Section 3-6 - Out-of-State provider's (a) Services furnished within service area. A service furnished by a provider located outside Wyoming, but within the service area, is Medicaid reimbursable if: - (i) The services are furnished in response to an emergency; or
- (ii) The provider has entered a provider agreement; and
- (A) The service is not available in the recipient's local trade area; and
- (B) The out-of-state provider is closer to the recipients residence than a provider of comparable services within Wyoming.
(b) Services furnished outside the service area. Services furnished by a provider located outside the service area are not Medicaid reimbursable unless: - (i) The service is furnished in response to an emergency;
- (ii) The recipient is outside the service area and the recipient's health would be endangered if he were required to return to the service area;
- (iii) The recipient is referred to a provider outside the service area when prior authorized and comparable services are not available within the service area; or
- (iv) The recipient is less than 19 years of age; and
- (A) Is a foster child not covered by Title IV-E of the Social Security Act and resides with a foster family out of state; or
- (B) Has been placed in an out-of-state institution.
(c) Retroactive enrollment. An individual or entity which furnishes services to a recipient prior to enrolling as a provider may enroll as a provider and receive Medicaid reimbursement for such services if the services are otherwise reimbursable pursuant to the rules of the Department. No Medicaid reimbursement shall be made before the provider seeking such reimbursement has enrolled.