Wyo. Code R. 048-0037-26
Medicaid
Chapter 26: Covered Services
Effective Date: 01/18/2025 to Current
Rule Type: Current Rules & Regulations
Reference Number: 048.0037.26.01182025
This Chapter is promulgated by the Wyoming Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through -124.
This Chapter has been adopted to establish the scope of covered services, except as otherwise specified by the Wyoming Department of Health, and shall apply to all clients and providers for all services furnished on or after the Chapter's effective date.
Except as otherwise specified in Chapter 1, or as specified herein, the terminology used in this Chapter is the standard terminology and has the standard meaning as used in health care, Medicaid and Medicare.
(a) 'Applied Behavior Analysis (ABA) Treatment.' Services provided to children between the ages of 0-20 years of age with a diagnosis of autism spectrum disorder in order to improve social, communication, and learning skills.
(b) 'Ambulatory Surgical Center (ASC) Facility.' A health care facility that specializes in providing surgery, pain management, and certain diagnostic services in an outpatient setting. ASC-qualified procedures are typically more complex than those done in a doctor's office but not so complex as to require an overnight stay.
(c) 'Ambulatory Surgical Center (ASC) Services.' Surgical procedures or other services offered by an ASC facility that do not require inpatient hospital care.
(d) 'Dental Services.' Professional services and dental appliances furnished by a dentist within the scope of their practice.
(e) 'Developmental Center.' An agency which:
(i) Provides developmental services to developmentally disabled children under the age of six; and
(ii) Is certified to provide services to clients under age twenty-one by the Developmental Disabilities Section of the Health Care Financing Division.
(f) 'Developmental Center Services.' Services provided to developmentally disabled clients under age twenty-one as part of an individualized education plan or as part of an individualized family services plan.
(g) “Diagnostic Assessment and Evaluation.” A comprehensive, multidisciplinary evaluation of a child five years of age or under, that:
(i) Is performed after a written referral from a physician, nurse practitioner or physician’s assistant licensed in Wyoming;
(ii) Is performed using standardized assessment tools or, if no standardized assessment tools are available based on the child’s chronological age or suspected developmental age, using criterion-based assessments; and
(iii) Includes an assessment of the following:
(A) Physical development, including fine and gross motor skills;
(B) Cognitive development;
(C) Speech development; and
(D) Social and emotional development.
(h) “Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services.” Services as described in 42 U/S/C/ 1396 (d)(r) and 42 C.F.R. Part 441, Subpart B.
(i) “Emergency Hospital Services.” Emergency hospital services, as defined by 42 C.F.R. § 440.170(e).
(j) “End Stage Renal Dialysis (ESRD) Services.” Services for outpatient dialysis and other treatment for persons with end-stage renal disease.
(k) “Family Planning Clinic Services.” Services for medically indicated diagnosis, treatment, counseling, contraceptive supplies or devices, which are prescribed or furnished to individuals of child-bearing age for purposes of enabling such individuals to determine the number and spacing of their children.
(l) “Habilitative Services.” Services that help patients keep, learn, or improve skills and functioning for daily living.
(m) “Hospice Services.” A program of care delivered in a person’s home or health care facility that provides reasonable and necessary medical and support services for the management of a terminal illness.
(n) “Interpretation Services.” Services that assist clients with oral or sign language interpretation.
(o) “Nurse Midwife Services” Nurse midwife services as defined by 42 C.F.R. § 440.165.
(p) 'Optometrist.' A person licensed to practice optometry by the Wyoming State Board of Examiners of Optometry or a similar agency in another state.
(q) 'Physician Services.' Professional services furnished by or under the supervision of a licensed physician.
(r) 'Preventive Services/Visits.' Any routine service or examination which is performed in the absence of a diagnosed illness, injury, or complaint.
(s) 'Public Institution.' Public institution, as defined by 42 C.F.R. § 435.1010.
(t) 'Radiology Services.' Professional or technical services in which radiographic instruments are used for diagnostic or therapeutic purposes.
(u) 'Rehabilitative Services.' Services that help patients keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the client was sick, hurt, or suddenly disabled.
