Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 9 - HOSPITAL SERVICES
Section 9-13 - Out-of-state hospitals
Universal Citation: WY Code of Rules 9-13
Current through September 21, 2024
(a) Hospital services provided within the service area but outside the State of Wyoming are not covered unless:
(i) The hospital service
is not available within the recipients local trade area, the out-of-state
hospital is closer to the recipient's residence than an in-state hospital which
offers the necessary services, and the hospital has executed a provider
agreement before the admission;
(ii) The hospital service is provided in
response to an emergency; or
(iii)
The recipient was, at the time the hospital services were provided, outside the
service area and the recipient's health would have been endangered if the
recipient had been required to travel to a hospital within the service
area.
(iv) The recipient is less
than 19 years of age, and
(A) Is a foster
child not covered by Title IV-E of the Social Security Act and resides with a
foster family out of state; or
(B)
Has been placed in an out-of-state institution.
(b) Hospital services provided outside the service area. A hospital service provided by a hospital located outside the service area is not Medicaid reimbursable unless:
(i) The hospital service is provided in
response to an emergency;
(ii) The
recipient was, at the time the hospital services were provided, outside the
service area and the recipient's health would be have been endangered if he had
been required to travel to a hospital within the service area;
(iii) The admission is the result of a
referral from a Wyoming physician to a physician outside the service area for
hospital services not available within Wyoming; or
(iv) The recipient is less than 19 years of
age, and
(A) Is a foster child not covered by
Title IV-E of the Social Security Act and resides with a foster family out of
state; or
(B) Has been placed in an
out-of-state institution.
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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