Wyoming

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Wyoming Medicaid

Administrator

Office of Equality Care, under the Wyoming Dept. of Health

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: No
Remote Patient Monitoring: No

Private Payer Law

Law Exists: No
Payment Parity: No

Professional Requirements

Licensure Compacts:
IMLC, NLC, ASLP-IC, EMS
Consent Requirements: Yes

Last updated 05/10/2021

Audio-Only Delivery

Medicaid: Telehealth Changes for COVID-19

STATUS; Active

Medicaid:  FQHC/RHC Tribal Facilities

STATUS; Active

Medicaid:  Home Health COVID-19

STATUS; Active

Medicaid:  BH Peer Specialist via Telehealth

STATUS; Active

Medicaid 1915(c) Waiver:  Appendix K – Supports Waiver; Comprehensive Waiver

STATUS; Expired January 26, 2021; extended through 6 months after conclusion of PHE.

Medicaid 1915(c) Waiver: Appendix K Extension – Supports Waiver

STATUS; Active, extended through 6 months after conclusion of PHE.

Medicaid 1915(c) Waiver:  Appendix K – Children’s Mental Health Waiver

STATUS; Expired February 28, 2021

Last updated 05/10/2021

Cross-State Licensing

No Reference Found

Last updated 05/10/2021

Easing Prescribing Requirements

No Reference Found

Last updated 05/10/2021

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K – Community Choices Waiver

STATUS: Expired January 26, 2021; extended through 6 months after conclusion of PHE.

Last updated 05/10/2021

Originating Site

Medicaid:  Home Health COVID-19

STATUS; Active

Last updated 05/10/2021

Private Payer

No Reference Found

Last updated 05/10/2021

Provider Type

Medicaid:  FQHC/RHC Tribal Facilities

STATUS; Active

Medicaid:  Home Health COVID-19

STATUS; Active

Medicaid:  BH Peer Specialist via Telehealth

STATUS; Active

Medicaid:  BH Group Therapy via Telehealth

STATUS; Active

Medicaid 1915(c) Waiver:  Appendix K – Children’s Mental Health Waiver

STATUS; Expired February 28, 2021

Last updated 05/10/2021

Service Expansion

Medicaid: Telehealth Changes for COVID-19

STATUS; Active

Medicaid:  FQHC/RHC Tribal Facilities

STATUS; Active

Medicaid:  Home Health COVID-19

STATUS; Active

Medicaid:  BH Peer Specialist via Telehealth

STATUS; Active

Medicaid:  BH Group Therapy via Telehealth

STATUS; Active

Medicaid 1915(c) Waiver:  Appendix K – Children’s Mental Health Waiver

STATUS; Expired February 28, 2021

Last updated 05/12/2021

Definitions

“Telehealth is the use of an electronic media to link beneficiaries with health professionals in different locations.  The examination of the client is performed via a real-time interactive audio and video telecommunications system. This means that the client must be able to see and interact with the off-site practitioner at the time services are provided via telehealth technology.”

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 117 (Apr. 2021), WY Division of Healthcare Financing Tribal Provider Manual, pg. 114 (Apr. 2021) & Institutional Provider Manual pg. 112.  (Accessed May 2021).

Last updated 05/12/2021

Email, Phone & Fax

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a client, or a consultation between two health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 119 (Apr. 2021), WY Division of Healthcare Financing Tribal Provider Manual, pg. 116, (Apr. 2021) & Institutional Provider Manual, (Apr. 2021), p. 114.  (Accessed May 2021).

Last updated 05/12/2021

Live Video

POLICY

For Medicaid payment to occur, interactive audio and video telecommunications must be permitting real-time communication between the distant site physician or practitioner and the patient.  The quality must be sufficient enough to assure the accuracy of the assessment, diagnosis, and visible evaluation of symptoms and potential medication side effects. A medical professional is not required to be present with the client at the originating site unless medically indicated. See manual for additional billing requirements.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 118-119 (Apr. 2021); Institutional Manual, pg. 113-114, (Apr. 2021); Tribal Provider Manual, pg. 115-116, (Apr. 2021), (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

Telehealth services must be properly documented when offered at the discretion of the provider as deemed medically necessary.

Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers).

Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the client is at a different location even though the pay to provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers. A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site) when applicable.

Quality assurance/improvement activities relative to telehealth delivered services need to be identified, documented and monitored. An evaluation process must also be instituted.

Documentation must indicate the visit took place via telehealth and must clearly identify the location of the hub and spoke sites.

Group psychotherapy is not a covered service.

For ESRD-related services, at least one face-to-face “hands on” visit must be furnished each month to examine the vascular access site by a qualified provider.

The same procedure codes and rates apply for telehealth as in person.  The modifier GT is used to identify the professional telehealth service.  Services must be medically necessary, follow generally accepted standards of care and be a service covered by Medicaid.

See manual for billing examples.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 117-120 (Apr. 2021); Institutional Manual, pg. 112-116, (Apr. 2021); Tribal Provider Manual, pg. 114-118, (Apr. 2021), (Accessed May 2021).

