048-6 Wyo. Code R. §§ 6-8 - Covered services
(a) HEALTH
CHECKs.
(b) Treatment and referral
services. Treatment and referral services are covered pursuant to the other
rules of the Department.
(c)
Expanded services. Expanded services are covered services if:
(i) There is a physician referral;
(ii) Prior authorized, if required;
and
(iii) Furnished in the most
cost effective setting, as determined by the Division.
(d) Transportation services.
(i) Ambulance transportation. Ambulance
transportation is covered pursuant to Chapter 15.
(ii) Administrative transportation. Necessary
transportation to obtain covered
services is available through the local office of DFS.
(e) Excluded services.
HEALTH CHECK treatment and referral services or expanded services do not
include:
(i) Services or treatments not
approved by the FDA;
(ii)
Experimental procedures;
(iii)
Procedures that are not medically necessary;
(iv) Procedures that are not generally
recognized as an accepted modality of medical practice or treatment;
(v) Educational services.
(f) Limits on services. HEALTH
CHECK services otherwise reimbursable if furnished in a particular setting must
be furnished in that setting and are subject to the reimbursement rules of the
Department.
Notes
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No prior version found.