048-2 Wyo. Code R. § 2-4
The following definitions shall apply in the interpretation and enforcement of these Rules. Where the context in which words are used in these Rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these Rules gender pronouns are used interchangeably. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender include individuals of the other gender.
(a) "Acquired brain injury." As defined in Chapter 43 of the Wyoming Medicaid Rules.
(b) "Acquired Brain Injury Home and Community Based Waiver." The Acquired Brain Injury Home and Community Based Waiver submitted to and approved by the Centers for Medicare and Medicaid Services, pursuant to Section 1915(c) of the Social Security Act.
(c) "Advocate." A person, chosen by the applicant or legal guardian, who supports and represents the rights and interests of the applicant in order to ensure the applicant's full legal rights and access to services. The advocate can be a friend, a relative, or any other interested person. An advocate has no legal authority to make decisions on behalf of an applicant.
(d) "Adult." A person eighteen years of age or older for purposes of this Chapter.
(e) "Adult Developmental Disabilities Home and Community Based Waiver." The Adult Developmental Disabilities Home and Community Based Waiver submitted to and approved by the Centers for Medicare and Medicaid Services, pursuant to Section 1915(c) of the Social Security Act.
(f) "Applicant." An individual who has been through the screening process pursuant to Section 7 of this Chapter and who is receiving emergency funding.
(g) "Application." A written statement, in the form specified by the Division, which is submitted to the Division, in which an individual indicates that he or she is interested in receiving covered services. An application may be submitted by one person on behalf of another, but shall have the legal guardian's signature, if applicable.
(h) "Assessment." A determination, pursuant to Section 6 of Chapter 41, Chapter 42, or Chapter 43 of the Wyoming Medicaid Rules, of an individual's functional capacity and needs.
(i) "Behavior support plan." A written plan that is developed based on a functional assessment of behaviors that negatively impact a person's ability to acquire, retain and/or improve the self-help, socialization and adaptive skills necessary to reside successfully in home and community based settings, and that contains multiple intervention strategies designed to modify the environment and teach new skills.
(j) "Caregiver." A person who provides services to an applicant.
(k) "Centers for Medicare and Medicaid Services (CMS)." The Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, its agent, designee or successor.
(l) "Chapter 1." Chapter 1 of the Developmental Disabilities Division Rules, Rules for Individually-Selected Service Coordination.
(m) "Chapter 41." Chapter 41, Adult Developmental Disabilities Home and Community Based Waiver of the Wyoming Medicaid Rules.
(n) "Chapter 42." Chapter 42, Children Developmental Disabilities Home and Community Based Waiver of the Wyoming Medicaid Rules.
(o) "Chapter 43." Chapter 43, Acquired Brain Injury Waiver Home and Community Based Waiver of the Wyoming Medicaid Rules.
(p) "Chapter 44." Chapter 44, Environmental Modifications and Specialized Equipment for Home and Community Based Waivers of the Wyoming Medicaid Rules.
(q) "Chapter 45." Chapter 45, Waiver Provider Certification and Sanctions of the Wyoming Medicaid Rules.
(r) "Children's Developmental Disabilities Home and Community Based Waiver." The Children's Developmental Disabilities Home and Community Based Waiver submitted to and approved by the Centers for Medicare and Medicaid Services, pursuant to Section 1915(c) of the Social Security Act.
(s) "Claim." A request by a provider for payment for covered services provided to an applicant.
(t) "Clinically eligible." Determination that an applicant has met the requirements set forth in Section 6 of Chapter 41, Chapter 42, or Chapter 43 of the Wyoming Medicaid Rules.
(u) "Covered services." Those services that are reimbursable pursuant to Section 8 of this Chapter.
(v) "Department." The Wyoming Department of Health, its agent, designee, or successor.
(w) "Department of Family Services (DFS)." The Wyoming Department of Family Services, its agent, designee, or successor.
(x) "Developmental disability." As defined in Chapter 41 and 42 of the Wyoming Medicaid Rules.
(y) "Director." The Director of the Department of Health or the Director's agent, designee, or successor.
(z) "Division." The Developmental Disabilities Division of the Department of Health, its agent, designee, or successor.
(aa) "Drug used as a restraint." Any drug that:
(bb) "Emergency." A circumstance or set of circumstances or the resulting state that calls for immediate action or an urgent need for assistance or relief, as defined in Section 6 of this Chapter.
