048-26 Wyo. Code R. §§ 26-4 - Covered Services

(a) The services and supplies specified in subsection (b) are covered services if medically necessary, subject to any exclusions or limitations contained in this Chapter and the Wyoming Department of Health.

(b) Covered services:

(i) ABA Treatment, for individuals between the ages of 0-20 with a diagnosis of Autism Spectrum Disorder;

(ii) Administrative Transportation;

(iii) Advanced Practitioner of Nursing (APN) services

(iv) Ambulance Services;

(v) ASC Services;

(vi) Audiology Services and hearing aids;

(vii) Certified Registered Nurse Anesthetist (CRNA) services;

(viii) Certified Community Mental Health Center Services (CMHC);

(ix) Comprehensive Outpatient Rehabilitation Facility (CORF) Services;

(x) Dental Services;

(xi) Dietician Services;

(xii) Developmental Center Services;

(xiii) Emergency Hospital Services;

(xiv) Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services;

(xv) ESRD services;

(xvi) Family Planning Clinic Services;

(xvii) Federally Qualified Health Center (FQHC) services;

(xviii) Certified Substance Abuse Treatment Center (SATC) Services;

(xix) Home and Community Based Services (HCBS);

(xx) Home Health Services;

(xxi) Hospice Services;

(xxii) Hospital Services (inpatient and outpatient);

(xxiii) Intermediate Care Facility for People with Intellectual Disabilities (ICF/ID) Services;

(xxiv) Institution for Mental Disease (IMD) Services furnished to individuals under twenty-two years of age and sixty-five years of age and older;

(xxv) Interpretation Services;

(xxvi) Laboratory Services;

(xxvii) Medical Supplies and Equipment;

(xxviii) Nurse Midwife Services;

(xxix) Nursing Facility Services;

(xxx) Occupational Therapy Services;

(xxxi) Pharmaceutical Services;

(xxxii) Physical Therapy Services;

(xxxiii) Physician Services;

(xxxiv) Psychiatric Residential Treatment Facility (PRTF) Services;

(xxxv) Psychological Services;

(xxxvi) Radiology Services;

(xxxvii) Rural Health Clinic (RHC) Services;

(xxxviii) Solid organ transplants and bone marrow transplants;

(A) For clients over the age of 21, transplants are limited to bone marrow, kidney, and liver;

(xxxix) Speech Therapy Services;

(xl) Swing bed Services;

(xli) Targeted case management;

(xlii) Vision Services and

(xliii) Weight reduction treatment, including intestinal bypass surgery, gastric bypass surgery, and gastric stapling.

Notes

048-26 Wyo. Code R. §§ 26-4

Amended, Eff. 12/17/2015. Amended, Eff. 4/9/2019. Amended, Eff. 5/7/2020. Amended, Eff. 5/13/2021.