Section 26-19 - 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);
- (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 services (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.
048-26 Wyo. Code R. § 26-19
Amended, Eff. 12/17/2015.