Wyoming Administrative Code › Agency 048 - Health, Department of › Sub-Agency 0037 - Medicaid › Chapter 41 - ADULT DEVELOPMENTAL DISABILITIES HOME AND COMMUNITY BASED WAIVER › Section 41-4 - 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 vice versa. Throughout these rules gender pronouns
				  are used interchangeably. The drafters have attempted to utilize each gender
				  pronoun in equal numbers, in random distribution. Words in each gender include
				  individuals of the other gender.
(a)
				"Advocate." A person, chosen by the participant or legal guardian, who supports
				and represents the rights and interests of the participant in order to ensure
				the participant's full legal rights and access to services. The advocate can be
				a friend, a relative, or any other interested person. An advocate has no legal
				authority to make decisions on behalf of a participant.
(b) "Adult." A person twenty-one years of age
				or older for purposes of the Adult Developmental Disabilities Home and
				Community Based Waiver.
(c) "Adult
				Developmental Disabilities Home and Community Based Waiver." The Adult
				Developmental Disabilities Home and Community Based Waiver submitted to and
				approved by the Centers for Medicare and Medicaid Services pursuant to Section
				1915(c) of the Social Security Act.
(d) "Applicant." An individual who is
				requesting services.
(e)
				"Application." A written statement, in the form specified by the Division,
				which is submitted to the Division, in which an individual indicates that he or
				she is interested in receiving covered services. An application may be
				submitted by one person on behalf of another but shall have the legal
				guardian's signature if applicable.
(f) "Assessment." A determination, pursuant
				to Section
				6 of
				this Chapter, of an individual's functional capacity and needs.
(g) "Behavior support plan." A written plan
				that is developed based on a functional assessment of behaviors that negatively
				impact a person's ability to acquire, retain, and/or improve the self-help,
				socialization, and adaptive skills necessary to reside successfully in home and
				community-based settings, and that contains multiple intervention strategies
				designed to modify the environment and teach new skills.
(h) "Caregiver." A person who provides
				services to a participant.
(i)
				"Case management." Services that assist participants in gaining access to
				needed waiver and other Wyoming Medicaid state plan services, as well as needed
				medical, social, educational, and other services, regardless of the funding
				source for the services to which access is gained. Case management services are
				provided by individually-selected service coordinators, whose responsibilities
				include ongoing monitoring of the provision of services included in the
				individual plan of care, and initiating and overseeing the process of
				assessment and reassessment of the participant's level of care and review of
				the individual plan of care.
(j)
				"Centers for Medicare and Medicaid Services (CMS)." The Centers for Medicare
				and Medicaid Services of the United States Department of Health and Human
				Services, its agent, designee, or successor.
(k) "Chapter 1." Chapter 1, Rules for
				Medicaid Administrative Hearings, of the Wyoming Medicaid Rules.
(l) "Chapter 3." Chapter 3, Provider
				Participation, of the Wyoming Medicaid Rules.
(m) "Chapter 16." Chapter 16, Medicaid
				Program Integrity, of the Wyoming Medicaid Rules.
(n) "Chapter 26." Chapter 26, Medicaid
				Covered Services, of the Wyoming Medicaid Rules.
(o) "Chapter 35." Chapter 35, Medicaid
				Benefit Recovery, of the Wyoming Medicaid Rules.
(p) "Chapter 39." Chapter 39, Recovery of
				Excess Payments, of the Wyoming Medicaid Rules.
(q) "Chapter 42." Chapter 42, DD Child Waiver
				Services, of the Wyoming Medicaid Rules.
(r) "Chapter 43." Chapter 43, Acquired Brain
				Injury Waiver Services, of the Wyoming Medicaid Rules.
(s) "Chapter 44." Chapter 44, Environmental
				Modifications and Specialized Equipment, of the Wyoming Medicaid
				Rules.
(t) "Chapter 45." Chapter
				45, Waiver Provider Certification and Sanctions, of the Wyoming Medicaid
				Rules.
(u) "Claim." A request by a
				provider for Medicaid payment for covered services provided to a
				participant.
(v) "Clinically
				eligible." Determination that a person has met the requirements set forth in
				Section
				6(b) of this
				Chapter.
(w) "Conservator." A
				person appointed by the court to manage the estate for an individual incapable
				of managing his or her financial affairs.
(x) "Covered services." Those services that
				are Medicaid reimbursable pursuant to Section
				7 of
				this Chapter.
(y) "Department." The
				Wyoming Department of Health, its agent, designee, or successor.
(z) "Department of Family Services (DFS)."
				The Wyoming Department of Family Services, its agent, designee, or
				successor.
(aa) "Developmental
				disability." As defined in federal law (
				42
				U.S.C. §
										15002(8) ), a
				severe, chronic disability of an individual that:
(i) Is attributable to a mental or physical
				impairment or combination of mental and physical impairments.
(ii) Is manifested before the individual
				attains age 22.
(iii) Is likely to
				continue indefinitely, and
(iv)
				Results in substantial functional limitations in 3 or more of the following
				areas of major life activity:
(A)
				Self-care
(B) Receptive and
				expressive language
(C)
				Learning
(D) Mobility
(E) Self-direction
(F) Capacity for independent living
(G) Economic self-sufficiency, and
(v) Reflects the individual's need
				for a combination and sequence of special, interdisciplinary, or generic
				services, individualized supports, or other forms of assistance that are of
				lifelong or extended duration and are individually planned and
				coordinated.