048-47 Wyo. Code R. §§ 47-4 - Definitions

Except as otherwise specified in Chapter 1 or as defined in this Section, the terminology used in this Chapter is the standard terminology and has the standard meaning used in accounting, healthcare, Medicaid, and Medicare

(a) "Diagnostic and Statistical Manual of the American Psychiatric Association (DSM)." The most recent editions of the Diagnostic and Statistical Manual of the American Psychiatric Association. Primary diagnoses are principle disorders requiring immediate attention.

(b) "Care Management Entity (CME)." An organizational entity that has a contract with the Department to serve as the locus of intensive care coordination, accountability, and provider of high fidelity wraparound services for defined populations of youth with serious emotional disturbance and their families

(c) "Child and Adolescent Service Intensity Instrument (CASII)." The CASII is a standardized tool from the American Academy of Child and Adolescent Psychiatrists that provides a determination of the appropriate intensity of services needed by youth, ages six to twenty (6-20) being served within a continuum of care.

(d) "Children's Mental Health Waiver (CMHW)." CMHW is a Department of Health Medicaid program that is managed by the care management entity that aims to help qualifying youth with serious emotional disturbance, reduce their level of service needs, and increase their natural supports in a relatively short amount of time, utilizing High Fidelity Wraparound.

(e) "Early Childhood Service Intensity Instrument (ECSII)." The ECSII is a tool from the American Academy of Child and Adolescent Psychiatrists that provides a determination of the appropriate intensity of service needs for infants, toddlers, and youth from ages four to five (4-5) years who are experiencing social/emotional development delays or challenges.

(f) "Excluded Populations." The Excluded Population includes:

(i) Medicaid beneficiaries who reside in nursing facilities or intermediate care facilities for Individuals with Intellectual Disabilities;

(ii) Medicaid beneficiaries who participate in a Home and Community Based Waiver Services (HCBS), including actively enrolled youth or youth who have met all the clinical criteria for and have been placed on a waitlist for the following waivers:

(A) Children's Developmental Disability Waiver - WY Waiver 0253;

(B) Developmental Disability Supports Waiver - WY Waiver #1060;

(C) Developmental Disability Comprehensive Waiver - WY Waiver #1061; and

(D) Long Term Care Waiver - WY Waiver #0236.

(iii) Medicare beneficiaries who receive services through the State Children's Health Insurance Title XXI program;

(iv) Medicaid beneficiaries for the period of retroactive eligibility;

(v) Any other youth, upon application, whose primary need is determined to be for services that are more habilitative in nature vs. the intensive rehabilitative nature of HFWA services. This need will be determined by a level of co-occurrence indicated as four (4) or five (5) in Dimension III on the CASII or a rating of four (4) or five (5) on the ECSII assessment.

(g) "High Fidelity Wraparound (HFWA)." High Fidelity Wraparound is an evidenced-based intensive care coordination model provided by the Medicaid Care Management Entity.

(h) "Level of Care (LOC)." The Level of Care document is required as part of the clinical eligibility determination process for Care Management Entity enrollment. The Level of Care form is completed by a qualified mental health professional who:

(i) Is licensed to diagnose and treat mental disorders, and has knowledge of the youth's level of care need;

(ii) Can attest that the youth meets one or more psychiatric inpatient criteria listed on the LOC form; and

(iii) Can attest that the youth can be safely served in the community with adequate services and supports in place.

(i) "Serious Emotional Disturbance (SED)." Serious Emotional Disturbance is a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely effects educational performance:

(i) An inability to learn that cannot be explained by intellectual, sensory or health factors;

(ii) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers;

(iii) Inappropriate behavior or feelings under normal circumstances;

(iv) A general pervasive mood of unhappiness or depression; and

(v) A tendency to develop physical symptoms or fears associated with personal school problems.

(j) "Serious Mental Illness (SMI)." Serious Mental Illness is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities.

Notes

048-47 Wyo. Code R. §§ 47-4

Adopted, Eff. 9/23/2019.