Diabetes Prevention Program (DPP)

The first session of a DPP program cannot be performed via telehealth, but sessions 2-16 can be.  The GT modifier should be used.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 247 (Apr. 2021); Tribal Provider Manual, pg. 335, (Apr. 2021), (Accessed May 2021).


ELIGIBLE PROVIDERS

Examples of eligible providers:

  • Physicians;
  • Advanced practice nurses with a specialty of psychiatry/mental health;
  • Physician’s assistant;
  • Psychologists and neuropsychologists;
  • Licensed Mental health professionals (LCSW, LPC, LMFT, LAT);
  • Board Certified Behavioral Analysts;
  • Speech therapist.

Provisionally licensed mental health professionals cannot bill Medicaid directly, but must provide services through a supervising provider.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 118 (Apr. 2021); Tribal Provider Manual, pg. 114-118, (Apr. 2021); & Institutional Manual, pg. 112-116, (Apr. 2021).  (Accessed mAY 2021).

Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the client is at a different location even though the pay to provider is the same. Examples include Community Mental Health Centers and Substance Abuse Treatment Centers.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 118 (Apr. 2021), (Accessed May 2021).


ELIGIBLE SITES

Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers). Providers shall not bill for both the spoke and hub site; unless, the provider is at one location and the client is at a different location even though the pay to provider is the same.

The Originating Site or Spoke site is the location of an eligible Medicaid client at the time the service is being furnished via telecommunications system occurs.

Authorized originating sites:

  • Hospitals;
  • Physician or practitioner offices (includes medical clinics);
  • Psychologists or neuropsychologists offices;
  • Community mental health or substance abuse treatment centers (CMHC/SATC);
  • Advanced practice nurses with specialty of psychiatry/mental health offices;
  • Office of a Licensed Mental Health Professional;
  • Federally Qualified Health Centers;
  • Rural Health Clinics;
  • Skilled nursing facilities;
  • Indian Health Services Clinics;
  • Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites). Independent renal dialysis facilities are not eligible originating sites;
  • Development Center;
  • Family Planning Clinics;
  • Public Health Offices

A medical professional is not required to be present at the originating site, unless medically indicated.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 117-118 (Apr. 2021); Institutional Manual, pg. 112-113, (Apr. 2021); Tribal Provider Manual, pg. 114-115, (Apr. 2021), (Accessed May 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Medicaid will not reimburse for the use or upgrade of technology, for transmission charges, for charges of an attendant who instructs a patient on the use of the equipment or supervises/monitors a patient during the telehealth encounter, or for consultations between professionals.

The originating site fee is not billable if the client uses their own equipment, such as a personal phone, tablet, or computer.

SOURCE:  : WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 119 (Apr. 2021). (Accessed May 2021).

When billing for the originating site facility fee, use procedure code Q3014. A separate or distinct progress note is not required to bill Q3014. Validation of service delivery would be confirmed by the accompanying practitioner’s claim with the GT modifier indicating the practitioner’s service was delivered via telehealth. Medicaid will reimburse the originating site provider the lesser of charge or the current Medicaid fee.  Providers cannot bill for Q3014 if clients used their own equipment, such as personal phones or computers.  Eligible sites include:

  • Hospitals
  • Office of a physician or other practitioner (this includes medical clinics)
  • Office of a psychologist or neuropsychologist
  • Community mental health or substance abuse treatment center (CMHC/SATC)
  • Office of an advanced practice nurse (APN) with specialty of psych/mental health
  • Office of a Licensed Mental Health Professional (LCSW, LPC, LMFT, LAT)
  • Federally Qualified Health Center (FQHC)
  • Rural Health Clinic (RHC)
  • Skilled nursing facility (SNF)
  • Indian Health Services Clinic (IHS)
  • Hospital-based or Critical Access Hospital-based renal dialysis centers (including satellites).
  • Independent Renal Dialysis Facilities are not eligible originating sites
  • Developmental Center
  • Family Planning Clinics
  • Public Health Offices

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 118-120 (Apr. 2021); Institutional Manual, pg. 112-115, (Apr. 2021); Tribal Provider Manual, pg. 115-117, (Apr. 2021), (Accessed May 2021).

Last updated 05/12/2021

Miscellaneous

Telehealth services must be properly documented when offered at the discretion of the provider as deemed medically necessary.

A single pay to provider can bill both the originating site (spoke site) and the distant site provider (hub site) when applicable.

The GT modifier must be billed by the distant site.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 114, 117, & 120  (Apr. 2021)Institutional Manual, pg. 112 & 115, (Apr. 2021)Tribal Provider Manual, pg. 114 & 117, (Apr. 2021), (Accessed May 2021).

Last updated 05/12/2021

Out of State Providers

If the provider is an out-of-state, non-enrolled provider and renders services to a Medicaid client, the provider may choose to enroll in the Medicaid Program and submit the claim according to Medicaid billing instructions, or bill the client.  Out-of-state providers furnishing services within the state on a routine or extended basis must meet all of the certification requirements of the State of Wyoming. The provider must enroll in Medicaid prior to furnishing services.

Each site will be able to bill for their own services as long as they are an enrolled Medicaid provider (this includes out-of-state Medicaid providers).

