Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 40 - PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES
Section 40-8 - Prior authorization
Current through September 21, 2024
(a) Prior authorization of PRTF services shall be governed by Medicaid Rules Chapter 3, Provider Participation.
(b) All inpatient psychiatric services for individuals under age twenty-one (21) furnished in a facility shall be prior authorized.
(c) The failure to obtain prior authorization shall result in the denial of Medicaid payment for the service.
(d) The facility shall submit a request for prior authorization in the manner specified by the Department before the submission of a claim for such services. The Department may request, and the facility shall provide additional information as necessary to review the plan of care.
(e) Reauthorization. The physician or the interdisciplinary team must review and reauthorize the client's plan of care every seven (7) to thirty (30) days. Reauthorized plans of care are subject to the prior authorization provisions of this Section.
(f) For the court ordered placement of a client in a PRTF, after a clinical review and determination that the PRTF placement no longer meets the medical necessity criteria outlined in Section 7, a transition period of up to thirty (30) days may be authorized permitting time for the necessary court hearings, MDT meetings and court orders to be updated. Upon expiration of an approved transitional period, no further reimbursement shall be authorized.