(v) 'Speech Therapy Services.' Outpatient services provided by or under the direct supervision of a licensed speech therapist pursuant to written orders of a physician.
(w) 'Vision Services.' Professional services and corrective lenses furnished by an Optometrist, optician, or Ophthalmologist within the scope of his practice.
(a) The services and supplies specified in subsection (b) are covered services if medically necessary, subject to any exclusions or limitations contained in this Chapter and the Wyoming Department of Health.
(b) Covered services:
(i) Applied Behavior Analysis (ABA) Treatment, for individuals between the ages of 0-20 with a diagnosis of autism spectrum disorder;
(ii) Administrative Transportation;
(iii) Advanced Practitioner of Nursing (APN) services
(iv) Ambulance Services including Ground and Air;
(v) Ambulatory Surgical Center (ASC) Services;
(vi) Audiology Services and hearing aids;
(xxviii) Institution for Mental Disease (IMD) Services furnished to individuals under twenty-two years of age and sixty-five years of age and older;
(xxix) Interpretation Services;
(A) For clients over the age of 21, transplants are limited to bone marrow, kidney, and liver;
(xlix) Speech Therapy Services;
(l) Swing bed Services;
(li) Targeted case management;
(lii) Vision Services and
(liii) Weight reduction treatment, including intestinal bypass surgery, gastric bypass surgery, and gastric stapling.
(a) The Wyoming Department of Health shall not cover the following services and supplies:
(i) Except in an emergency, services furnished without the consent of the client or the client’s legal guardian;
(ii) Experimental procedures which are not generally accepted or used by a provider's peer group as current or standard practice;
(iii) Examinations or reports required for legal purposes or other purposes not specifically related to medical care;
(iv) Services furnished outside the United States;
(v) Services furnished to an individual 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 except as allowed by Federal law;
(vi) Services provided to an individual during the first seventy-two (72) hours of emergency detention;
(vii) Services provided to clients age 22 - 64 in an Institute for Mental Diseases (IMD), including Medicare secondary claims;
(viii) Unless pre-approved, services which exceed the service limitations;
(ix) Services provided pursuant to a court order if such services:
(A) Are not covered services;
(B) Exceed service limitations;
(C) Are furnished by a health care practitioner or facility that is not a provider on the date(s) of services;
(D) Have not received prior authorization, if applicable; or
(E) Have not received admission certification, if applicable.
(a) Eligible providers. A facility or distinct portion of a facility certified under Medicare to provide ASC services.
(b) Covered services. (i) All surgical procedures covered by Medicare; and (ii) Additional surgical procedures pre-authorized and which may be provided as outpatient hospital services.
(a) Eligible providers. Physicians, independently practicing licensed Audiologists, and hearing aid equipment providers. (b) Covered services. (i) Audiological function tests; (ii) Hearing aid examinations; and (iii) Hearing aid equipment.
(a) Eligible providers. Hospitals and physicians that employ a CRNA or independently practicing CRNAs. (b) Covered services. Anesthesia services, except as otherwise specified by the Wyoming Department of Health. (c) Excluded services. Anesthesia services when performed in conjunction with a surgical procedure that: (i) Is not a covered service; (ii) Requires prior authorization that has not been obtained; or (iii) Requires informed consent by the client that has not been obtained.
(a) Eligible providers. Facilities certified by Medicare as a CORF. (b) CORF services are limited to: (i) Drugs and biologicals that cannot be self-administered; (ii) Medical supplies and equipment;
(iii) Nursing services; (iv) Occupational therapy; (v) Orthotics and prosthetics; (vi) Physician Services; (vii) Physical therapy; (viii) Respiratory therapy; (ix) Social or psychological services; and (x) Speech therapy. (c) Excluded services. (i) Services directed at general conditioning or maintenance; and (ii) Services that exceed the limitations imposed by the Wyoming Department of Health.