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 33 & 117 (Apr. 2021)Institutional Manual, pg. 33 & 112, (Apr. 2021)Tribal Provider Manual, pg. 34 & 114, (Apr. 2021), (Accessed May 2021).

Last updated 05/12/2021

Overview

Wyoming Medicaid reimburses for live video under some circumstances. There is no reference to store-and-forward or remote patient monitoring reimbursement.

Last updated 05/12/2021

Remote Patient Monitoring

POLICY

No Reference Found


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 05/12/2021

Store and Forward

POLICY

Telehealth does not include a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a healthcare practitioner and a client, or a consultation between two health care practitioners asynchronous “store and forward” technology.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 119 (Apr. 2021); Institutional Manual, pg. 114, (Apr. 2021); Tribal Provider Manual, pg. 116, (Apr. 2021), (Accessed May 2021).


ELIGIBLE SERVICES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 05/12/2021

Definition

No Reference Found

Last updated 05/12/2021

Parity

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

Last updated 05/12/2021

Requirements

No Reference Found

Last updated 05/12/2021

Cross State Licensing

No Reference Found

Last updated 05/12/2021

Definitions

Physicians and Surgeons

“Telemedicine means the practice of medicine by electronic communication or other means from a physician in a location to a patient in another location, with or without an intervening health care provider.”

SOURCE: WY Statutes Sec. 33-26-102.(a(xxix))  (Accessed May 2021).

Occupational Therapy

“Occupational therapy telehealth means the provision of occupational therapy services across a distance, using telecommunications technology for the evaluation, intervention or consultation without requiring the occupational therapist and recipient to be physically located in the same place.”

SOURCE: WY Statutes Sec. 33-40-102.(a(v)) (Accessed May 2021).

Board of Chiropractic Examiners

“Telehealth” means the delivery of healthcare services using electronic communications, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening healthcare provider.

SOURCE: WY Admin Rules. Board of Chiropractic Examiners. Ch. 1, Sec. 3 (t). (Accessed May 2021).

Physical Therapy

“Consultation by means of telecommunications” means that a physical therapist renders professional or expert opinion or advice to another physical therapist or health care provider via telecommunications or computer technology from a distant location. It includes the transfer of data or exchange of educational or related information by means of audio, video, or data communications.

SOURCE: WY Admin Rules. Board of Physical Therapy. Ch. 1 Sec. 4 (d). (Accessed May 2021).

Audiology

“Telehealth” means the application of telecommunication technology to deliver audiology or speech-language pathology services at a distance for assessment, intervention, and/or consultation.

SOURCE: WY Statutes Annotated Sec. 33-33-402, Sec. 2(y). (Accessed May 2021).

Speech Language Pathology

“Telehealth” means the delivery of speech-language pathology or audiology services using electronic communications, information technology, or other means between a Licensee in one location and a patient in another location.

SOURCE: WY Admin Rules. Board of Examiners of Speech-Language Pathology and Audiology Ch. 13, Sec. 2(b). (Accessed May 2021).

Last updated 05/12/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC (Accessed May 2021).

Member of the Audiology and Speech-Language Pathology Interstate Compact.

SOURCE: ASLP Compact.  (Accessed May 2021).

Member of the Nurse Licensure Compact

SOURCE: Nurse Licensure Compact (Accessed May 2021).

Member of Recognition of EMS Personnel Licensure Interstate Compact.

SOURCE: MS Compact Member States & Commissioners. (Accessed May 2021).

Last updated 05/12/2021

Miscellaneous

Boards have power to adopt rules and regulations allowing the practice of telemedicine/telehealth and the use of telemedicine/telehealth technologies within an applicable profession or occupation consistent with the profession’s or occupation’s duties and obligations. For purposes of this paragraph, telemedicine/telehealth shall be defined within each promulgated rule in a manner applicable to the individual profession or occupation and in a manner which facilitates the development and promotion of uniform, system wide standards for the practice of telemedicine/telehealth and the use of telemedicine/telehealth technologies.

SOURCE:  WY Code 33-1-303(a(iv)). (Accessed May 2021).

Last updated 05/12/2021

Online Prescribing

Initially prescribing a controlled substance through the Internet, World Wide Web or any similar proprietary or common carrier electronic system without a documented physician-patient relationship is subject to review, discipline and consequences to license.

SOURCE: WY Statutes Annotated Sec. 33-26-402(a(xxxiii)). (Accessed May 2021).

Last updated 05/12/2021

Professional Board Standards

WY Board of Chiropractic Examiners

SOURCE: WY Admin. Code, Chiropractic Board, Ch. 11, (Accessed May 2021).

WY Board of Occupational Therapy

SOURCE: WY Admin Rules. Board of Occupational Therapy. Ch. 3, (Accessed May 2021).

WY Board of Physical Therapy

SOURCE: WY Admin Rules. Board of Physical Therapy. Ch. 1, (Accessed May 2021).

WY Board of Examiners of Speech-Language Pathology and Audiology

SOURCE: WY Admin Rules, Speech Language Pathology and Audiology, Ch. 13, Sec. 2(b). Accessed May 2021.