048-1 Wyo. Code R. § 1-5

Current through April 27, 2019

Section 1-5 - Payment of Program Benefits

(a) Benefits are only payable after all other possible third parties (e.g., private/group insurance. Medicare, Medicaid, Indian Health Service (IHS) or the Veterans Administration) have met their responsibilities to pay, or after it is determined that there are no third parties that may be liable for payment.

• (i) If dialysis has begun and there is no verifiable third party payer, the Program will pay the dialysis center a fiat rate fee, as determined by the Program, per treatment for up to ninety (90) days.

• (ii) One sixty (60) day extension of the fiat rate fee may be granted at the discretion of the Program in an extenuating circumstance,

(b) Benefits for dialysis treatments, home training, home dialysis partners/technicians, stabilization, hospitalization, laboratory charges, home dialysis supplies. Program-approved medications, and transportation, are payable to Providers, up to a maximum per recipient per year.

• (i) Recipients who have a kidney transplant are eligible for the Program-approved medications benefit only.

(c) Reimbursement for Program-approved medications, insurance premiums, and ESRD related travel expenses are payable to recipients up to a maximum per recipient per year.

• (i) Kidney transplant recipients are eligible for the Program-approved medications benefit only.

048-1 Wyo. Code R. § 1-5