Wyo. Code R. 048 | Wyoming Administrative Rules 048 — Health, Department of

1439 988

Chapter 1 General Provisions

Wyo. Code R. 048.0082.1.02272026 § 1 Authority

The Wyoming Department of Health (Department) promulgates these Rules under 2023 Wyoming Session Laws chapter 70 and Wyoming Statute § 35-25-502(c)(ii).

History

Effective 2026-02-27

Wyo. Code R. 048.0082.1.02272026 § 2 Purpose and Applicability

(a) This Chapter allows for appropriate information sharing between and across crisis and emergency response systems for the purpose of real-time crisis care coordination including deployment of linked crisis services specific to the crisis response, the definitions of terms used in these Rules, the standards incorporated by reference, and other general provisions.

History

Effective 2026-02-27

Wyo. Code R. 048.0082.1.02272026 § 3 Definitions

(a) The following definitions apply to these Rules, unless otherwise specified:

(i) "988" means the designated three-digit dialing code that will route callers to the National Suicide Prevention Lifeline (NSPL) and a local 988 Center.

(ii) "988 Center" means a vendor in Wyoming that has been certified to answer calls, texts, chats, or other modalities from the NSPL. This term is equivalent to the statutory term "Crisis Center" or "Crisis Hotline Center." When interpreting and construing these rules, the term "988 center" is used in lieu of "Crisis Center" or "Crisis Hotline."

(iii) "Data" means the minimum information necessary to operate a 988 Center, the program, and respond to crises, excluding information used for technical assistance.

(iv) "Deidentified or Aggregate data" means data summarized across a population that cannot reasonably be linked to an individual.

(v) "Help Seeker" means an individual making contact with a 988 Center.

(vi) "National Suicide Prevention Lifeline" means the national network of local 988 Centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress in the United States twenty-four hours a day, seven days a week.

(vii) "Network Administrator" means the vendor selected at the federal level to administer the 988 network. When interpreting and construing these rules, the term "Network Administrator" is used in lieu of "Administrator."

History

Effective 2026-02-27

Wyo. Code R. 048.0082.1.02272026 § 4 Information Sharing

(a) The Network Administrator of the NSPL requires agreements with local 988 Centers in order to share information for the purposes of responding to crises. The information shared may include individually identifiable health information, collected or received by the 988 Center provided by the Help Seeker. The Network Administrator should treat Data as confidential and maintain the privacy and security of the Data in accordance with applicable Federal and State laws or regulations. The Network Administrator should only use or disclose Data as permitted or required by applicable law.

(b) The 988 Center shall treat Data as confidential and maintain the privacy and security of the Data in accordance with applicable Federal and State laws or regulations. The 988 Center shall only use or disclose Data as permitted or required by applicable law.

(c) The 988 Centers shall only disclose to the Department the minimum amount of Data necessary for public health reporting requirements. The public health reporting requirements shall be established federally by the Substance Abuse and Mental Health Services Administration and by the Department. The Department shall provide the reporting requirements to the Network Administrator and 988 Centers in grant documentation, such as grant guidance or requirements.

(d) The Department shall treat any Data received from or reported by the Network Administrator and 988 Centers as confidential and maintain the privacy and security of the Data in accordance with applicable Federal and State laws or regulations. The Department shall only use or disclose Data as permitted or required by applicable law.

(e) Mobile Crisis Teams may only use or disclose Data as permitted or required by applicable law.

(f) The Network Administrator may give the Department system access to publicly available Data for the use in public health reporting requirements.

(g) The advisory body may request de-identified data from the Department. When the advisory body requests Data including personally identifiable information, the Help Seeker shall provide authorization or the request will be denied. Under W.S. § 35-25-505, the Department may disclose de-identified or aggregate Data to the advisory body.

History

Effective 2026-02-27

Wyo. Code R. 048.0082.1.02272026 § 5 Incorporations by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these Rules:

(i) The Department has determined that incorporation of the full text in these Rules would be cumbersome or inefficient given the length or nature of the Rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at https://health.wyo.gov/behavioralhealth/mhsa/ and is available for public inspection and copying at cost at the same location.

