WAG 20-03-04-b.

HFS pays deductibles and coinsurance based on established pricing procedures for clients receiving Medicare who meet the criteria. When HFS makes these payments for Medicaid covered services, the total amount paid cannot be more than the lesser of Medicare's allowable charges or DPA's maximum rate minus Medicare payment for the services provided. For non-Medicaid covered services for QMB clients only, the total amount paid cannot be more than Medicare's allowable charges minus Medicare payment.