Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 26 - COVERED SERVICES
Section 26-28 - Client Co-Payments

Universal Citation: WY Code of Rules 26-28

Current through September 21, 2024

(a) Clients who receive the following services shall make a co-payment:

(i) Eye examinations;

(ii) FQHC services;

(iii) Physician office visits;

(iv) Physician home visits;

(v) Psychiatric services;

(vi) RHC services;

(vii) Non-Emergent hospital emergency services; and

(viii) Pharmaceutical products.

(b) Co-payment amounts. Co-payment amounts shall be made as specified in State Plan Amendment 4.18-A.

(c) Exceptions. Co-payment requirements of this Section shall not apply to:

(i) Emergency services;

(ii) Family planning clinic services;

(iii) Clients under the age of twenty-one (21);

(iv) Pregnant women;

(v) Residents of a nursing facility;

(vi) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim;

(vii) Items and services furnished directly to an American Indian or Alaska Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of an "Indian" at Section 4 of the Indian HealthCare Improvement Act ( 25 U.S.C. § 1608);

(viii) Hospice Services; and

(ix) Inpatient hospital stays.

(d) Providers shall be responsible for collecting the co-payment. The amount of the co-payment shall be automatically deducted by the Wyoming Department of Health from the Medicaid allowable payment, regardless of whether the co-payment is actually paid. For purposes of this section, a provider shall not deny service to a client due to a client"s inability to make the co-payment, unless a client regularly refuses to make co-payments.

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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