048-9 Wyo. Code R. §§ 9-9 - Inpatient hospital services

(a) Covered services. Subject to the service limitations of Section 11, inpatient hospital services are covered services if provided:

(i) Pursuant to the written orders of a physician;

(ii) By or under the supervision of a physician; and

(iii) Subject to subsections (b) and (c)

(b) Excluded services.

(i) Abortions, except to the extent required by federal law;

(ii) Alcohol and chemical dependency rehabilitation services;

(iii) Non-covered services provided as part of a recipient's treatment for covered services;

(iv) Nursing facility services, except as provided by Chapter 28;

(v) Oxygen or other supplies specified in Attachment A to Chapter 7 that are provided to a recipient for use in a nursing facility;

(vi) Court ordered medical services that are:

(A) Not covered services;

(B) In excess of service limitations;

(C) Have not received admission certification;

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

(E) Furnished by a hospital that is not a provider on the date(s) of service;

(vii) Services provided pursuant to standing orders, including, but not limited to, routine laboratory or radiology procedures;

(viii) Services provided to a person 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;

(ix) Services provided to an individual in emergency detention;

(x) Sterilizations which are not provided in conformance with the requirements of 42 C.F.R. 442 Subpart F, which is adopted by this reference; and

(xi) Other services as specified in Chapter 26.

(c) Limited services:

(i) Alcohol and chemical dependency services. Treatment for alcohol and chemical dependency is limited to detoxification and/or stabilization of acute conditions;

(ii) Psychiatric services. Except as provided pursuant to Chapter 6, psychiatric services are limited to stabilization of acute conditions. Such services are not covered services unless:

(A) The recipient is evaluated by a multidisciplinary team within 48 hours after admission;

(B) The multidisciplinary team prepares an individualized treatment plan; and

(C) The medical record documents a plan of active treatment and individual, group or family therapy directed to achieve the goals specified in the individualized treatment plan.

Notes

048-9 Wyo. Code R. §§ 9-9