048-26 Wyo. Code R. §§ 26-5 - Services Not Covered

(a) The Wyoming Department of Health shall not cover the following services and supplies:

(i) Except in an emergency, services furnished without the consent of the client or the client's legal guardian;

(ii) Experimental procedures which are not generally accepted or used by a provider's peer group as current or standard practice;

(iii) Examinations or reports required for legal purposes or other purposes not specifically related to medical care;

(iv) Services furnished outside the United States;

(v) Services furnished to an individual who is an inmate of a public institution, or an individual that is in the custody of a state, local, or federal law enforcement agency;

(vi) Services provided to an individual during the first seventy-two (72) hours of emergency detention;

(vii) Services provided to clients age 22 - 64 in an IMD, including Medicare secondary claims;

(viii) Unless pre-approved, services which exceed the service limitations;

(ix) Services provided pursuant to a court order if such services:

(A) Are not covered services;

(B) Exceed service limitations;

(C) Are furnished by a health care practitioner or facility that is not a provider on the date(s) of services;

(D) Have not received prior authorization, if applicable; or

(E) Have not received admission certification, if applicable.

(x) Abortions, except to the extent required by 42 C.F.R. § 441.200§ 441.208;

(xi) Acupuncture;

(xii) Alcohol and chemical rehabilitation furnished to an inpatient, except for purposes of detoxification or stabilization of acute conditions;

(xiii) Autopsies;

(xiv) Biofeedback therapies and equipment;

(xv) Chronic pain rehabilitation;

(xvi) Community mental health services furnished outside Wyoming;

(xvii) Cosmetic procedures;

(xviii) Custodial care including but not limited to non-skilled, personal care. Personal care would include help with activities of daily living, such as bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom;

(xix) Infertility services, includes but is not limited to counseling, reverse sterilization and artificial insemination;

(xx) Missed or canceled appointments;

(xxi) Personal comfort items;

(xxii) Private-duty nursing services;

(xxiii) Sterilizations, unless the requirements of 42 C.F.R. § 441.250§ 441.259 are satisfied; and

(xxiv) Gender reassignment surgery.

Notes

048-26 Wyo. Code R. §§ 26-5

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