(b) Each code, standard, rule, and regulation incorporated by reference in these Rules is further identified as follows. The Department incorporates by reference:

(i) Rules, Office of Administrative Hearings, General Agency, Board or Commission Rules, Ch. 2 (2017), which the Department refers to as the "OAH Contested Case Rules" under Chapter 2 of these Rules and may be found at: http://rules.wyo.gov.

History

Effective 2026-02-27

127 Aging Division

Chapter 1 General Provisions

Wyo. Code R. 048.0003.1.12052005 General Provisions

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 1

GENERAL PROVISIONS

Section 1. Authority. The Division, pursuant to W.S. 9-2-1208(c)(iv) is authorized to adopt rules and regulations governing programs and services for the elderly in the State of Wyoming, and the Wyoming Administrative Procedures Act at W.S. § 16-3-101 et seq.

Section 2. Applicability. These rules apply to all grantees/contractors under the Division.

Section 3. Purpose.

(a) The purpose of these rules is to establish standards for the delivery of services to the elderly, including program operations standards directly related to the quality of such services.

(b) The Department may issue manuals, bulletins, or both, to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

(c) 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.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicated that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules 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. Except as otherwise specified in this section, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, health insurance, Medicare, and Medicaid.

(a) "Adult Day Care" means a congregate setting providing care for older persons needing periodic supervision, with services aimed at maintaining and restoring health, nutrition, speech and physical therapy, and leisure activities.

(b) "Allowable Third Party In-Kind" means property or services which benefit a grant supported project and which are contributed by non-Federal third parties without charge to the grantee.

(c) "AoA" means the Administration on Aging within the United States Department of Health and Human Services, Washington, D.C.

(d) "Assess" means to conduct a periodic on-site visit to review the grantee/contractor.

(e) "At-risk" means a person unable to perform normal daily tasks independently due to multiple problems which can include, but are not limited to, physical, emotional, or cognitive functioning, environment, abuse and neglect.

(f) "Case-Management" means a set of logical steps and a process of interaction within a service network which assure that a client receives needed services in a supportive, efficient and cost effective manner.

(g) "Adult Home Care" means services designed to assist individuals in avoiding inappropriate or premature institutionalization through case management.

(h) "Congregate site" means the place where eligible participants are served meals and other services.

(i) "Contractor" means a recipient of funds under the Division with an approved contract to provide services.

(j) "Corrective steps" means action plan.

(k) "Discretionary Grant" means a grant for a specified service or program as provided for in the program announcement.

(l) "Division" means the Department of Health, Aging Division.

(m) "Elderly" means any person at least sixty (60) years of age.

(n) "Eligibility" means the guidelines whereby a grantee/contractor will be considered for funding or service under the Division.

(o) "Eligible entity" means an agency that can apply for designation as a planning or service area, which includes only 1) units of local purpose government, 2) regional metropolitan areas, and 3) Indian reservations.

(p) "Eligible participant" means anyone at least sixty (60) years of age or their spouse, except where more stringent requirements are specified.

(q) "Equipment" means items costing more than $500.00 or having the life expectancy of more than one year.

(r) "Evaluate" means to develop a written report based on monitoring and assessment of grants and contracts.

(s) "Feasible," in reference to special diets, means the availability of a dietitian or nutritionist to implement diets and adequate budgets to pay for such services.

(t) "Fee schedule" means guidelines related to the units of service and income category of the eligible participants to allow him or her to contribute to the project.

(u) "Grantee" means a recipient of funds under the Division with an approved grant to provide services.

(v) "Handicapped non-elderly" means a person under the age of sixty (60) who is handicapped as defined by 42 U.S. C.8003 (1978).

(w) "Home health care" means health services provided in the home by qualified individuals under medical supervision.

(x) "Homemaker" means trained personnel who provide assistance to older persons in the performance of home related activities, such as cooking or light housekeeping.

(y) "Hospice" means services provided to a terminally ill individual who remains at home with family.

(z) "Legal Assistance" means services provided by the Legal Assistance Developer Program.

