Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 47 - CHILDREN'S MENTAL HEALTH WAIVER (CMHW) AND CARE MANAGEMENT ENTITY (CME) RULES › Section 47-4 - Definitions

Current through July 13, 2024
Except as otherwise specified in Chapter 1 or as defined in
				  this Section, the terminology used in this Chapter is the standard terminology
				  and has the standard meaning used in accounting, healthcare, Medicaid, and
				  Medicare
(a) "Diagnostic and
				Statistical Manual of the American Psychiatric Association (DSM)." The most
				recent editions of the Diagnostic and Statistical Manual of the American
				Psychiatric Association. Primary diagnoses are principle disorders requiring
				immediate attention.
(b) "Care
				Management Entity (CME)." An organizational entity that has a contract with the
				Department to serve as the locus of intensive care coordination,
				accountability, and provider of high fidelity wraparound services for defined
				populations of youth with serious emotional disturbance and their
				families
(c) "Child and Adolescent
				Service Intensity Instrument (CASII)." The CASII is a standardized tool from
				the American Academy of Child and Adolescent Psychiatrists that provides a
				determination of the appropriate intensity of services needed by youth, ages
				six to twenty (6-20) being served within a continuum of care.
(d) "Children's Mental Health Waiver (CMHW)."
				CMHW is a Department of Health Medicaid program that is managed by the care
				management entity that aims to help qualifying youth with serious emotional
				disturbance, reduce their level of service needs, and increase their natural
				supports in a relatively short amount of time, utilizing High Fidelity
				Wraparound.
(e) "Early Childhood
				Service Intensity Instrument (ECSII)." The ECSII is a tool from the American
				Academy of Child and Adolescent Psychiatrists that provides a determination of
				the appropriate intensity of service needs for infants, toddlers, and youth
				from ages four to five (4-5) years who are experiencing social/emotional
				development delays or challenges.
(f) "Excluded Populations." The Excluded
				Population includes:
(i) Medicaid
				beneficiaries who reside in nursing facilities or intermediate care facilities
				for Individuals with Intellectual Disabilities;
(ii) Medicaid beneficiaries who participate
				in a Home and Community Based Waiver Services (HCBS), including actively
				enrolled youth or youth who have met all the clinical criteria for and have
				been placed on a waitlist for the following waivers:
(A) Children's Developmental Disability
				Waiver - WY Waiver 0253;
(B)
				Developmental Disability Supports Waiver - WY Waiver #1060;
(C) Developmental Disability Comprehensive
				Waiver - WY Waiver #1061; and
(D)
				Long Term Care Waiver - WY Waiver #0236.
(iii) Medicare beneficiaries who receive
				services through the State Children's Health Insurance Title XXI
				program;
(iv) Medicaid
				beneficiaries for the period of retroactive eligibility;
(v) Any other youth, upon application, whose
				primary need is determined to be for services that are more habilitative in
				nature vs. the intensive rehabilitative nature of HFWA services. This need will
				be determined by a level of co-occurrence indicated as four (4) or five (5) in
				Dimension III on the CASII or a rating of four (4) or five (5) on the ECSII
				assessment.