048-1 Wyo. Code R. § 1-4
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 visa versa. Throughout these rules gender pronouns are used interchangeably, except where the context dictates otherwise. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender shall include individuals of the other gender.
(a) Administrator means the Administrator of the Community and Family Health Division.
(b) Adverse Action means a termination, suspension, or reduction of benefits or covered services. Adverse Action does not include the denial of services because they are not covered services, or other issues about the scope of covered services.
(c) Affidavit means a written notarized statement of facts made voluntarily under oath.
(d) Aggrieved means any applicant/client, participating facility, or provider who has been subject to an adverse action by the Community and Family Health Division.
(e) Appeal means a Contestants resort to district court after a final adverse agency determination or decision.
(f) Applicant means a person whose written application for the MCH Programs has been submitted to Community and Family Health Division, but there has been no final determination of eligibility.
(g) Approved Facility means a facility enrolled with Wyoming EqualityCare, which includes, but is not limited to an in-state or out-of-state inpatient/outpatient hospital facility e.g. laboratory and radiology.
(h) Approved Provider means a provider enrolled with Wyoming EqualityCare and who has signed an agreement with MCH.
(i) Care Coordination means case management of family-centered, community-based, culturally competent coordinated health care using a multi-disciplinary approach.
(j) Childrens Special Health (CSH) means a federally mandated program to assist in infrastructure building, gathering of data, and promoting policies to promote the health of the underserved children and youth with special health care needs.
(k) Approved Provider means a person who is determined eligible for MCH programs.
(l) Complaint means a written request in which a person requests a hearing. The written request (complaint) must include at minimum: name, address, telephone number, and the reason for the request, including the nature of the Division action, order, or determination being contested.
(m) Contestant means the applicant/client, a facility, or representative who brings a complaint against the Division.
(n) Contested Case means a disputed action taken by the Department involving eligibility, termination of eligibility, suspension of eligibility, denial of medical services, denial of payment for medical services, or reduction of services.
(o) Date of Action means the intended date on which a termination, suspension, or reduction becomes effective.
(p) Date of Eligibility means the date of acceptance to MCH for coverage of approved medical services for a specific diagnosis or treatment.
(q) Date of Service means date or range of dates on which a service was provided.
(r) Department means the Department of Health (WDH), its agent, designee, or successor.
(s) Designee means the appointed agent of the Director or the Administrator having all the authority of the Director or the Administrator.
(t) Director means Director of the Department of Health.
(u) Division means the Community and Family Health Division (CFHD).
(v) Excess Payments means includes, but is not limited to:
(w) Family Income means the total amount of gross income reported from family members, including child support, alimony, family benefits, retirement, Social Security (SSI, SSDI, or Survivors Benefits received), and any and all other income which includes dividends/interest, business income, donations, and real estate.
(x) Family Members means the eligible client, parent(s), stepparent(s) or legal guardian(s), all minor children, and any dependent adult living in the house who are financially dependent upon the parent(s), stepparent(s) or legal guardian(s).
(y) Hearing means a contested case being presented before a designated hearing officer.
(z) Hearing Officer means any employee of the Department or other designated by the director to serve as the presiding officer at a hearing held under these rules. This person cannot be employed by with MCH or otherwise have independent knowledge of the pending action.
(aa) Maternal High Risk Program (CSH) means a program to provide limited financial assistance to a high risk pregnant woman receiving tertiary care as ordered by her provider(s), which requires a higher level of care for a pregnancy than is available within a Wyoming hospital. This may also include financially eligible adults who need genetic counseling.
(bb) MCH Program means the Childrens Special Health (CSH), Newborn Intensive Care (NBIC) or Maternal High Risk (MHR) Programs.
(cc) Medical Treatment means medical or surgical services; limited medical equipment or devices provided to the client.
(dd) Newborn Intensive Care Program (NBIC) means a program to provider limited financial assistance to a newborn who requires tertiary care related to intensive respiratory support or a diagnosis of congenital anomalies.
(ee) Notice of Action means a written statement informing the contestant of the action the Department intends to make, the reason(s) for the intended action, the specific regulation(s) that support the action intended, an explanation of the clients right to request a hearing, and an explanation of the circumstances under which a continuation of benefits may be maintained pending a hearing.
(ff) Prior Authorization means the approval of a request to provide a specific service before the provision of the service.
(gg) Program Manager means the administrator(s) of MCH Programs.
(hh) Qualified Alien means a lawfully admitted alien is qualified if he or she:
(ii) "Request for a Hearing" means a clear expression in writing by the contestant, or authorized representative, requesting an opportunity to present the case to a reviewing authority.
(jj) "Resident" means a person who is living in the state with the intention of making a permanent home meeting residency criteria defined in Chapter II, Section 2. a (ii).
(kk) "Termination" means to remove a client from the program, or close the file.
(ll) Tertiary Care" means medical care at a level III medical facility.
048-1 Wyo. Code R. § 1-4