(aa) "Legal Assistance Developer" means the statewide program which provides and develops legal assistance for the elderly.

(bb) "Long Term Care" means a continuum of care ranging from assisted independence in activities of daily living to institutionalization.

(cc) "Monitor" means to review program or fiscal reports as compared to the approved budget and service plan.

(dd) "Non-eligible meal participant" means a guest or staff person under age sixty (60) and not a spouse of a person age sixty (60) or more, eating a meal at a congregate site.

(ee) "Nutrition services" means congregate and home delivered meals and other nutrition services, including outreach and nutrition education provided to the elderly by grantees/contractors.

(ff) "Older Americans Act" means 42 U.S.C. 3001, et seq. (1965, as amended)

(gg) "Ombudsman" means an advocate responsible for handling complaints concerning institutional care facilities, boarding homes, adult day and home care agencies.

(hh) "Plan of action" means steps for corrective measures.

(ii) "Program Income" means financial contributions or fees paid by the clients and/or their families for services provided.

(jj) "RDA" means recommended dietary allowance.

(kk) "Regional Metropolitan Area" is a designation of several cities and/or counties or other geographic areas so stated in the description of each specific area.

(ll) "Respite care" means supervising or staying with older persons thereby permitting their family or other primary caregiver to have time free of the caregiving responsibility.

(mm) "Service provider" means a contractor or grantee.

(nn) "Sponsor" means the grantee or parent organization responsible for the terms of the grant.

(oo) "State Advisory Council" means the ten (10) members appointed by the Director of the Department of Health responsible to advise the Division.

(pp) "State plan" means a document promulgated by the Division, conforming with an established format of goals, objectives, budget and assurances prescribed by the AoA.

(qq) "Supplemental grant" means a grant to augment an existing program or service provision.

(rr) "Supportive Services" means any service that meets standards prescribed by the Assistant Secretary for Aging in the United States Department of Health and Human Services in Washington, D.C., as being necessary for the general welfare of elderly individuals.

(ss) "USDA" means United Stated Department of Agriculture.

(tt) "Units of general purpose local government" means any city council or county commission.

Section 5. Severability Clause. If any provision of these rules or the application to any program, person, service or circumstance is held invalid, such invalidity shall not affect the other provisions or applications thereof that can be given effect despite the invalid provision or application.

History

Effective 2005-12-05

Chapter 2 Aging Division Administration

Wyo. Code R. 048.0003.2.12052005 Aging Division Administration

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 2

AGING DIVISION ADMINISTRATION

Section 1. Compliance. The Division shall require that all grantees/contractors comply with the rules set forth herein.

Section 2. State plan. A state plan on aging shall be developed by the Division at the time specified in the Older Americans Act. The plan shall:

(a) Provide for a comprehensive and coordinated system for services as specified in the Older Americans Act.

Section 3. Division Records. Records shall be maintained as follows:

(a) Program, fiscal and personnel records shall be maintained in compliance with state and federal requirements and shall be housed in the Division office until such time as they are no longer needed for current management use.

(b) The Administrator of the Division shall designate a person who shall maintain and manage the Division records file.

(c) The records file will be reviewed annually by designated Division staff and a determination will be made if individual records are to be:

(i) Held at the Division; stored in Archives; or, destroyed.

(d) The Division shall notify all grantees/contractors of the date until which fiscal reports need to be retained by such grantees/contractors.

(e) If any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of a three year period, after an audit is closed, the records shall be retained until completion of the action and resolution of all issues that arise from it, or until the end of this regular three year period, whichever is longer.

(f) All grantees/contractors shall document record retention from the designated date, in accordance with Section 4(a) - (e).

Section 4. Hearing Process - Appeal.

(a) The Division shall provide an opportunity for a hearing for:

(i) An eligible entity applying for designation as a planning and service area whose application has been denied.

(ii) An eligible entity whose application for designation as a planning and service has been approved, but the designation of an area agency on aging has been withheld by the Division.

(iii) A grantee/contractor who was providing nutritional services under the Older Americans Act before 1978, and whose application has been denied.

