Drugs shall be covered for a SeniorCare participant only if the participant is within the United States, Canada or Mexico. Drugs provided by a person in another state who is not certified as a border status provider shall be covered only under either of the following circumstances:

1. (1) As a result of an accident or sudden illness, the individual needs the drug to prevent the individual’s death or the serious impairment of the individual’s health.
2. (2) When the department has granted prior authorization for provision of a non-emergency service, except that prior authorization is not required for non-emergency services provided to Wisconsin participants by border status providers certified by the Wisconsin medical assistance program.

History

History: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03.