Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 9 - HOSPITAL SERVICES › Section 9-4 - Definitions

Current through July 13, 2024
(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:
(i) Able to withstand repeated
				use;
(ii) Primarily used to serve a
				medical purpose;
(iii) Generally
				not useful to a person in the absence of an illness or injury; and
(iv) Appropriate for home use.