048-12 Wyo. Code R. § 12-6

Current through April 27, 2019

Section 12-6 - Covered Services

(a) The services and supplies specified in subsection (b) shall be covered services if the services are:

• (i) Intermittent;

• (ii) Medically necessary;

• (iii) Ordered by a physician;

• (iv) Documented in a plan of treatment; and

• (v) Expected to last six (6) months or less.

(b) Covered services.

The following shall be covered services:

• (i) Skilled nursing services provided by a registered nurse for a client's condition while in the acute phase;

• (ii) Home health aide services supervised by a registered nurse;
  • (A) Supervision shall be as follows:
    • (1) The registered nurse shall be available for consultation in person or by telephone; and
    • (2) The registered nurse shall make personal visits to the home:
      • (I) At least every two (2) weeks if the client is receiving skilled nursing care; or
      • (II) At least every sixty (60) days if the only services the client is receiving are home health aide services. The supervisory visits shall occur while the aide is furnishing services. Supervisory visits shall not be a covered service.
  • (B) Each home health aide encounter shall include at least one (1) of the following personal care services, but shall include all ordered services that can be provided in one encounter unless medically indicated otherwise:
    • (1) Bath (bed, sponge, tub, shower, or shampooing hair);
    • (2) Nail or skin care (applying lotion to clients shall not constitute personal care);
    • (3) Oral hygiene;
    • (4) Toileting and elimination;
    • (5) Safe transfers/assisted ambulation;
    • (6) Assist with dressing;
    • (7) Assisted range of motion/positioning; or
    • (8) Assisted nutrition or fluid intake (meal set-up, meal preparation, feeding assistance or meal supervision).

• (iii) Physical therapy services provided by a physical therapist;

• (iv) Speech, hearing, and language services provided by a speech therapist;

• (v) Occupational therapy services provided by an occupational therapist;

• (vi) Medical social services provided by a social worker.

• (vii) Disposable medical supplies provided by a provider in accordance with the plan of treatment.

048-12 Wyo. Code R. § 12-6

Amended, Eff. 8/7/2017.

Amended, Eff. 9/6/2018.