program income and must be used to support the delivery of HHSC FPP services.The co-pay must include all prescriptions.The co-pay schedule must be updated when the revised Federal Poverty Guidelines are released annually.The maximum co-pay amount must not exceed $30.Contractors may opt to use the pre-approved PSPS Optional Co-Pay Table Based on Monthly Federal Poverty Level (FPL), which can be found in Section 9000, Resources) Contractors must maintain a co-pay schedule, approved by HHSC in advance, which must have proportional FPL increments and co-pay amounts (Note: An example of a co-pay schedule is provided by HHSC to contractors annually, following release of the Federal Poverty Guidelines.Contractors must have a system for aging accounts receivable, which must be documented in the contractor’s policy and procedures and must clearly indicate a period for removing balances from an individual’s account due to inability to pay.Contractors must keep records of individual co-pays paid and any balance owed.Individuals who are assessed a co-pay shall be presented with the bill at the time of service.Individuals may not be charged an added co-pay for services that are provided by referral. ![]()
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