048-26 Wyo. Code R. § 26-30

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Current through April 27, 2019

Section 26-30 - Client Co-Payments

(a) Except as specified in subsection (c), clients who receive the following services shall make a co-payment:

(i) Chiropractor evaluation and management services;

(ii) Eye examinations;

(iii) FQHC services;

(iv) Physician office visits;

(v) Physician home visits;

(vi) Psychiatric services;

(vii) RHC services;

(viii) Non-Emergent hospital emergency services; and

(ix) Pharmaceutical products.

(b) Co-payment amounts. Co-payment amounts shall be made as specified in State Plan Amendment 4.18-A.

(c) Exceptions. Co-payment requirements of this Section shall not apply to:

(i) Emergency services;

(ii) Family planning clinic services;

(iii) Clients under the age of twenty-one (21);

(iv) Pregnant women;

(v) Residents of a nursing facility;

(vi) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim;

(vii) Items and services furnished directly to an American Indian or Alaska Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of an "Indian" at Section 4 of the Indian HealthCare Improvement Act ( 25 U.S.C. § 1608 );

(viii) Hospice Services; and

(ix) Inpatient hospital stays.

(d) Collection of co-payment. Providers shall be responsible for collecting the co-payment. The amount of the co-payment shall be automatically deducted by the Department from the Medicaid allowable payment, regardless of whether the co-payment is actually paid. For purposes of this section, a provider shall not deny service to a client due to a client's inability to make the co-payment, unless a client regularly refuses to make co-payments.

048-26 Wyo. Code R. § 26-30

Amended, Eff. 12/17/2015.

Amended, Eff. 4/9/2019.