A: Femlisp has simplices and simplex-product cells. I.e. it has the interval in 1D, triangle and square in 2D, tetrahedron, prism, and cube in 3D, and so on for higher dimensions. It does not have pyramids. It would be rather easy to incorporate also those in the mesh module, but it is not clear to me how the construction should look like in higher dimensions.
A: Yes, it can handle more or less arbitrary refinement rules, especially anisotropic product-cell refinement is available.