Wyo. Code R. 048-0053-6
State Hospital
Chapter 6: Standards for the Designation of Hospitals
Effective Date: 10/30/2006 to 12/11/2006
Rule Type: Expired Emergency Rules & Regulations
Reference Number: 048.0053.6.10302006
(NOTE: For the 120 days the emergency rules are in effect, the following rules shall apply. Emergency rules are no longer in effect 120 days after filing with the Secretary of State).
This Chapter is promulgated by the Department pursuant to the Involuntary Commitment Act, 2006 Session, Enrolled Act No. 60, codified at W.S. 25-10-104 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.
(a) To establish standards for the designation of hospitals pursuant to W.S. 25-10-104.
(b) The Department may issue manuals, bulletins or both to interpret the provisions of this rule. Such manuals and bulletins shall be consistent with and reflect the policies contained in this rule and regulation. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this rule and regulation.
Terminology. Except as otherwise specified, the terminology used in this rule is the standard terminology used in the industry, and has the standard meaning used in accounting, healthcare, Medicaid and Medicare.
General Methodology. The Department reimburses designated facilities for covered services using specific charges agreed upon in the contracting process and pursuant to W.S. 25-10-112(d).
The incorporation by reference of any external standard is intended to be the incorporation of that standard as it is in effect on the effective date of this Chapter of this rule and regulation.
The following definitions shall apply in the interpretation and enforcement of this rule. Where the context in which words are used in this rule indicates that such is the intent, words in the singular shall include the plural and vice versa. Throughout this rule gender pronouns are used interchangeably, except where the context dictates otherwise. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender shall include individuals of the other gender.
For the purpose of this rule, the following shall apply:
(a) Active Treatment® means treatment as defined in 42 CFR 482.61 (c) Standard: Treatment Plan.
(b) Acute Care® means inpatient services provided to persons with mental illness having a short and relatively severe course.
(c) Admission® means that period of time in which a patient officially enters, or is admitted, to a hospital.
(d) Admission Certification® means the certification made pursuant to W.S. 25-10-109 (emergency detention) and/or Title 25-10-110 (involuntary hospitalization).
(e) CARF Accreditation® means accreditation according to the Commission on Accreditation of Rehabilitation Facilities.
(f) CMS Certification® means the certification process under the Centers for Medicare and Medicaid Services.
(g) Covered Services® means inpatient psychiatric services for individuals rendered pursuant to W.S. 25-10-104, W.S. 25-10-109 and W.S. 25-10-110.
(h) Patient® means an individual receiving treatment for a mental illness pursuant to W.S. 25-10-101 through 25-10-305.
(i) Department® means the Wyoming Department of Health.
(j) ADSM IV® means the current edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, which is incorporated by this reference.
(k) Emergency Detention® means the detention of a person pursuant to W.S. 25-10-109.
(l) Field Audit® means a visit to each designated hospital at least once a year to review services rendered to patients pursuant to W.S. 25-10-101 et seq.
(m) Financial Records® means all records, in whatever form, including financial reports, used or maintained by a facility in the conduct of its business affairs and which are necessary to substantiate or understand the information contained in the hospital cost reports or claims.
(n) Hospital® means an institution or a unit in an institution providing one (1) or more of the following to patients by or under the supervision of an organized medical staff, as indicated in the Rules and Regulations for Licensure of Hospitals, Chapter 12, Section 4, Definitions (m):
(i) Diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons;
(ii) Rehabilitation services for the mental health rehabilitation of injured, disabled or sick persons;
(iii) Acute care;
(iv) Psychiatric care;
(v) Swing Beds.
(o) Individual Written Plan of Care® means a written treatment plan that meets the requirements of 42 CFR 482.61.
(p) AICAHO® means the Joint Commission for the Accreditation of Healthcare Organizations.
(q) Medical Records® means all documents, in whatever form, in the possession of or subject to the control of the facility, which describe the recipient's diagnosis, condition and/or treatment.
(r) Medical Records Review® means the Department of Health, Wyoming State Hospital's review of the designated hospital's medical records and/or financial records, to determine:
(i) If the costs incurred by the designated hospital are reasonably related to the care furnished to the patient; and
(ii) If the care furnished to the patient was medically necessary for the specific treatment of the patient's psychiatric illnesses.
(s) Medicare® means the health insurance program for the aged and disabled established pursuant to Title XVIII of the Society Security Act.
(t) Physician® means an individual licensed under the laws of this state to practice medicine.
(u) Treatment® means diagnosis, evaluation, medication, therapy or prescribed care other than observation, supervision or discharge planning.
Section 5. Designated Hospital®. To be considered a designated hospital® a hospital must meet the following minimum requirements:
(i) Any hospital that meets the special provisions applying to psychiatric hospitals® as found in 42 CFR 482.60, as being qualified to treat persons with mental illnesses pursuant to W.S. 25-10-104.
(ii) General hospitals with specific inpatient psychiatric units, as well as free standing psychiatric hospitals, as being qualified to treat persons with mental illnesses pursuant to W.S. 25-10-104.
(iii) Hospitals that do not have a specific inpatient psychiatric unit, but which do have psychiatric services available and psychiatrist(s) as part of the medical staff, as being qualified to treat persons with mental illnesses pursuant to W.S. 25-10-104.
(iv) This rule also establishes standards to designate other licensed treatment facilities, limited licensed hospitals which have psychiatrist(s) available for consultation, as being qualified to treat persons with mental illnesses pursuant to W.S. 25-10-104.
To be accepted as a designated hospital or other treatment facility to enter into a contract with the Wyoming State Hospital, the hospital or facility must submit a letter of intent to the Wyoming State Hospital. Enclosed with the letter of intent must be the following documents:
(a) A copy of the hospital or facility’s license issued by the Wyoming Department of Health’s Office of Healthcare Licensing & Surveys;
(b) A copy of the hospital or facility’s most recent JCAHO or CARF accreditation certificate;
(c) Proof of Medicare certification; and proof of Medicaid certification.
Once verification of all documents has been completed by the Wyoming State Hospital, a letter of the decision as to the designation will be sent. If the hospital is accepted, a contract outlining the hospital or facility’s responsibilities with regard to accepting patients and providing treatment for persons with mental illnesses as defined in W.S. 25-10-109 and W.S. 25-10-110 will commence.
Recertification will be conducted annually and in the same manner as described above.
Continued contracts will be initiated by March 1 of each calendar year to commence by July 1 of each calendar year.
Designated hospitals shall provide reports to the Wyoming State Hospital detailing the services rendered to patients under these rules and pursuant to W.S. 25-10-101 et seq. These reports shall include, but are not limited to:
(a) Continued emergency detention. All medical records as well itemized billing statements for which the designated hospital is seeking payment from the Department of Health.
(b) Title 25 involuntary commitments. All medical records as well as itemized billing statements for which the designated hospital is seeking payment from the Department of Health.
(c) The designated hospital shall submit quarterly reports to the Wyoming State Hospital in the manner prescribed in the contract and/or compliance manuals.
(d) The designated hospital shall submit documentation of all efforts made to recover all costs of treatment from public and private health insurance, from patients, and from government benefit programs as required by W.S. 25-10-112(d).
The Wyoming Department of Health or its designee will conduct annual visits to designated hospitals to review compliance with these rules and with the respective contract entered into pursuant to W.S. 25-10-104(a)(iii), as well as to review methods of treatment for all patients with mental illness.
Payment for services rendered at designated hospitals and/or other licensed treatment facilities will be made pursuant to W.S. 25-10-112(d).
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and/or bulletins, which are inconsistent with this Chapter.
If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.