Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 6 - HEALTH CHECK (FORMERLY EPSDT) PROGRAM › Section 6-4 - Definitions

Current through July 13, 2024
(a) "ACIP". The Advisory Committee for
				Immunization Practices of the Centers for Disease Control, United States Public
				Health Service, HHS.
(b)
				"Administrative transportation". Transportation by means other than an
				ambulance to obtain covered services.
(c) "Ambulance". An ambulance as defined by
				Chapter 15, which definition is incorporated by this reference.
(d) "Appropriate immunizations". Those
				immunizations recommended by the Division of Preventive Medicine, and the ACIP
				recommended schedule of vaccinations.
(e) "Appropriate laboratory tests". Those
				tests which a HEALTH CHECK provider determines to be appropriate for a
				recipient under age twenty-one. Appropriate laboratory tests may include a
				blood lead level test, anemia tests, sickle cell test, and tuberculin
				test.
(f) "Chapter 3". Chapter 3,
				Provider Participation, of the Wyoming Medicaid Rules.
(g) "Chapter 15". Chapter 15, Ambulance
				Services, of the Wyoming Medicaid rules.
(h) "Chapter 26". Chapter 26, Covered
				Services, of the Wyoming Medicaid rules.
(i) "Claim". A request by a HEALTH CHECK
				provider for payment of Medicaid funds for services provided to a
				recipient.
(j) "Covered service".
				Services provided to a recipient that may be reimbursed as provided in this
				Chapter.
(k) "Dental screening". An
				oral assessment of a recipient by a HEALTH CHECK provider.
(l) "Department". The Wyoming Department of
				Health, its designee, agent or successor.
(m) "Department of Family Services (DFS)".
				The Wyoming Department of Family Services, its designee, agent or
				successor.
(n) "Developmental
				screening". An examination of a recipient and an evaluation of a recipients
				activities to determine whether he or she is within the normal range of
				achievement for the recipients age group and cultural background.
(o) "Division". The Division of Health Care
				Financing of the Department, its successor, agent or designee.
(p) "Division of Preventive Medicine". The
				Division of Preventive Medicine of the Department, its successor, agent or
				designee.
(q) "Early and periodic
				screening, diagnosis and treatment services ("EPSDT)". Early and periodic
				screening, diagnosis and treatment services as defined in
				42 U.S.C. §
										1396 d(r), which is incorporated by this
				reference.
(r) "Excess payments".
				Medicaid funds received by a HEALTH CHECK provider which exceed the Medicaid
				allowable payment.
(s) "Expanded
				services". Medically necessary health care, including diagnostic services and
				treatment, which are reimbursable pursuant to
				42 U.S.C. §
										1396 d, and which are not otherwise
				reimbursable under the Wyoming Medicaid State Plan.
(t) "Eyecare practitioner". An optometrist or
				an ophthalmologist.
(u) "HEALTH
				CHECK". A comprehensive EPSDT screening examination of a well-child or young
				adult up to age twenty-one which includes all of the following:
(i) A comprehensive health and developmental
				history, including a developmental screening, a nutritional screening, and a
				mental health screening;
(ii) An
				unclothed physical examination;
(iii) Appropriate immunizations;
(iv) Appropriate laboratory tests;
(v) Age appropriate health education and
				counseling;
(vi) Vision
				screening;
(vii) Hearing
				screening;
(viii) Dental screening;
				and
(ix) Treatment or referral
				services for any diagnosed abnormalities.