Section 14134


Except for any prescription, refill, visit, service, device, or item for which the programs payment is ten dollars ($10) or less, in which case no copayment shall be required, a recipient of services under this chapter shall be required to make copayments not to exceed the maximum permitted under federal regulations or federal waivers, as follows:


Copayment of five dollars ($5) shall be made for nonemergency services received in an emergency department or emergency room when the services do not result in the treatment of an emergency medical condition or inpatient admittance. For the purposes of this section, nonemergency services means services not required to, as appropriate, medically screen, examine, evaluate, or stabilize an emergency medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, so that the absence of immediate medical attention could reasonably be expected to result in any of the following:


Placing the individuals health, or, with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy.


Serious impairment to bodily functions.


Serious dysfunction of any bodily organ or part.


Copayment of one dollar ($1) shall be made for each drug prescription or refill.


Copayment of one dollar ($1) shall be made for each visit for services under subdivisions (a) and (h) of Section 14132.


The copayment amounts set forth in paragraphs (1), (2), and (3) may be collected and retained, or waived by the provider.


The department shall not reduce the reimbursement otherwise due to providers as a result of the copayment. The copayment amounts shall be in addition to any reimbursement otherwise due to the provider for services rendered under this program.


This section does not apply to emergency services, family planning services, or to any services received by any of the following:


A child in AFDC-Foster Care, as defined in Section 11400.


A person who is an inpatient in a health facility, as defined in Section 1250 of the Health and Safety Code.


A person 18 years of age or under.


A woman receiving perinatal care.


Paragraph (2) does not apply to a person 65 years of age or over.


A provider of service shall not deny care or services to an individual solely because of that persons inability to copay under this section. However, an individual shall remain liable to the provider for any copayment amount owed.


This section shall not apply to preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force provided by a physician or other licensed practitioner of the healing arts, or any approved adult vaccines and their administration recommended by the Advisory Committee on Immunization Practices. Pursuant to Section 1905(b) of the federal Social Security Act (42 U.S.C. Sec. 1396d(b)), these services shall be provided without any cost sharing by the beneficiary in order for the state to receive an increased federal medical assistance percentage for these services.


The department shall seek any federal waivers necessary to implement this section. The provisions for which appropriate federal waivers cannot be obtained shall not be implemented, but provisions for which waivers are either obtained or found to be unnecessary shall be unaffected by the inability to obtain federal waivers for the other provisions.


The director shall adopt regulations necessary to implement this section as emergency regulations in accordance with Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code. The adoption of the regulations shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The director shall transmit these emergency regulations directly to the Secretary of State for filing and the regulations shall become effective immediately upon filing. Upon completion of the formal regulation adoption process and prior to the expiration of the 120 day duration period of emergency regulations, the director shall transmit directly to the Secretary of State for filing the adopted regulations, the rulemaking file, and the certification of compliance as required by subdivision (e) of Section 11346.1 of the Government Code.


Original source: https://­leginfo.­legislature.­ca.­gov/­faces/­codes_displaySection.­xhtml?lawCode=WIC&sectionNum=14134.­ External link icon (last accessed December 5, 2016).