(cc) "Emergency Case Management." Services provided, as defined in Section 8, that are provided by an Individually Selected Service Coordinator.
(dd) "Emergency referral." A person who:
(ee) "Emergency Service Plan." A plan that addresses the basic health, safety, medical, and support needs of a person and that includes the services provided.
(ff) "Extraordinary Care Committee (ECC)." A committee that has the authority to approve or deny individual plans of care, emergency funding, and funding due to a material change in circumstance or other condition justifying an increase in funding as defined in Section 12 of Chapter 41, Chapter 42, or Chapter 43 of the Wyoming Medicaid Rules.
(gg) "Financial records." All records, in whatever form, used or maintained by a provider in the conduct of its business affairs and which are necessary to substantiate or understand the information contained in the provider's cost reports or a claim.
(hh) "Functionally necessary." A service that is:
(ii) "Funding." State funds available to pay for covered services. Funding does not include any other funds available to the Department that are not designated for covered services.
(jj) "Generally Accepted Auditing Standards (GAAS)." Current auditing standards, practices, and procedures established by the American Institute of Certified Public Accountants.
(kk) "Guardian." A person lawfully appointed as guardian to act on the behalf of the applicant.
(ll) "Individually-Selected Service Coordinator (ISC)." For the purposes of this Chapter, an individual or entity that is qualified pursuant to Chapter 1, Rules for Individually-Selected Service Coordination of the Rules of the Developmental Disabilities Division, to act as an individually-selected service coordinator, and to provide emergency case management services.
(mm) "Inventory for Client and Agency Planning (ICAP)." An instrument used by the Division to help determine eligibility and to determine the needs of the applicant, available from Riverside Publishing, its successor, or designee.
(nn) "Institution." An Intermediate Care Facility for people with Mental Retardation (ICF/MR), nursing facility, hospital, prison, or jail.
(oo) "Mechanical restraint." Any device attached or adjacent to a person's body that he or she cannot easily move or remove that restricts freedom of movement or normal access to the body.
(pp) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act, 42 U.S.C. § 1900, et seq. and the Wyoming Medical Assistance and Services Act. "Medicaid" includes any successor or replacement program enacted by Congress and/or the Wyoming Legislature.
(qq) "Medical records." All documents, in whatever form, in the possession of or subject to the control of a provider, which describe the applicant's diagnosis, condition or treatment, including, but not limited to, the emergency service plan.
(rr) "Medicare." The health insurance program for the aged and disabled established pursuant to Title XVIII of the Social Security Act, 42 U.S.C. § 1395, et seq. "Medicare" includes any successor or replacement program enacted by Congress and/or the Wyoming Legislature.
(ss) "Mental retardation." As defined in Chapter 41 and Chapter 42 of the Wyoming Medicaid Rules.
(tt) "Personal restraint." The application of physical force or physical presence without the use of any device, for the purposes of restraining the free movement of the body of the person. The term personal restraint does not include briefly holding without undue force a person in order to calm or comfort him or her, or holding a person's hand to safely escort him or her from one area to another.
(uu) "Physician." A person licensed to practice medicine or osteopathy by the Wyoming Board of Medical Examiners or a similar agency in a different state.
(vv) "Provider." A person or entity that is certified by the Division to furnish covered services and is currently enrolled as a Medicaid Waiver provider.
(ww) "Psychologist." A person licensed to practice psychology pursuant to W.S. § 33-27-113(a)(v).
(xx) "Related condition." As defined in Chapter 41 and Chapter 42 of the Wyoming Medicaid Rules.
(yy) "Restraint." A ''personal restraint,'' ''mechanical restraint,'' or ''drug used as a restraint,'' as defined in this section.
(zz) "Seclusion." The involuntary confinement of a person alone in a room or an area from which the person is physically prevented from leaving. Providers seeking reimbursement for services shall not use seclusion.
(aaa) "Services." Medical, habilitation, or other services, equipment, or supplies appropriate to meet the needs of an applicant.
(bbb) "Skilled nursing services." Services listed in the emergency service plan that are within the scope of the Wyoming Nurse Practice Act.
(ccc) "Supervision and Safety Services." For the purposes of this Chapter, services designed to meet the applicant's health, safety, and supervision needs.
(ddd) "Waiver." Any Home and Community Based Waiver administered by the Division that has been submitted to and approved by the Centers for Medicare and Medicaid Services pursuant to Section 1915(c) of the Social Security Act.
048-2 Wyo. Code R. § 2-4