048-9 Wyo. Code R. § 9-4
(a) "Admission". The act that allows a recipient to officially enter a hospital to receive inpatient hospital services or outpatient services under the supervision of a physician who is a member of the hospitals medical staff.
(b) "Acute". Having a short and relatively severe course.
(c) "Admission certification". The determination pursuant to Chapter 8 that all or part of a recipients inpatient hospitalization is or was medically necessary and that Medicaid funds may be used to pay the admitting physician, hospital, and other providers of inpatient hospital services for providing medically necessary services, subject to the rules of the Department.
(d) "Ancillary services". Services provided by the hospital to a recipient who is an inpatient or an outpatient in the hospital as specified in Section 12.
(e) "Certified". Certified by the survey agency as in compliance with applicable statutes and rules.
(f) "Chapter 3". Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.
(g) "Chapter 6". Chapter 6, Health Check (formerly EPSDT) Program, of the Wyoming Medic-aid Rules.
(h) "Chapter 8". Chapter 8, Inpatient Hospital Certification, of the Wyoming Medicaid Rules.
(i) "Chapter 16". Chapter 16, Medicaid Program Integrity, of the Wyoming Medicaid Rules.
(j) "Chapter 24". Chapter 24, Wyoming Hospital Reimbursement System, of the Wyoming Medicaid Rules.
(k) "Chapter 26". Chapter 26, Covered Services, of the Wyoming Medicaid Rules.
(l) "Chapter 28". Chapter 28, Swingbed Services, of the Wyoming Medicaid Rules.
(m) "Chapter 30". Chapter 30, Level of Care Inpatient Hospital reimbursement, of the Wyoming Medicaid Rules.
(n) "Chapter 31". Chapter 31, Selective Contracting of Hospital Services, of the Wyoming Medicaid Rules.
(o) "Chapter 32". Chapter 32, Disproportionate Share Hospitals, of the Wyoming Medicaid Rules.
(p) "Chapter 33". Chapter 33, Reimbursement of Outpatient Hospital Services, of the Wyoming Medicaid Rules.
(q) "Claim". A request by a provider for Medicaid payment for covered services provided to a recipient.
(r) "Copayment". A charge assessed to a recipient by a provider that has furnished covered services.
(s) "Court ordered medical treatment". Services provided to a recipient pursuant to an order entered by a court of competent jurisdiction.
(t) "Covered service". A health service or supply eligible for Medicaid reimbursement pursuant to the rules and policies of the Department. Hospital "covered services" does not include nursing facility services provided in a swingbed.
(u) "Department". The Wyoming Department of Health, its agent, designee, or successor.
(v) "DFS". The Wyoming Department of Family Services, its agent, designee, or successor.
(w) "Division". The Health Care Financing Division of the Department, its agent, designee, or successor.
(x) "Durable medical equipment". Equipment that is:
(y) "Emergency". The sudden onset of a medical 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:
(z) "Emergency detention". A person detained or involuntarily hospitalized pursuant to W.S. § 25-10-109.
(aa) "Emergency hospital services". "Emergency hospital services" as defined in 42 C.F.R. § 440.170(e), which is incorporated by this reference, furnished to a recipient in response to an emergency.
(bb) "Excess payments". Medicaid funds received by a provider which exceed the Medicaid allowable payment established by the Department.
(cc) "Extended psychiatric services". "Extended psychiatric services" as defined by Chapter 30, which definition is incorporated by this reference.
(dd) "HCFA". The Health Care Financing Administration of the United States Department of Health and Human Services, its agent, designee, or successor.
(ee) "Hospital". An institution that:
(ff) "Hospital clinic". An outpatient clinic located on the same premises as a hospital.
(gg) "Hospital services". Inpatient or outpatient services provided to a recipient.
(hh) "Individualized treatment plan". A written treatment plan, prepared by a multidisciplinary team, that documents the need for treatment of sufficient intensity to warrant inpatient hospitalization, and that includes:
(ii) "Inpatient". An "inpatient" as defined by 42 C.F.R. § 440.2(a), which is incorporated by this reference.
