048-20 Wyo. Code R. § 20-4

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Current through April 27, 2019

Section 20-4 - Definitions

(a) "Certified." Approved by the Department to provide ICF/IID services.

(b) "Excess payments." Medicaid funds received by a provider:

(i) That exceed the provider's per diem rate;

(ii) Pursuant to a per diem rate which is subsequently determined to be erroneous or based on erroneous information; or

(iii) Pursuant to an interim payment rate that is based on projected costs which exceed the facility's actual costs for the interim payment rate period.

(c) "Facility." An ICF/IID.

(d) "Infirmary services." Sub-acute hospital services provided on the premises of a facility.

(e) "Interim payments." Payments to a new facility or a newly certified facility pursuant to subsection 5(c) during the time between the effective date of the new facility's provider agreement and the determination of a per diem rate pursuant to this rule.

(f) "Intermediate care facility for individuals with Intellectual Disabilities (ICF/IID)." An intermediate care facility as defined by 42 U.S.C. 1396d(d) that has at least fifteen certified beds. "ICF/IID" includes that portion of the Wyoming Life Resource Center which is certified to provide intermediate care facility services for those with intellectual disabilities.

(g) "Per diem rate." The Medicaid reimbursement rate determined pursuant to this rule.

(h) "Provider." An ICF/IID that has a provider agreement with the Department and that is certified to provide services to recipients.

(i) "Provider agreement." A formal written agreement between the Department and an ICF/IID that is certified to provide services to recipients.

(j) "Services." Intermediate care facility services for those with intellectual disabilities as defined in 42 U.S.C. 1396d(d).

(k) "Services and supplies included in the per diem rate." In addition to those services and supplies specified in Chapter 7, Attachment A.

(l) "Services and supplies not included in the per diem rate." Services and supplies which are not included in the per diem rate include, but are not limited to:

(i) Barber and beauty shop services;

(ii) Clothing;

(iii) Cigarettes, cigars, pipes and tobacco;

(iv) Cosmetics;

(v) Hospital services;

(vi) Prosthetic devices;

(vii) Ventilators; and

(viii) Customized wheelchairs that are fitted or fabricated to a specific individual and cannot be used by any other person, and electric wheelchairs, including batteries.

(m) "Temporary absence." When a recipient is out of a facility for hospitalization or therapeutic home visits. Temporary absences for hospitalization:

(i) Shall not exceed fifteen (15) days per year, and

(ii) The recipient must intend to and have a reasonable expectation of returning to the facility.

(iii) Temporary absences for therapeutic home visits shall:
- (A) Be part of the recipient's plan of care, and
- (B) Be limited to fifteen (15) days in duration no more than once per month, not to exceed thirty (30) days per calendar year. A recipient receiving infirmary services is not absent from the facility.

(n) "Unique costs." The following services and supplies are unique costs and shall be included in the per diem rate if they are provided by the facility or by a third party under contract to the facility to or for the benefit of a recipient:

(i) Audiology services;

(ii) Case management services;

(iii) Dental services;

(iv) Dietary services and adaptive equipment;

(v) Dry cleaning expenses incurred on behalf of residents;

(vi) Habilitation services,

(vii) Hearing aids;

(viii) Infirmary services;

(ix) Laboratory services;

(x) Music therapy services;

(xi) Occupational therapy services;

(xii) Optical services;

(xiii) Orthotic services;

(xiv) Physical therapy services;

(xv) Physician services;

(xvi) Podiatry services;

(xvii) Prescription drugs;

(xviii) Pre-vocational training services and supplies;

(xix) Psychological services;

(xx) Recreational therapy services;

(xxi) Social services;

(xxii) Speech therapy services; and

(xiii) Transportation services

(o) "Wyoming Life Resource Center." The Wyoming state training school as established pursuant to W.S. §§ 25-5-101 through 25-5-135.

048-20 Wyo. Code R. § 20-4

Amended, Eff. 6/14/2017.