(a) Covered services for clients under the age of twenty-one (21): (i) Preventive visits; (ii) Restorative fillings, crowns, and tooth replacement; (iii) Extractions; (iv) Partial or complete dentures; (v) Root canal therapy; (vi) Periodontal treatment; (vii) Oral and maxillofacial surgery; (viii) Orthodontic treatment for severe malocclusions; and (ix) Palliative treatment. (b) Covered services for clients age twenty-one (21) and older:
(i) Preventive visits; (ii) Extractions; (iii) Palliative treatment; and (iv) Oral and maxillofacial surgery.
(a) Eligible providers. Dietitians. (b) Covered services. (i) Medically necessary professional services furnished by a dietitian, as prescribed by a physician, nurse practitioner or physician assistant. (c) Service limitations. (i) Medicaid reimbursement for Dietitian service(s) shall be limited to a total of twenty (20) visits per calendar year, unless pre-approved. (ii) The limitations of this subsection shall not apply to: (A) A client who is under age twenty-one (21); or (B) A pregnant woman.
(a) Eligible providers. Developmental Centers certified by the Developmental Disabilities Section and under contract with that office to provide such services. (b) Covered services. Diagnostic assessment and evaluation, behavioral health, speech, physical therapy services, occupational therapy services, and case management services.
(a) Emergency Hospital Services are covered at the most accessible enrolled hospital available that is equipped to furnish appropriate Emergency Hospital Services.
(a) Eligible Providers. Free-standing or hospital-based facilities certified by Medicare to provide ESRD services. (b) Covered services. ESRD services for outpatient dialysis and other treatment for persons with end-stage renal disease.
(a) Eligible Providers. A clinic, which is neither located on the premises of a hospital nor owned by a hospital and meets the minimum requirements for routine contraceptive management as specified by the state Public Health Division. A laboratory in a clinic shall be licensed by the State of Wyoming.
(b) Covered Services. The following services are covered when furnished under the supervision of a physician, nurse practitioner or physician assistant who is directly affiliated with the clinic. A provider is directly affiliated with the clinic if there is a contract between the provider and the clinic under which the provider is obligated to supervise the following care furnished to the clinic's patients:
(a) Eligible providers. Hospice providers certified by Medicare and located within the State of Wyoming. Services provided by a hospice provider located outside the State of Wyoming shall not be eligible for Medicaid reimbursement unless the services are pre-approved.
(b) Covered services. The following services shall be covered if provided pursuant to a written plan of care established by the hospice provider and approved by the client's attending physician:
(c) Limitations. During the time a client elects to receive hospice services, the client shall waive all rights to Medicaid payments for the following services:
(i) Hospice Services provided by a provider other than the hospice provider designated by the client (unless provided under arrangements by the designated hospice); and
(ii) Any Medicaid services that are related to the treatment of the terminal illness (or a related condition) for which hospice services were elected, or services that are equivalent to hospice services, except for services:
(A) Provided by the designated hospice, either directly or by arrangement with another provider;
(B) Provided by the client’s attending physician if that physician is neither an employee of the designated hospice nor receiving compensation from the hospice for furnishing such services;
(C) Provided as room and board by a nursing facility if the client is a resident of a nursing facility;
(D) Provided by a Home and Community Based Waiver; or
(E) Delivered to a client under the age of twenty-one (21) years. Clients under the age of twenty-one (21) shall be eligible for curative services as well as terminal illness hospice care.
(d) Medicaid allowable payment. The Medicaid allowable payment shall be determined as follows:
(i) The Medicaid allowable payment to the hospice provider for room and board furnished in a nursing facility shall be ninety-five percent (95%) of the nursing facility's per diem rate. The hospice provider shall be responsible for paying the nursing facility for the room and board services furnished to a client of hospice services.
(ii) Providers providing hospice services in an inpatient hospice facility that does not meet eligibility criteria for inpatient hospice care billing may receive room and board payments from Wyoming Medicaid. Payments for room and board shall follow the method established in Section 16, (d)(i) and pay one hundred percent (100%) of the rates established by that method. This is intended to ensure client choice of setting does not cause a difference between nursing home and standalone hospice settings.
