048-26 Wyo. Code R. §§ 26-28 - Client Co-Payments
(a) Clients who receive the following
services shall make a co-payment:
(i) Eye
examinations;
(ii) FQHC
services;
(iii) Physician office
visits;
(iv) Physician home
visits;
(v) Psychiatric
services;
(vi) RHC
services;
(vii) Non-Emergent
hospital emergency services; and
(viii) 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)
Providers shall be responsible for collecting the co-payment. The amount of the
co-payment shall be automatically deducted by the Wyoming Department of Health
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.
Notes
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