048-9 Wyo. Code R. §§ 9-10 - Outpatient hospital services

(a) Covered services. Subject to the service limitations of Section 11, outpatient hospital services are covered services if provided:

(i) Pursuant to the written orders of a physician;

(ii) By or under the supervision of a physician and

(iii) Subject to subsection (b).

(b) Limited and excluded services.

(i) The limitations and exclusions specified in Sections 11 and 12;

(ii) Cardiac rehabilitation programs are covered if provided in the outpatient department of a hospital, and:

(A) The recipient has:

(I) Documented diagnosis, in medical records, of acute myocardial infarction within the preceding twelve months;

(II) Had coronary bypass surgery; or

(III) Stable angina pectoris; and

(B) The recipients condition requires direct, continuing supervision by a physician.

(iii) Diabetic education programs are covered if:

(A) The recipient is newly diagnosed as diabetic; or

(B) The recipient is an unstable diabetic who is newly insulin dependent.

(iv) Itinerant physician clinic services are covered if the clinic is conducted by a physician who has a contractual agreement with the hospital.

(v) Except as otherwise specified in this Chapter, physical, occupational or speech therapy services are covered if prescribed by the attending physician and recertified by the attending physician every thirty days, and:

(A) Prescribed as part of the plan of treatment during an inpatient hospital stay and such therapy continues on an outpatient basis until the plan of treatment is concluded;

(B) Prescribed as a direct result of outpatient surgery or injury; or

(C) Prescribed and provided to prevent inpatient hospitalization.

(vi) Psychiatric services are covered if:

(A) The recipient is evaluated by a multi- disciplinary treatment team of mental health professionals; and

(B) Provided pursuant to an individualized treatment plan.

(vii) Any other services limited or excluded by Chapter 26.

Notes

048-9 Wyo. Code R. §§ 9-10