048-40 Wyo. Code R. § 40-4
(a) "Active treatment." "Active treatment" as defined in 42 C.F.R. § 441.154, which is incorporated by this reference.
(b) "Acute." Having a short and relatively severe course.
(c) "Admission." The act that allows a reciept to officially enter a facility.
(d) "Admission certification." The determination pursuant to Chapter 8 that all or part of a reciept's's admission is or was medically necessary and that medicaid funds may be used to pay the facility and other providers of covered services for providing medically necessary services, subject to the rules of the Department.
(e) "Base rate." The rate which the Department of Family Services pays to a facility for room and board.
(f) "CARF." The Commission for the Accreditation of Residential Facilities, its agent, designee, or successor.
(g) "Certification of need for services." A certification pursuant to Section 8 that meets the requirements of 42 C.F.R. § 441.152 & 153, which requirements are incorporated by this reference.
(h) "Certified." Certified by DFS as in compliance with applicable statutes and rules.
(i) "Chapter 3." Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.
(j) "Chapter 4." Chapter 4, Third Party Liability, of the Wyoming Medicaid Rules.
(k) "Chapter 6." Chapter 6, Health Check (formerly EPSDT) Program, of the Wyoming Medicaid Rules.
(l) "Chapter 8." Chapter 8, Inpatient Hospital Certification, of the Wyoming Medicaid Rules.
(m) "Chapter 16." Chapter 16, Medicaid Program Integrity, of the Wyoming Medicaid Rules.
(n) "Chapter 26." Chapter 26, Covered Services, of the Wyoming Medicaid Rules.
(o) "Chapter 30." Chapter 30, Level of Care Inpatient Hospital reimbursement, of the Wyoming Medicaid Rules.
(p) "Chapter 39." Chapter 39, Recovery of Excess Payments, of the Wyoming Medicaid Rules.
(q) "Claim." A request by a provider for Medicaid payment for covered services provided to a recipient.
(r) "CMS." The Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, its agent, designee, or successor.
(s) "COA." The Council on Accreditation for Children and Family Services.
(t) "Court ordered placement." The placement of a reciept in a facility pursuant to an order entered by a court of competent jurisdiction, other than an involuntary commitment pursuant to Title 25 of the Wyoming Statutes.
(u) "Covered service." Inpatient psychiatric services for individuals under age twenty-one.
(v) "Department." The Wyoming Department of Health, its agent, designee, or successor.
(w) "Desk review." A review by the Department or DFS of a facility's financial records, medical records, or both, to determine;
(x) "DFS." The Wyoming Department of Family Services, its agent, designee, or successor.
(y) "DSM-IV." The fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, which is incorporated by this reference. The DSM-IV is published by the American Psychiatric Association, Washington, D.C., and is available from the publisher.
(z) "Emergency." The sudden onset of a medical or psychiatric condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:
(aa) "Emergency detention." A person detained or involuntarily hospitalized pursuant to W.S. § 25-10-109.
(bb) "Enrolled." Enrolled as defined in Chapter 3, Section 3(l), which is incorporated by this reference.
(cc) "Excess payments." Medicaid funds received by a provider which exceed the Medicaid allowable payment.
(dd) "Extended psychiatric services." Extended psychiatric services as defined by Chapter 30, which definition is incorporated by this reference.
(ee) "Facility." An FPRTC or a group home which has been certified by DFS or a similar agency in another state, and which is not licensed as a hospital.
(ff) "Field audit." An examination, verification and review of a provider's financial records, medical records, or both, and any supporting or related documentation conducted by employees, agents or representatives of the Department or HHS. A field audit may be conducted at the facility.
(gg) "Financial records." All records, in whatever form, including financial reports, used or maintained by a facility in the conduct of its business affairs and which are necessary to substantiate or understand the information contained in the facility's cost reports or a claim.
(hh) "Financial Report." A report of a facility's costs for a specified fiscal period prepared and submitted in the form and manner specified by the Department. Financial report includes any supplemental request by the Department for additional information relating the facility's costs.
(ii) "Foster home." A home certified by DFS as a foster home.
(jj) "Freestanding Psychiatric Residential Treatment Center (FPRTC)." A Freestanding Psychiatric Residential Treatment Center which has been accredited by CARF, COA, or JCAHO, and which is not licensed as a hospital.
(kk) "Generally accepted auditing standards (GAAS)." Auditing standards, practices and procedures established by the American Institute of Certified Public Accountants.
(ll) "Group Home." An institution certified by DFS as a group home.
(mm) "Hospital." An institution that:
(nn) "Individual written plan of care (plan of care)." A written treatment plan, prepared by an interdisciplinary team, that meets the requirements of 42 C.F.R. § 441.155, which is incorporated by this reference, except that the plan must be completed within seven calendar days of an individual's admission to the facility.
(oo) "Inpatient psychiatric services for individuals under age twenty-one." Inpatient psychiatric services for individuals under age twenty-one as defined in 42 C.F.R. § 441 -Subpart D, which definition is incorporated by this reference.
(pp) "Institution." An establishment that furnishes (in single or multiple facilities) food, shelter, and some treatment or services to four or more persons unrelated to the proprietor.
(qq) "Interdisciplinary team." A team that meets the requirements of 42 C.F.R. § 441.156, which is incorporated by this reference.
(rr) "JCAHO." The Joint Commission for the Accreditation of Healthcare Organizations.
(ss) "Local agency." The County office of DFS, its agent, designee or successor.
(tt) "Master treatment plan." The initial plan of care for an individual.
(uu) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act and/or the Wyoming Medical Assistance and Services Act. "Medicaid" includes any successor or replacement program enacted by Congress or the Wyoming Legislature.
(vv) "Medicaid allowable payment." The per diem rate determined pursuant to Section 13.
(ww) "Medical necessity" or "medically necessary." A covered service that is:
(xx) "Medical record." All documents, in whatever form, in the possession of or subject to the control of the facility which describe the recipient's diagnosis, condition or treatment.
(yy) "Medicare." The health insurance program for the aged and disabled established pursuant to Title XVIII of the Social Security Act.
(zz) "MFCU." The Medicaid Fraud Control Unit of the Wyoming Attorney General's Office, its agent, designee, or successor.
(aaa) "Overpayments." Overpayments as defined in Chapter 3 9, which definition is incorporated by this reference.
(bbb) "Patient." An individual who receives services at an FPRTC.
(ccc) "Physician." A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners or a comparable agency in another state.
(ddd) "Prior authorization." Approval by the Department pursuant to Section 9.
(eee) "Provider." A Provider as defined by Chapter 3, which definition is incorporated by this reference.
(fff) "Provider agreement." A provider agreement as defined by Chapter 3, which definition is incorporated by this reference.
(ggg) "Rate." A facility's medicaid allowable payment.
(hhh) "Recipient." A person who has been determined eligible for Medicaid.
(iii) "Recipient under age twenty-one." A recipient before or during the month in which he or she turns twenty-one years of age.
(jjj) "Standing orders." Orders from a physician or other provider that a certain service or services be provided to every patient, regardless of diagnosis.
(kkk) "Supervision." Supervision as defined by Chapter 26, which definition is incorporated by this reference.
(lll) "Third party liability." Third party liability as determined pursuant to Chapter 4, which is incorporated by this reference.
(mmm) "Usual and customary per diem charge." A provider's per diem charge for comparable services provided to non-Medicaid recipients other than persons eligible for payment on a reduced or sliding fee schedule.
048-40 Wyo. Code R. § 40-4