048-26 Wyo. Code R. §§ 26-17 - Hospital Services
(a) Hospital
Services (including ancillary services provided in a hospital) shall be covered
services if provided:
(i) Pursuant to the
written orders of a licensed physician; and
(ii) By or under the supervision of a
licensed physician.
(b)
Inpatient Hospital Psychiatric Services. Psychiatric services are limited to
stabilization of acute conditions. Such services shall only be covered services
when:
(i) The client is evaluated by a
multidisciplinary team within forty-eight (48) hours after admission;
(ii) The multidisciplinary team prepares an
individualized treatment plan; and
(iii) The medical record documents a plan of
active treatment and individual, group, or family therapy directed to achieve
the goals specified in the individualized treatment plan.
(c) Limitations on Hospital Services.
(i) Medicaid reimbursement for outpatient
hospital services shall be limited to a total of twelve (12) visits per
calendar year to a hospital clinic, a hospital emergency room (for
non-emergency services), and a physician's office, unless additional visits are
pre-approved.
(ii) Exceptions. The
limitations of subsection (c)(i) shall not apply to:
(A) An individual seeking emergency services
who is diagnosed with an emergent condition;
(B) An individual seeking family planning
clinic services;
(C) A client who
is under age twenty-one (21);
(D) A
pregnant woman;
(E) Items and
services furnished directly by the Indian Health Services, an Indian Tribe,
Tribal Organization, or Urban Indian Organization, or through a referral under
a purchase order contract health service (as described in 42 C.F.R., Ch. I,
Subch. M, Pt. 136, Subpart C) to an American Indian or Alaskan Native who is
enrolled as a member of a Federally-Recognized Tribe or otherwise meets the
definition of "Indian" at Section
4 of the Indian Healthcare Improvement Act
( 25 U.S.C. § 1608);
(F) A
resident of a nursing facility; or
(G) A client who is also eligible for
Medicare and where Medicare has reimbursed the provider for the
claim.
Notes
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