(iii) Total Medicaid payments to a hospice provider for inpatient care furnished to clients of hospice services shall not exceed twenty percent (20%) of the aggregate number of days of hospice care provided by the hospice provider to all Medicaid clients during the applicable twelve-month period. The limit shall be applied as follows:
(A) For each twelve-month period beginning on November 1, the Department shall determine the aggregate number of days of inpatient care furnished by each hospice provider to clients of hospice services (the number of days of inpatient care shall include general inpatient care and inpatient respite care); and (B) If payments for inpatient services exceed twenty percent (20%) of the total days of Medicaid services, the Medicaid payments for such services shall be considered overpayments and shall be recovered.
(a) Hospital Services (including ancillary services provided in a hospital) shall be covered services if provided:
(b) Inpatient Hospital Psychiatric Services. Psychiatric services are limited to stabilization of acute conditions. Such services shall only be covered services when:
(i) The client is evaluated by a multidisciplinary team within forty-eight (48) hours after admission;
(ii) The multidisciplinary team prepares an individualized treatment plan; and
(iii) 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.
(c) Limitations on Hospital Services.
(i) Medicaid reimbursement for outpatient hospital services shall be limited to a total of twelve (12) visits per calendar year to a hospital clinic, a hospital emergency room (for non-emergency services), and a physician's office, unless additional visits are pre-approved.
(ii) Exceptions. The limitations of subsection (c)(i) shall not apply to:
(A) An individual seeking emergency services who is diagnosed with an emergent condition;
(B) An individual seeking family planning clinic services;
(C) A client who is under age twenty-one (21);
(D) A pregnant woman;
(E) Items and services furnished directly by the Indian Health Services, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or through a referral under a purchase order contract health service (as described in 42 C.F.R., Ch. I, Subch. M, Pt. 136, Subpart C) to an American Indian or Alaskan Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of “Indian” at Section 4 of the Indian Healthcare Improvement Act (25 U.S.C. § 1608);
(F) A resident of a nursing facility; or
(G) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim.
(a) Interpreters shall adhere to national standards developed by the National Council on Interpreting in Healthcare (NCIHC), to include accuracy, confidentiality, impartiality, role boundaries, professionalism, professional development, and advocacy.
(b) Covered Services. The interpretation provider shall only bill for time spent with the client.
(i) Excluded services. Interpreter services in conjunction with the following services:
(A) Inpatient and outpatient hospital services;
(B) Services in an Intermediate Care Facility for persons with Intellectual Disabilities (ICF/ID);
(C) Nursing Facility services;
(D) Ambulance Services by public providers;
(E) PRTF services;
(F) Comprehensive Inpatient and Outpatient Rehabilitation Facility Services;
(G) Services provided by other agencies and organizations receiving federal funding;
(H) Interpreter services provided by a family member, volunteer, associate, or friend; and
(I) Reimbursement for interpreter travel to and from the appointment.
(a) Eligible providers. Independent laboratories certified by Medicare, hospitals laboratories, and physician offices with a laboratory licensed by the state in which the laboratory is located.
(b) Covered services. Professional or technical laboratory services ordered by a licensed provider under their scope of practice. Services shall be directly related to the diagnosis and treatment of the patient as specified in the ordering provider's treatment plan.
(c) Excluded services:
(i) Handling charges where a specimen is referred by one (1) laboratory to another;
(ii) Post-mortem examinations;
(iii) Fees charged to obtain immediate results;
(iv) Technician callback fees; and
(v) Services that are not FDA approved.
(d) Limited services:
(i) Specimen collection fees shall be paid only to the provider that collects the specimen from the client.
(ii) Only one collection fee shall be allowed for each type of specimen for each client encounter, regardless of the number of specimens extracted.
(iii) Clinical laboratory services routinely performed by non-physicians shall not be entitled to a professional component.
(a) Covered services. Professional services furnished by a licensed nurse midwife that are:
(i) Throughout the maternity period; and
(ii) Within the scope of the nurse midwife's practice as permitted by the Wyoming Nursing Practice Act.
(b) Excluded and limited services. Services furnished in a hospital or a clinic shall be covered only to the extent the facility permits such services.
(a) Eligible providers. Licensed independent occupational therapists, hospitals, physicians, PRTFs, and developmental centers that employ licensed occupational therapists.
