048-6 Wyo. Code R. § 6-8

Current through April 27, 2019

Section 6-8 - Covered services

(a) HEALTH CHECKs.

(b) Treatment and referral services. Treatment and referral services are covered pursuant to the other rules of the Department.

(c) Expanded services. Expanded services are covered services if:

(i) There is a physician referral;

(ii) Prior authorized, if required; and

(iii) Furnished in the most cost effective setting, as determined by the Division.

(d) Transportation services.

(i) Ambulance transportation. Ambulance transportation is covered pursuant to Chapter 15.

(ii) Administrative transportation. Necessary transportation to obtain covered
services is available through the local office of DFS.

(e) Excluded services. HEALTH CHECK treatment and referral services or expanded services do not include:

(i) Services or treatments not approved by the FDA;

(ii) Experimental procedures;

(iii) Procedures that are not medically necessary;

(iv) Procedures that are not generally recognized as an accepted modality of medical practice or treatment;

(v) Educational services.

(f) Limits on services. HEALTH CHECK services otherwise reimbursable if furnished in a particular setting must be furnished in that setting and are subject to the reimbursement rules of the Department.

048-6 Wyo. Code R. § 6-8