Wyoming Administrative Code
Agency 048 - Health, Department of
Sub-Agency 0037 - Medicaid
Chapter 26 - COVERED SERVICES
Section 26-3 - Definitions

Universal Citation: WY Code of Rules 26-3

Current through September 21, 2024

Except as otherwise specified in Chapter 1, or as specified herein, the terminology used in this Chapter is the standard terminology and has the standard meaning as used in health care, Medicaid and Medicare

(a) "Applied Behavior Analysis (ABA) Treatment." Services provided to children between the ages of 0-20 years of age with a diagnosis of Autism Spectrum Disorder in order to improve social, communication, and learning skills.

(b) "Ambulatory Surgical Center (ASC) Facility." A health care facility that specializes in providing surgery, pain management, and certain diagnostic services in an outpatient setting. ASC-qualified procedures are typically more complex than those done in a doctor's office but not so complex as to require an overnight stay.

(c) "Ambulatory Surgical Center (ASC) Services." Surgical procedures or other services offered by an ASC facility that do not require overnight inpatient hospital care.

(d) "Dental Services." Professional services and dental appliances furnished by a dentist within the scope of his practice.

(e) "Developmental Center." An agency which:

(i) Provides developmental services to developmentally disabled children under the age of six; and

(ii) Is certified to provide services to clients under age twenty-one by the Developmental Disabilities Section of the Health Care Financing Division.

(f) "Developmental Center Services." Services provided to developmentally disabled clients under age twenty-one as part of an individualized education plan or as part of an individualized family services plan.

(g) "Diagnostic Assessment and Evaluation." A comprehensive, multi-disciplinary evaluation of a child five years of age or under, that:

(i) Is performed after a written referral from a physician licensed in Wyoming;

(ii) Is performed using standardized assessment tools or, if no standardized assessment tools are available based on the child's chronological age or suspected developmental age, using criterion based assessments; and

(iii) Includes an assessment of the following:
(A) Physical development, including fine and gross motor skills;

(B) Cognitive development;

(C) Speech development; and

(D) Social and emotional development.

(h) "Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services. Services as described in 42 U/S/C/ 1396 (d)(r) and 42 C.F.R. Part 441, Subpart B.

(i) "Emergency Hospital Services." Emergency hospital services, as defined by 42 C.F.R. § 440.170(e).

(j) "End Stage Renal Dialysis (ESRD) Services." Services for outpatient dialysis and other treatment for persons with end-stage renal disease.

(k) "Family Planning Clinic Services." Services for medically approved diagnosis, treatment, counseling, contraceptive supplies or devices, which are prescribed or furnished to individuals of child-bearing age for purposes of enabling such individuals to determine the number and spacing of their children.

(l) "Habilitative Services." Services that help patients keep, learn, or improve skills and functioning for daily living.

(m) "Hospice Services." A program of care delivered in a person's home or health care facility that provides reasonable and necessary medical and support services for the management of a terminal illness.

(n) "Interpretation Services." Services that assist clients with oral or sign language interpretation.

(o) "Nurse Midwife Services" Nurse midwife services as defined by 42 C.F.R. § 440.165.

(p) "Optometrist." A person licensed to practice optometry by the Wyoming State Board of Examiners of Optometry or a similar agency in another state.

(q) "Physician Services." Professional services furnished by or under the supervision of a licensed physician.

(r) "Preventive Services/Visits." Any routine service or examination which is performed in the absence of a diagnosed illness, injury, or complaint.

(s) "Public Institution." Public institution, as defined by 42 C.F.R. § 435.1010.

(t) "Radiology Services." Professional or technical services in which X-rays or scans are used for diagnostic or therapeutic purposes.

(u) "Rehabilitative Services." Services that help patients keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the client was sick, hurt, or suddenly disabled.

(v) "Speech Therapy Services." Outpatient services provided by or under the direct supervision of a licensed speech therapist pursuant to written orders of a physician.

(w) "Vision Services." Professional services and corrective lenses furnished by an Optometrist, optician, or Ophthalmologist within the scope of his practice.

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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