048-26 Wyo. Code R. §§ 26-28 - Client Co-Payments

(a) Clients who receive the following services shall make a co-payment:

(i) Federally Qualified Health Centers (FQHC) services;

(ii) Physician office visits;

(iii) Physician home visits;

(iv) Psychiatric services;

(v) Rural Health Centers services;

(b) Co-payment amounts. Co-payment dollar amounts shall be assigned as specified in State Plan Amendment 4.18-A.

(c) Exceptions. Co-payment requirements of this Section shall not apply to:

(i) Emergency services;

(ii) Family planning clinic services;

(iii) Clients under the age of twenty-one (21);

(iv) Pregnant women;

(v) Residents of a nursing facility or swing bed facility;

(vi) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim;

(vii) Items and services furnished directly to an American Indian or Alaska Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of an "Indian" at Section 4 of the Indian HealthCare Improvement Act ( 25 U.S.C. § 1608);

(viii) Hospice Services; and

(ix) Inpatient hospital stays.

(x) Any individual or service where cost sharing is prohibited by Federal law or State law as specifically delineated in State Plan Amendment 4.18-A.

(d) Providers shall be responsible for collecting the co-payment. The amount of the co-payment shall be automatically deducted by the Wyoming Department of Health from the Medicaid allowable payment, regardless of whether the co-payment is actually paid. For purposes of this section, a provider shall not deny service to a client due to a client's inability to make the co-payment, unless a client regularly refuses to make co-payments.

Notes

048-26 Wyo. Code R. §§ 26-28

Amended, Eff. 12/17/2015. Amended, Eff. 4/9/2019. Amended, Eff. 5/7/2020. Amended, Eff. 5/13/2021. Amended, Eff. 1/18/2025.