§ 42-4-103 — Authorized services and supplies

(a) Services and supplies authorized for medical
assistance under this chapter include:
(i) Inpatient hospital services;
(ii) Outpatient hospital services;
(iii) Laboratory and x-ray services;
(iv) Skilled nursing home services;
(v) The professional services of a licensed and
certified physician, osteopathic physician or chiropractic
doctor;
(vi) Home health services;
(vii) Family planning services;
(viii) Services provided by an authorized rural
health care clinic;
(ix) Midwife services provided by a:
(A) Certified nurse midwife licensed by the
board of nursing;
(B) Midwife licensed by the board of midwifery.
(x) Early and periodic screening, diagnosis and
treatment for individuals who have not attained the age of
twenty-one (21) years in accordance with Title XIX of the
federal Social Security Act;
(xi) Premiums, deductibles and coinsurance under
federal Medicare Part A, hospital insurance, and Part B,
supplemental medical insurance;
(xii) The professional services of a licensed
optometrist;
(xiii) Prescription drugs and oxygen;
(xiv) Prosthetic devices which are necessary to
replace a missing portion of the body or assist in correcting a
dysfunctional portion of the body including training required to
implement the use of the device but excluding dental prostheses;
(xv) Licensed rehabilitation center services and if
specifically prescribed by a licensed physician, outpatient
services of a privately operated licensed occupational, speech,
audiology or physical therapy center and the professional
services of a licensed occupational therapist, licensed speech
pathologist, licensed audiologist or a licensed physical
therapist;
(xvi) Services provided by an institution for mental
illnesses;
(xvii) Services provided under a federal home and
community based waiver;
(xviii) The professional services of a licensed
dentist which may be legally and alternatively performed by a
licensed physician or osteopathic physician and except as
provided under paragraph (a)(x) of this section, which are not
primarily provided for the care, treatment or replacement of
teeth or structures directly supporting teeth;
(xix) Services provided by a freestanding ambulatory
surgical center;
(xx) Services provided by a certified mental health
center or community substance abuse treatment center; mental
health services provided to qualified recipients by a licensed
physician or under the direction of a physician if an individual
treatment plan is established in writing, approved and
periodically reviewed by a licensed physician; services provided
by a licensed mental health professional. Authorized services
shall include services provided by a person holding a
provisional license as a mental health professional if the
services were provided under the supervision of a licensed
mental health professional. The department of health shall by
rule and regulation or within the state plan for medical
assistance and services, define those services qualifying as
mental health services under this paragraph and, pursuant to
W.S. 9-2-102, establish standards for certification under this
paragraph. As used in this paragraph "licensed mental health
professional" means a licensed professional counselor, a
licensed marriage and family therapist, a licensed addictions
therapist or a licensed clinical social worker;
(xxi) Services provided by intermediate care
facilities;
(xxii) Services provided by an intermediate care
facility as defined under 42 U.S.C. § 1396d(d);
(xxiii) Services provided by freestanding end stage
renal dialysis clinics or centers;
(xxiv) Services provided by advanced practitioners of
nursing;
(xxv) Hospice care as defined in W.S. 35-2-
901(a)(xii) and authorized under 42 U.S.C. §
1396a(a)(10)(A)(ii)(VII) including hospice care in a hospice
facility for an eligible individual and room and board for
individuals receiving the care in a hospice facility.
Reimbursement rates for hospice care shall be set annually to
match Medicare hospice reimbursement rates. The room and board
reimbursement rate for hospice facilities shall not exceed one
hundred percent (100%) of the statewide average of the Medicaid
nursing home room and board rate when an eligible individual is
receiving hospice. For the purposes of this paragraph, "eligible
individual" means a person who is eligible for hospice care as
defined in the state Medicaid plan in effect on July 1, 2012;
(xxvi) Tuberculosis ambulatory care authorized under
42 U.S.C. § 1396a(a)(10)(A)(ii)(XII);
(xxvii) Targeted case management services, which
shall be services which will assist targeted individuals
eligible under the state plan in gaining access to needed
medical, social, educational and other services;
(xxviii) Skilled nursing home extraordinary care in
accordance with W.S. 42-4-104(d);
(xxix) Bone marrow, kidney and liver transplant
services;
(xxx) Programs and services provided under the school
health program;
(xxxi) Services of a licensed dietitian;
(xxxii) Air ambulance transport services, consistent
with W.S. 42-4-123;
(xxxiii) Clubhouse rehabilitation services in
accordance with W.S. 42-4-124;
(xxxiv) The professional services of a school
psychologist;
(xxxv) The professional services of a school social
worker;
(xxxvi) School based services delivered pursuant to
an individualized education program, including services:
(A) Provided by an otherwise enrolled Medicaid
provider type;
(B) Provided by a licensed professional in a
school setting; or
(C) Otherwise covered under this chapter to
support delivery of special education programs and services.
(xxxvii) The professional services of a licensed
pharmacist;
(xxxviii) Podiatry services provided by a podiatrist
licensed by the board of registration in podiatry, if referred
to a podiatrist by a physician, physician assistant or an
advanced practice registered nurse.
(b) In addition to other payments authorized under this
chapter, the department may provide payments to skilled nursing
homes which are providing services covered under this chapter
if:
(i) The nursing home demonstrates that one hundred
percent (100%) of the additional amount received will be
expended upon direct patient care personnel salaries and
benefits; and
(ii) The nursing home agrees to provide sufficient
data to the department substantiating compliance with paragraph
(i) of this subsection.
(c) For purposes of implementing Medicaid reform pursuant
to 2013 Wyoming Session Laws, Chapter 117, the department may
apply for any applicable waivers or permissions to allow
exceptions to federal conflict free case management definitions
for frontier and rural areas, which to the extent consistent
with federal law, shall implement a system using a neutral third
party to ensure no conflicts exist. Consistent with federal law,
the department may phase in the independent case management
system. In negotiating a waiver pursuant to this subsection,
the department shall, to the extent practicable and approved by
the center for Medicare and Medicaid services:
(i) Allow an individual or agency to provide case
management and direct services to discrete clients if the
services are provided under conflict free circumstances;
(ii) When implementing updated case manager
educational standards, provide for a three (3) year transition
period and allow credit for prior case manager experience.