048-9 Wyo. Code R. §§ 9-13 - Out-of-state hospitals

(a) Hospital services provided within the service area but outside the State of Wyoming are not covered unless:

(i) The hospital service is not available within the recipients local trade area, the out-of-state hospital is closer to the recipient's residence than an in-state hospital which offers the necessary services, and the hospital has executed a provider agreement before the admission;

(ii) The hospital service is provided in response to an emergency; or

(iii) The recipient was, at the time the hospital services were provided, outside the service area and the recipient's health would have been endangered if the recipient had been required to travel to a hospital within the service area.

(iv) The recipient is less than 19 years of age, and

(A) Is a foster child not covered by Title IV-E of the Social Security Act and resides with a foster family out of state; or

(B) Has been placed in an out-of-state institution.

(b) Hospital services provided outside the service area. A hospital service provided by a hospital located outside the service area is not Medicaid reimbursable unless:

(i) The hospital service is provided in response to an emergency;

(ii) The recipient was, at the time the hospital services were provided, outside the service area and the recipient's health would be have been endangered if he had been required to travel to a hospital within the service area;

(iii) The admission is the result of a referral from a Wyoming physician to a physician outside the service area for hospital services not available within Wyoming; or

(iv) The recipient is less than 19 years of age, and

(A) Is a foster child not covered by Title IV-E of the Social Security Act and resides with a foster family out of state; or

(B) Has been placed in an out-of-state institution.

Notes

048-9 Wyo. Code R. §§ 9-13