Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0036 - Land Commissioners, Board of › Chapter 1 - GENERAL PROVISIONS › Section 1-4 - Definitions

Current through July 13, 2024
The following definitions shall apply in the interpretation
				  and enforcement of these rules. Where the context in which words are used in
				  these rules indicates that such is the intent, words in the singular number
				  shall include the plural and visa versa. Throughout these rules gender pronouns
				  are used interchangeably, except where the context dictates otherwise. The
				  drafters have attempted to utilize each gender pronoun in equal numbers, in
				  random distribution. Words in each gender shall include individuals of the
				  other gender.
(a) Administrator means
				the Administrator of the Community and Family Health Division.
(b) Adverse Action means a termination,
				suspension, or reduction of benefits or covered services. Adverse Action does
				not include the denial of services because they are not covered services, or
				other issues about the scope of covered services.
(c) Affidavit means a written notarized
				statement of facts made voluntarily under oath.
(d) Aggrieved means any applicant/client,
				participating facility, or provider who has been subject to an adverse action
				by the Community and Family Health Division.
(e) Appeal means a Contestants resort to
				district court after a final adverse agency determination or
				decision.
(f) Applicant means a
				person whose written application for the MCH Programs has been submitted to
				Community and Family Health Division, but there has been no final determination
				of eligibility.
(g) Approved
				Facility means a facility enrolled with Wyoming EqualityCare, which includes,
				but is not limited to an in-state or out-of-state inpatient/outpatient hospital
				facility e.g. laboratory and radiology.
(h) Approved Provider means a provider
				enrolled with Wyoming EqualityCare and who has signed an agreement with
				MCH.
(i) Care Coordination means
				case management of family-centered, community-based, culturally competent
				coordinated health care using a multi-disciplinary approach.
(j) Childrens Special Health (CSH) means a
				federally mandated program to assist in infrastructure building, gathering of
				data, and promoting policies to promote the health of the underserved children
				and youth with special health care needs.
(k) Approved Provider means a person who is
				determined eligible for MCH programs.
(l) Complaint means a written request in
				which a person requests a hearing. The written request (complaint) must include
				at minimum: name, address, telephone number, and the reason for the request,
				including the nature of the Division action, order, or determination being
				contested.
(m) Contestant means the
				applicant/client, a facility, or representative who brings a complaint against
				the Division.
(n) Contested Case
				means a disputed action taken by the Department involving eligibility,
				termination of eligibility, suspension of eligibility, denial of medical
				services, denial of payment for medical services, or reduction of
				services.
(o) Date of Action means
				the intended date on which a termination, suspension, or reduction becomes
				effective.
(p) Date of Eligibility
				means the date of acceptance to MCH for coverage of approved medical services
				for a specific diagnosis or treatment.
(q) Date of Service means date or range of
				dates on which a service was provided.
(r) Department means the Department of Health
				(WDH), its agent, designee, or successor.
(s) Designee means the appointed agent of the
				Director or the Administrator having all the authority of the Director or the
				Administrator.
(t) Director means
				Director of the Department of Health.
(u) Division means the Community and Family
				Health Division (CFHD).
(v) Excess
				Payments means includes, but is not limited to:
(i) Overpayments;
(ii) Payments made as a result of system
				errors;
(iii) Payments for premiums
				or services furnished to a non-client;
(iv) Payments for non-covered services
				furnished to a client.