Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 9 - HOSPITAL SERVICES
Section 9-9 - Inpatient hospital services
Universal Citation: WY Code of Rules 9-9
Current through September 21, 2024
(a) Covered services. Subject to the service limitations of Section 11, inpatient hospital services are covered services if provided:
(i) Pursuant to the written orders of a
physician;
(ii) By or under the
supervision of a physician; and
(iii) Subject to subsections (b) and
(c)
(b) Excluded services.
(i) Abortions, except to the extent
required by federal law;
(ii)
Alcohol and chemical dependency rehabilitation services;
(iii) Non-covered services provided as part
of a recipient's treatment for covered services;
(iv) Nursing facility services, except as
provided by Chapter 28;
(v) Oxygen
or other supplies specified in Attachment A to Chapter 7 that are provided to a
recipient for use in a nursing facility;
(vi) Court ordered medical services that are:
(A) Not covered services;
(B) In excess of service
limitations;
(C) Have not received
admission certification;
(D) Have
not received prior authorization, if so required; or
(E) Furnished by a hospital that is not a
provider on the date(s) of service;
(vii) Services provided pursuant to standing
orders, including, but not limited to, routine laboratory or radiology
procedures;
(viii) Services
provided to a person who is an inmate of a public institution or an individual
that is in the custody of a state, local, or federal law enforcement
agency;
(ix) Services provided to
an individual in emergency detention;
(x) Sterilizations which are not provided in
conformance with the requirements of 42 C.F.R. 442 Subpart F, which is adopted
by this reference; and
(xi) Other
services as specified in Chapter 26.
(c) Limited services:
(i) Alcohol and chemical dependency services.
Treatment for alcohol and chemical dependency is limited to detoxification
and/or stabilization of acute conditions;
(ii) Psychiatric services. Except as provided
pursuant to Chapter 6, psychiatric services are limited to stabilization of
acute conditions. Such services are not covered services unless:
(A) The recipient is evaluated by a
multidisciplinary team within 48 hours after admission;
(B) The multidisciplinary team prepares an
individualized treatment plan; and
(C) The medical record documents a plan of
active treatment and individual, group or family therapy directed to achieve
the goals specified in the individualized treatment plan.
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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