048-1 Wyo. Code R. §§ 1-3 - [Effective until 9/26/2024] Definitions
(a) The following definitions apply to these
Rules, unless otherwise specified:
(i)
"Administrator" means the Senior Administrator of the Wyoming Department of
Health, Behavioral Health Division, as well as the Senior Administrator's
designees.
(ii) "Adverse action"
means:
(A) For an individual seeking services
or a client, an adverse action is a termination, reduction, or denial of
services or eligibility.
(B) For a
provider, an adverse action is the denial or revocation of certification, or
the denial or termination of a contract with the Department.
(iii) "BHC-Full Benefit Plan"
means the Behavioral Health Center (BHC) Full benefit plan, which covers a
comprehensive set of mental health and substance use disorder treatment
services at behavioral health centers. The BHC-Full benefit plan is a
non-Medicaid benefit plan, it does not cover pharmacy or medical benefits and
is limited to individuals who meet eligibility criteria. The provider network
is limited to providers with active contracts with the Wyoming Department of
Health, Behavioral Health Division for related behavioral health
services.
(iv) "BHC-Screen Benefit
Plan" means the Behavioral Health Center (BHC) Screen benefit plan, which is a
non-Medicaid benefit plan and does not cover pharmacy or medical benefits and
is used to determine whether an individual qualifies for the BHC-Full benefit
plan. The provider network is limited to providers with active contracts with
the Wyoming Department of Health, Behavioral Health Division for related
behavioral health services.
(v)
"Behavioral health services" means mental health or substance use disorder
treatment services and supports provided to persons with mental illness or
substance use disorders.
(vi)
"Bio-psychosocial and spiritual needs" means the biological, psychological,
social, and spiritual needs of a client, which play a significant role in a
behavioral health disorder and contribute to the client's
functioning.
(vii) "Certification"
means a process to formally recognize that a provider has met the requirements
of these Rules to provide substance use disorder treatment services to court
ordered individuals or behavioral health services purchased by the
Department.
(viii) "Co-occurring"
means the coexistence of both a mental illness and a substance use
disorder.
(ix) "Corrective action"
means a necessary change in provider policy or practice that is a result of a
complaint, an investigation process, site visit findings, or noncompliance with
a contract provision, a resolution plan, or these Rules.
(x) "Department" means the Wyoming Department
of Health, Behavioral Health Division.
(xi) "Emergency services" means direct
contact with a person in a mental health crisis as an intervention to prevent
escalation of the crisis and to triage the person into needed
services.
(xii) "Engagement
services" means face-to-face staff contact, which may include delivery through
telehealth, with an individual who is waiting to be admitted into treatment for
the purpose of maintaining the individual's motivation and to help prepare them
for treatment.
(xiii)
"Evidence-based practice" means a behavioral health intervention that:
(A) Shows statistically significant
effectiveness through empirical research in treating specific problems and
populations;
(B) Is consistent with
relevant clinical expertise; and
(C) Considers client preferences and
values.
(xiv) "Executive
director" means the individual responsible for the overall management of a
provider. The term encompasses other titles including, but not limited to,
chief executive officer, sole proprietor, president, or program
administrator.
(xv) "Governing
board" means the board of directors of a private nonprofit corporation, a
community board as defined in W.S. §
35-1-613(a)(i),
or a public agency as defined in W.S. §
35-1-613(a)(vi).
(xvi) "Intensive outpatient program" or "IOP"
means structured substance use disorder and mental health treatment programming
consisting primarily of counseling and education. IOP is more intensive than
outpatient counseling, less intensive than residential care and can function as
a step-down from residential care.
(xvii) "Intervention services" means skilled
treatment services indicated by client need, which include, individual and
group counseling, family counseling, educational groups, skills training,
occupational and recreational therapy, medication assisted treatment, and
psychotherapy.
(xviii) "Medication
assisted treatment" or "MAT" means the use of medications, excluding those used
for detoxification, which are used in combination with counseling and
behavioral therapies to support recovery and provide a whole-person approach to
the treatment of substance use disorders. Medications utilized in MAT approved
by the Food and Drug Administration (FDA) and the Substance Abuse and Mental
Health Services Administration (SAMHSA).
(xix) "Multi-county consortium" means a
formal agreement between two or more providers in different counties to share
funding, administrative support, clinical staff, or other resources to ensure a
continuum of service availability and increase cost effectiveness.
(xx) "National accreditation" means
accreditation issued by The Joint Commission (TJC), the Commission on
Accreditation of Rehabilitation Facilities (CARF), or National Integrated
Accreditation for Healthcare Organizations (NIAHO).
(xxi) "Ombudsman program" means a program
which advocates for the rights of individuals by investigating and resolving
problems and grievances, providing information, and working with institutions,
organizations, and agencies to increase the effective provision of services to
the people they serve.
(xxii)
"Promising practice" means an administrative or clinical practice that has some
scientific research or data showing positive outcomes but does not have enough
evidence to support generalizable conclusions.
(xxiii) "Provider" means a provider of
behavioral health services funded by the Department or a provider of substance
use disorder services to persons referred or ordered to receive services by a
court.
(xxiv) "Qualified clinical
staff" means persons who are licensed or certified in Wyoming to practice:
(A) As a mental health or addictions
professional under the Wyoming Mental Health Professions Licensing Act, W.S.
§
33-38-101 to -113;
(B) Psychology under W.S. §
33-27-113 to -123;
(C) Medicine under the Medical Practice Act,
W.S. §
33-26-101 to -703; or
(D) As an Advanced Practice Registered Nurse
under the Wyoming Nurse Practice Act, W.S. §
33-21-119 to -157 or the Advanced
Practice Registered Nurse Compact, W.S. §
33-21-301 to -302.
(xxv) "Recovery supports" means
non-clinical provider-sponsored activities and services which advance a sense
of hope, complement and support treatment, increase and sustain treatment
engagement, improve outcomes, and enhance recovery. Generally, recovery
supports are developed and conducted by persons who are in recovery. Recovery
supports do not include 12-Step meetings.
(xxvi) "Residential treatment services" means
services provided in a freestanding or hospital-based facility, which provides
room and board, and which operates twenty-four (24) hours per day, seven (7)
days per week. A residential treatment facility provides evaluation, a planned
regimen of treatment services including the staff-monitored administration of
prescribed medication, and other supports as indicated by the client's
treatment plan.
(xxvii) "Resolution
plan" means a written plan to implement corrective actions identified by the
Department to achieve measurable improvements in efficiency, effectiveness,
performance, accountability, outcomes, or other indicators.
(xxviii) "SAMHSA" means the Substance Abuse
and Mental Health Services Administration within the United States Department
of Health and Human Services.
(xxix) "Service area" means a single county,
multiple counties, or a region, designated by the Department to serve as the
geographic area in which contracted services are to be provided.
(xxx) "Variance" means a permanent change to
a required standard in Chapter 2 or 5. A variance may be requested at any
time.
(xxxi) "Waiver" means a
temporary change to a required standard in Chapter 2 or 5. A waiver may be
requested at any time.
Notes
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