(b) Covered services.
(i) Prescribed rehabilitative occupational therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness;
(ii) Occupational therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;
(iii) Occupational therapy services furnished in a developmental center or PRTF to a client pursuant to:
(A) An individualized education plan (IEP) developed by the school system or PRTF; or
(B) An individualized family services plan developed by a developmental center.
(c) Service limitations.
(i) Unless pre-approved, Medicaid reimbursement for client occupational therapy visits shall be limited to twenty (20) visits per calendar year.
(ii) Habilitative services are not covered for clients 21 years of age or older.
(iii) Except as otherwise specified in this Chapter, occupational therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician’s assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician’s assistant, or other practitioner of the healing arts every one hundred eighty (180) days.
(a) Eligible providers Licensed independent physical therapists, physicians, hospitals, PRTFs, and developmental centers that employ licensed physical therapists.
(b) Covered services.
(i) Prescribed rehabilitative physical therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness as prescribed by a physician;
(ii) Physical therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;
(iii) Physical therapy services prescribed as a direct result of outpatient surgery required as a result of an injury; and (iv) Physical therapy services provided to a client under age twenty-one (21) with chronic disabilities when furnished by a developmental center or PRTF pursuant to an:
(A) Individualized education plan developed by the school system or PRTF; or
(B) Individualized family services plan developed by a developmental center.
(c) Service limitations.
(i) Unless pre-approved, Medicaid reimbursement for client physical therapy visits shall be limited to a total of twenty (20) visits per calendar year.
(ii) Habilitative services are not covered for clients 21 years of age or older.
(iii) Except as otherwise specified in this Chapter, physical therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts every one hundred eighty (180) days.
(a) Covered services. Medically necessary professional services furnished by or under the supervision of a licensed physician, except as otherwise specified by this Chapter.
(b) Excluded or limited services.
(i) Anesthesia services shall be limited as follows:
(A) An anesthesiologist shall not receive Medicaid reimbursement for a consultation in addition to any other anesthesia services for the same surgery.
(B) Anesthesia services shall not be covered when performed in conjunction with:
(I) A non-covered surgical procedure; or
(II) A procedure requiring client consent if proper consent was not obtained not withstanding emergency procedures where consent cannot reasonably be obtained.
(ii) The following allergy and clinical immunotherapy services are excluded:
(A) Sublingual, intracutaneous and subcutaneous provocative and neutralization testing; and (B) Neutralization therapy for food allergies.
(iii) Cosmetic surgery:
(A) Services intended solely to improve an individual's physical appearance and which do not restore bodily function or correct a physical deformity are excluded.
(B) Reconstructive surgery procedures which are intended to improve bodily functions and the appearance of a body area which has been altered by disease, trauma, congenital or developmental anomalies, or previous surgical procedures shall be covered only if authorized prior to the procedure.
(iv) Dermatology. The following shall be excluded:
(A) Removal of lesions not suspected to be precancerous, unless medically necessary to restore a bodily function; and
(B) Services performed primarily for cosmetic reasons.
(v) Medical supplies. Expendable medical supplies normally used in a physician's office shall be included in the Medicaid payment for the office visit or test performed. The actual cost of special expendable supplies prescribed for home use by a client may be separately billed to Medicaid.
(vi) Prolonged care shall be limited to a total of three (3) hours per day unless there is documentation in the medical records that additional prolonged care was medically necessary.
(vii) Sterilizations shall not be covered unless the requirements of 42 C.F.R. § 441 are satisfied.
(viii) Therapeutic injections shall not be covered unless:
(A) The drug cannot be administered orally;
(B) The drug cannot be self-administered; and
(C) The drug is reasonable and medically necessary.
