Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 25 - ICF/MR SERVICES › Section 25-4 - Definitions

Current through July 13, 2024
(a) "Admission." The act that allows an
				individual to officially enter a facility to receive services.
(b) "Applicant." A person, including a
				patient, who has applied for Medicaid benefits and is a resident or is seeking
				admission to a facility.
(c)
				"Certified." A facility that is certified pursuant to
				42 C.F.R.
				442 Subpart C, which is incorporated by this
				reference, to provide ICF/MR services.
(d) "Chapter III." Chapter III, Provider
				Participation, of the Wyoming Medicaid Rules.
(e) "Chapter XX." Reimbursement of
				Intermediate Care Facilities for the Mentally Retarded, of the Wyoming Medicaid
				rules.
(f) "Classification in
				Mental Retardation." The Classification in Mental Retardation (19 83 ed.) of
				the American Association on Mental Deficiency, which is hereby incorporated by
				reference. The book is published by the American Association on Mental
				Deficiency in Washington, D.C., and is available from the publisher.
(g) "Covered service." ICF/MR
				services.
(h) "Date of Admission."
				The date an individual enters a facility and begins receiving
				services.
(i) "Department." The
				Wyoming Department of Health, its agent, designee or successor.
(j) "Discharge." The act by which an
				individual who has been a patient in a facility ceases to be a patient and the
				facility ceases to be legally responsible for providing care for such
				individual. Discharge does not include an individuals temporary
				absence.
(k) "Division." The
				Division of Health Care Financing of the Department, its agent, designee or
				successor.
(l) "Evaluation of need
				for ICF/MR services." A review, pursuant to Section
				8,
				by an IDT or such other person or entity specified by the Department, of an
				applicants or recipients physical and mental condition for the purpose of
				determining whether ICF/MR services are medically necessary.
(m) "Facility." An ICF/MR.
(n) "HCFA." The Health Care Financing
				Administration of the United States Department of Health and Human
				Services.
(o) "Interdisciplinary
				team (IDT)." A team of professionals which includes a QMRP, a social worker and
				a registered nurse.
(p) "Individual
				educational plan (IEP)." A written plan for children under the age of
				twenty-one developed by the IDT, in consultation with the child's school
				district, using standard assessments and standard evaluative measures to
				determine the strengths and needs of an individual. The IEP shall include short
				term and long term goals, and the training and treatment programs to achieve
				those goals.
(q) "Individual
				program plan (IPP)." A written plan developed by the IDT using standard
				assessments and standard evaluative measures to determine the strengths and
				needs of an individual. The IPP shall include short term and long term goals,
				and the training and treatment programs to achieve those goals.
(r) "Infirmary services." Sub-acute hospital
				services provided on the premises of a facility.
(s) "Intermediate care facility for the
				mentally retarded (ICF/MR)." An intermediate care facility as defined by
				42 U.S.C.
				1396 d(c) that has at least fifteen certified
				beds. "ICF/MR" includes that portion of the Wyoming State Training School which
				is certified to provide ICF/MR services.
(t) "Intermediate care facility for the
				mentally retarded (ICF/MR) services." Intermediate care facility services for
				the mentally retarded as defined in
				42 U.S.C.
				1396 d(d) and the regulations promulgated by
				HCFA, and which are provided in an ICF/MR.
(u) "Local agency." The County field office
				of the Wyoming Department of Family Services.
(v) "Medicaid." Medical assistance and
				services provided pursuant to Title XIX of the Social Security Act and the
				Wyoming Medical Assistance and Services Act.
(w) "Medicaid allowable payment." The maximum
				Medicaid reimbursement as determined pursuant to Chapter XX and the other rules
				of the Department.
(x) "Medical
				necessity" or "medically necessary." A health service that is required to
				diagnose, treat, cure or prevent an illness, injury or disease which has been
				diagnosed or is reasonably suspected; to relieve pain; or to improve and
				preserve health and be essential to life. The service must be:
(i) Consistent with the diagnosis and
				treatment of the recipient's condition;
(ii) In accordance with the standards of good
				medical practice among the provider's peer group;
(iii) Required to meet the medical needs of
				the recipient and undertaken for reasons other than the convenience of the
				recipient or the provider; and
(iv)
				Provided in the least costly setting required by the recipient's
				condition.