Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0053 - State Hospital › Chapter 6 - DESIGNATED HOSPITALS › Section 6-4 - Definitions

Current through July 13, 2024
The following definitions shall apply in the interpretation
				  and enforcement of Chapters 6, 7, and 8 of these rules:
(a) "CARF Accreditation" means accreditation
				according to the Commission on Accreditation of Rehabilitation
				Facilities.
(b) "Centers for
				Medicare and Medicaid (CMS) Certification" means the state survey agency has
				determined that a healthcare entity has been determined to meet the Social
				Security Act's provider or supplier definitions, and is in compliance with
				standards required by Federal regulations.
(c) "Claims" means the process of billing the
				allowable cost of services under the Act to the Department or responsible
				county pursuant to Wyo. Stat. Ann. §
									
										25-10-112.
(d) "CMS 1500" means the billing claim form
				for healthcare services approved by the Centers for Medicaid and Medicare
				Services, which is used by physicians (formerly the HCFA 1500).
(e) "Department" means the Wyoming Department
				of Health.
(f) "Designated
				Hospital" means a general hospital or psychiatric treatment hospital or unit
				that provides care to an individual detained under Wyo. Stat. Ann. §§
									
										25-10-109 through -110.1, which is under an
				agreement with the Department and bills the Department or the responsible
				county for the costs of care under the Act.
(g) "Directed Outpatient Commitment" means as
				defined at Wyo. Stat. Ann. §
									
										25-10-110.1.
(h) "Emergency Detention" means the detention
				of a person pursuant to Wyo. Stat. Ann. §
									
										25-10-109.
(i) "Inpatient psychiatric treatment" means
				the medical diagnosis, treatment and care of persons with mental illness
				requiring hospitalization which is provided under the direction of a licensed,
				board certified psychiatrist, directed at reducing the risk, symptoms and
				impact of the psychiatric disorder.
(j) "Involuntary hospitalization" means the
				hospitalization of a person against his will under Wyo. Stat. Ann. §
									
										25-10-110, at the Wyoming State Hospital or
				at a designated hospital or treatment provider under agreement with the
				Department to provide inpatient psychiatric treatment.
(k) "JCAHO" means the Joint Commission for
				the Accreditation of Healthcare Organizations.
(l) "Medicaid" means medical assistance and
				services provided pursuant to Title XIX of the Social Security Act or the
				Wyoming Medical Assistance and Services Act, at Wyo. Stat. Ann. §§
									
										42-4-101,
et seq
.
(m) "Medically necessary" means items and
				services which may be justified as reasonable, necessary, or appropriate, based
				on evidence-based clinical standards of care, as measured by the Level of Care
				Utilization System (LOCUS) tool.
(n) "Medical Records" means all documents in
				the possession of or subject to the control of the designated hospital, which
				describe the patient's psychiatric assessments, diagnosis, condition or
				treatment.
(o) "Treatment Provider"
				or "treatment center" means a community mental health center under contract or
				agreement with the Department to provide outpatient or residential treatment to
				persons with mental illness or substance use disorders.
(p) "Universal billing claim form" means the
				national standardized form used by hospitals and other healthcare facilities or
				treatment providers which summarizes the allowable costs for services provided
				by the hospital or other treatment provider.
(q) "Utilization Review" means the process of
				comparing requests for medical services to guidelines deemed appropriate for
				such services.