Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 3 - PROVIDER ENROLLMENT AND PARTICIPATION, PRE-AUTHORIZATION, PAYMENT AND SUBMISSION OF CLAIMS BY PROVIDERS
Section 3-7 - Out-of-State Providers
Universal Citation: WY Code of Rules 3-7
Current through September 21, 2024
(a) A service furnished by an enrolled provider located outside Wyoming is Medicaid reimbursable if:
(i) The services are needed
because of a medical emergency;
(ii) The client is located outside of Wyoming
and the client's health would be endangered if required to return to the state;
(iii) The Department determines,
on the basis of medical advice, that the needed medical services, or necessary
supplementary resources, are more readily available in the other
state;
(iv) It is general practice
for clients in a particular locality in Wyoming to use medical resources in
another state;
(v) The client is
referred to a provider outside Wyoming when prior authorized and comparable
services are not available within the state;
(vi) The out-of-state provider is closer to
the client's residence than a provider of comparable services within Wyoming;
or
(vii) The client is less than 22
years of age; and
(A) Is a foster child and in
the custody of the Wyoming Department of Family Services who resides with a
foster family out of state and whose Medicaid coverage cannot otherwise be
transferred to the receiving state; or
(B) Has been placed in an out-of-state
institution.
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