(jj) "Inpatient hospital service". "Inpatient hospital services" as defined in 42 C.F.R. § 440.10, which is incorporated by this reference.
(kk) "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.
(ll) "Laboratory services". Professional or technical laboratory services.
(mm) "Local trade area". The geographic area surrounding the recipient's residence, including portions of states other than Wyoming, commonly used by other persons in the same area to obtain similar services.
(nn) "Local agency". The County office of DFS, its agent, designee or successor.
(oo) "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.
(pp) "Medical necessity" or "medically necessary". An inpatient or outpatient hospital service that is:
(qq) "Medical record". All documents, in whatever form, in the possession of or subject to the control of the hospital which describe the recipients diagnosis, condition or treatment.
(rr) "Medicare". The health insurance program for the aged and disabled established pursuant to Title XVIII of the Social Security Act.
(ss) "Multidisciplinary team". A team of health care professionals which includes a physician and a mental health professional.
(tt) "Nursing facility services". "Nursing facility services" as defined by 42 U.S.C. § 1396 d(f), which is incorporated by this reference.
(uu) "Orthotics". Medical appliances or devices, other than routine foot appliances, used to strengthen weak or defective parts of the body, to aid mobility or to serve other medical purposes.
(vv) "Outpatient". An "outpatient" as defined by 42 C.F.R. § 440.20(a), which is incorporated by this reference.
(ww) "Outpatient hospital services". "Outpatient hospital services" as defined in 42 C.F.R. § 440.20(a), which is incorporated by this reference.
(xx) "Physical therapist". A person licensed to practice as a physical therapist by the Wyoming State Board of Physical Therapy or a similar agency in another state.
(yy) "Physical therapy services". Physical therapy services as defined by the rules and policies of the Department.
(zz) "Physician". A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners or a comparable agency in another state, or a person licensed to practice dentistry by the Wyoming Board of Dental Examiners or a comparable agency in another state.
(aaa) "Physician services". Physician services as defined by the rules of the Department.
(bbb) "Preadmission certification number (PCN)". Preadmission certification number as defined by Chapter 8, which definition is incorporated by this reference.
(ccc) "Prior authorization". Approval by the Division, pursuant to the prior authorization provisions of Chapter 3, which are incorporated by this reference, before covered services are provided.
(ddd) "Prosthetics". An item or device which replaces a missing part of the body.
(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) "Psychiatric services". "Level of care psychiatric services" as defined by Chapter 30, which definition is incorporated by this reference.
(hhh) "Public institution". An institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control. "Public institution" does not include:
(iii) "Radiology services". Professional or technical services in which X-rays or rays from radioactive substances are used for diagnostic or therapeutic purposes.
(jjj) "Recipient". A person who has been determined eligible for Medicaid.
(kkk) "Recipient under age twenty-one". A recipient before or during the month in which he or she turns twenty-one years of age.
(lll) "Service limitations". "Service limitations" as defined by Chapter 26, which definition is incorporated by this reference.
(mmm) "Service area". The State of Wyoming and the following cities or towns: Craig, Colorado; Idaho Falls, Montpelier and Pocatello, Idaho; Billings and Bozeman, Montana; Kimball and Scottsbluff, Nebraska; Custer, Deadwood, Rapid City and Spearfish, South Dakota; and Ogden and Salt Lake City, Utah.
(nnn) "Standing orders". Orders from a physician or other provider that a certain service or services be provided to every patient, regardless of diagnosis.
(ooo) "Supervision". Supervision as defined by Chapter 26, which definition is incorporated by this reference.
(ppp) "Survey agency". The Medical Facilities Office of the Department, its agent, designee or successor.
(qqq) "Swingbed". A bed in a hospital which is certified for either inpatient hospital services or nursing facility services.
(rrr) "Swingbed services". Nursing facility services provided to a recipient in a swing-bed.
048-9 Wyo. Code R. § 9-4