048-34 Wyo. Code R. § 34-4
(a) "Admission certification." Admission certification as defined by Chapter 8, which definition is incorporated by this reference.
(b) "Administrator." The administrator of the Division, the administrators agent, designee or successor.
(c) "Chapter I." Chapter I, Rules for Medicaid Administrative Hearings, of the Wyoming Medic-aid rules.
(d) "Chapter 3." Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.
(e) "Chapter 4." Chapter 4, Third Party Liability, of the Wyoming Medicaid Rules.
(f) "Chapter 8." Chapter 8, Inpatient Admission Certification, of the Wyoming Medicaid Rules.
(g) "Chapter 30." Chapter 30, Level of Care Inpatient Hospital Reimbursement, of the Wyoming Medicaid Rules.
(h) "Chapter 32." Chapter 32, Disproportionate Share Hospital Reimbursement, of the Wyoming Medicaid Rules.
(i) "Claim." A request by a provider for Medicaid payment for HCBS waiver services provided to a recipient.
(j) "Covered service." A health service or supply eligible for Medicaid reimbursement pursuant to the rules and policies of the Department.
(k) "Department." The Wyoming Department of Health, its agent, designee or successor.
(l) "Division." The Division of Health Care Financing of the Department, its agent, designee or successor.
(m) "Enrolled." Enrolled as defined in Chapter 3, which definition is incorporated by this reference.
(n) "Excess payments." Medicaid funds received by a provider which exceed the Medicaid allowable payment established by the Department.
(o) "HCFA." The Health Care Financing Administration of the United States Department of Health and Human Services, its agent, designee or successor.
(p) "HHS." The United States Department of Health and Human Services, its agent, designee or successor.
(q) "Home or community-based waiver services (HCBS)." Services provided under a waiver from HCFA that are not otherwise available under the Wyoming Medicaid state plan. Such services enable the elderly, disabled, and chronically mentally ill persons, who would otherwise be placed in an institution, to live in the community. Section 1915(c) of the Social Security Act specifies the services that may be included as HCBS waiver services. HCBS waiver services includes home and community-based services as specified in the applicable waiver.
(r) "Hospital." A hospital as defined in Chapter 30, which definition is incorporated by this reference.
(s) "Institution." A hospital, ICF/MR or nursing facility.
(t) "Intermediate care facility for the mentally retarded (ICF/MR)." An intermediate care facility as defined by 42 U.S.C. 1396(d)(d), which definition is incorporated by this reference.
(u) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act and the Wyoming Medical Assistance and Services Act.
(v) "Medicaid fee schedule." The Medicaid fee schedule developed pursuant to Chapter 3.
(w) "Medicaid third party liability cost avoidance waiver." A waiver from HCFA pursuant to 42 C.F.R. 433.139(e).
(x) "Medical record." All documents, in whatever form, in the possession of or subject to the control of a provider which describe the recipients diagnosis, condition or treatment, including, but not limited to, the plan of care for the recipient.
(y) "Nursing facility." A nursing facility as defined in 42 U.S.C. 1396 r(a), which definition is incorporated by this reference.
(z) "Plan of care." A written plan of care developed by qualified individuals pursuant to the applicable waiver, and approved by the Division.
(aa) "Prior authorized." Approval by the Division pursuant to the procedures contained in Chapter 3, which are incorporated by this reference.
(bb) "Qualified individual." A health care professional or other individual specified in a waiver as qualified.
(cc) "Provider." A provider as defined by Chapter 3, which definition is incorporated by this reference.
(dd) "Recipient." A person who has been determined eligible to receive Medicaid.
(ee) "Services." Health services or supplies.
(ff) "Third party liability." Third party liability as determined pursuant to Chapter 4, which is incorporated by this reference.
(gg) "Waiver." A waiver granted by HCFA pursuant to Section 1915(c) of the Social Security Act (codified at 42 U.S.C. 1396 n(c)). HCBS waivers follow federal guidelines and audit procedures.
048-34 Wyo. Code R. § 34-4