Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 12 - HOME HEALTH SERVICES
Section 12-8 - Prior Authorization
Universal Citation: WY Code of Rules 12-8
Current through September 21, 2024
(a) Prior authorization of home health services shall be governed by Chapter 3.
(b) All home health services require prior authorization.
(c) The failure to obtain prior authorization shall result in the denial of Medicaid payment for the service.
(d) The provider shall submit the following as part of the prior authorization request.
(i) Submission of plan of treatment. The
provider shall submit a written request for prior authorization on the forms
specified by the Department, including the plan of treatment, before the
submission of a claim for such services. The Department may request additional
information as necessary to review the plan of treatment.
(A) The plan of treatment shall include a
statement that the home health services are appropriate and medically
necessary.
(B) The plan of
treatment shall be reviewed, signed, and dated by the attending physician at
least once every sixty (60) days.
(ii) Face to face visit. All new home health
orders shall be accompanied by documentation of a face to face visit having
occurred between the client and the attending physician (ordering provider)
within the ninety (90) days prior to the start of home health
services.
(iii) Documentation of
Medicare status. For clients eligible under both Wyoming Medicaid and Medicare,
documentation from the ordering provider shall be included indicating the
client is not home-bound and would not qualify for home health services under
their Medicare benefits.
(iv) The
Department or their designee may request additional information as necessary to
review the prior authorization.
(e) Denial of plan of treatment. If a plan of treatment is disapproved, the provider may submit a revised plan of treatment or additional documentation as necessary for the Department's reconsideration.
Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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