(c) Service Limitations. Unless pre-approved, Medicaid reimbursement for client visits to a physician, ophthalmologist, physician assistant, nurse practitioner, optometrist and to the outpatient department of a hospital shall be limited to a total of twelve (12) visits per calendar year. The limitations of this subsection shall not apply to:
(i) A client seeking emergency services who is diagnosed with an emergent condition;
(ii) A client seeking family planning clinic services;
(iii) A client who is under age twenty-one (21);
(iv) A pregnant woman;
(v) Items and services furnished directly by the Indian Health Services, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or through a referral under a purchase order contract health service (as described in 42 C.F.R., Ch. I, Subch. M, Pt. 136, Subpart C) to an American Indian or Alaskan Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of a “Indian” as Section 4 of the Indian Healthcare Improvement Act (25 U.S.C. § 1608);
(vi) A resident of a nursing facility; or
(vii) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim.
(a) Eligible providers. Licensed independent radiology practices, hospitals, and physician practices.
(b) Excluded services:
(i) Unordered radiological studies; and
(ii) Separate consultations procedures unless ordered by the attending physician, nurse practitioner or physician’s assistant.
(c) Limited services:
(i) Routine mammography is limited as follows:
(A) One mammography between the ages of thirty-five (35) and thirty-nine (39); and
(B) One mammography per year at age forty (40) and after.
(ii) Services performed in a physician’s office shall be covered only if performed by or under the direct supervision of the physician.
(iii) Services performed in a hospital using equipment owned by the provider. The provider may bill for the total procedure if the technical component is not billed by the hospital.
(a) Eligible Providers. Independent licensed speech therapists, physicians, hospitals, PRTFs, and developmental centers that employ licensed speech therapists.
(b) Covered Services.
(i) Prescribed rehabilitative speech therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness as prescribed by a physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts;
(ii) Speech therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;
(iii) Speech therapy prescribed as a direct result of outpatient surgery required as a result of an injury; and
(iv) Speech therapy services provided to a client under age twenty-one (21) with chronic disabilities when furnished by a developmental center or a PRTF pursuant to an:
(A) Individualized Education Plan (IEP) developed by the school system or PRTF; or
(B) Individualized family services plan developed by a developmental center.
(c) Service limitations.
(i) Medicaid reimbursement for client speech therapy visits shall be limited to thirty (30) visits per calendar year, unless pre-approved.
(ii) Habilitative services are not covered for clients 21 years of age or older.
(iii) Except as otherwise specified in this Chapter, speech therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts every one hundred eighty (180) days.
(a) Eligible providers. Case managers.
(b) Covered services. Case management services provided only to target groups.
(a) Eligible providers. Optometrist, opticians and licensed ophthalmologists. (b) Covered services. Medical treatment for clients: (i) At risk of eye diseases, including eye disease secondary to chronic illness; or (ii) With eye injuries. (c) Additional covered services for clients under twenty-one (21) years of age: (i) Medically necessary contact lenses; (ii) Eyeglasses; (iii) Medically necessary photosensitive lenses; (iv) Routine eye examinations; and (v) Vision therapy.
(a) Clients who receive the following services shall make a co-payment: (i) Federally Qualified Health Centers (FQHC) services; (ii) Physician office visits; (iii) Physician home visits; (iv) Psychiatric services; (v) Rural Health Centers services; (b) Co-payment amounts. Co-payment dollar amounts shall be assigned as specified in State Plan Amendment 4.18-A. (c) Exceptions. Co-payment requirements of this Section shall not apply to: (i) Emergency services; (ii) Family planning clinic services; (iii) Clients under the age of twenty-one (21);
(iv) Pregnant women;
(v) Residents of a nursing facility or swing bed facility;
(vi) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim;
(vii) Items and services furnished directly to an American Indian or Alaska Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of an “Indian” at Section 4 of the Indian HealthCare Improvement Act (25 U.S.C. § 1608);
(viii) Hospice Services; and
(ix) Inpatient hospital stays.
(x) Any individual or service where cost sharing is prohibited by Federal law or State law as specifically delineated in State Plan Amendment 4.18-A.
(d) Providers shall be responsible for collecting the co-payment. The amount of the co-payment shall be automatically deducted by the Wyoming Department of Health from the Medicaid allowable payment, regardless of whether the co-payment is actually paid. For purposes of this section, a provider shall not deny service to a client due to a client’s inability to make the co-payment, unless a client regularly refuses to make co-payments.