(iv) Any other grantee/contractor whose application to provide services has been denied.

(v) A grantee/contractor under termination, suspension, reduction of funds, or audit exception by the Division for failure to comply with the terms of the grant or contract.

(vi) An individual after exhaustion of the local hearing process, if:

(A) The individual believes that he or she has been denied a service that is available under the grant/contract because the local policy is stricter than the federal or state law or policy covering either the service or eligibility; and

(B) The individual has already requested and been denied a hearing from the grantee/contractor; or

(b) If an eligible entity, grantee/contractor or individual seeks a hearing because of any Division action taken pursuant to Section 4 (a) (i)-(vi) of this Chapter, the individual, grantee/contractor, or eligible entity must:

(i) Submit a written request to the Division not later than thirty (30) calendar days following the receipt of notice of action taken by the Division or grantee/contractor, pursuant to Section 4(a)(i)-(v). The written request must include, as a minimum:

(A) A statement of the action taken by the grantee/contractor or Division;

(B) An outline of the reasons for questioning the action taken by the grantee/contractor or Division; and

(C) A summary statement of any new or unique situations occurring after the determination was made that could have an impact on the decision.

(i) Notify all parties of the time, date and place of the hearing, which shall be set not later than ninety (90) days after the receipt of the request for the hearing;

(ii) Appoint an impartial hearing officer;

(iii) Enter an order within fifteen (15) days of the hearing, based upon findings of fact and conclusions of law, prepared by the impartial hearing officer; and

(iv) Send written notification of the order to all parties by certified mail.

(d) The Contestant shall:

(i) Present his/her arguments refuting the basis for the denial of service area, designation, or approval of a grant or contract.

(ii) Have an opportunity to be represented by legal counsel or any other representative of their choosing;

(iii) Have an opportunity to present witnesses and evidence and to question the witnesses and evidence offered by the Division.

(iv) Provide to the Division access to the individual's, grantee's or eligible entity's records containing information not yet submitted to the Division, but relevant to the contested action; and

(v) Provide to the Division an opportunity to question the witnesses and evidence offered by the contestant.

(e) The Division may terminate formal hearing procedures at any point if the Division and the contestant negotiate a written agreement resolving the issue(s) that led to the hearing, or when the contestant withdraws, in writing, his/her request for a hearing.

(f) If the proposed action would suspend or terminate the contract, grant or services already being provided to the contestant, funding or provision of services shall be continued until an order is entered by the Division.

(g) Payment provided to the contestant while the decision is under appeal will be repaid to the Division or grantee by the contestant within thirty (30) days after a Division order finding against the contestant has been entered.

Section 5. Public Hearings - Public Notice.

(a) The Division shall hold at least one public hearing in the state on a New State Plan.

(i) The public hearing shall include:

(A) Forty-five (45) days public notice of time and place in at least one (1) newspaper of statewide circulation;

(B) Access to information upon which the meeting is being held; and

(ii) A written summary of review and comments received at the public hearing shall be kept on file at the Division.

(b) The Division shall give public notice as prescribed by the Secretary of State, of new rules or changes in current rules and regulations.

Section 6. Monitoring, Assessing, Evaluating of and Technical Assistance to Grantees and Contractors.

(a) The Division shall monitor, assess, evaluate and provide technical assistance to grantees/contractors as specified below:

(i) Monitoring: The Division will review and analyze required monthly and quarterly program performance reports and fiscal reports.

(A) The Division staff will periodically conduct an on-site review of each grantee to evaluate individual client records and reports, and to ensure that:

(I) Services to individual clients are being provided as requested on the intake form;

(II) Services are received according to each client's functional status;

(III) Each client's physical and emotional well-being and safety are being taken into consideration;

(IV) Care plans, contracts, and service agreements are followed as specified; and

(V) Quality of life and of care is assured in each individual case, consistent with an approved plan and funding.

(ii) Assessing: The Division will annually conduct an on-site review of each grantee to compare objectives and budgets with performance reports and annualized expenditures, in compliance with the terms of the grant.

(A) A written report will be sent to the grantee within thirty (30) days of the on-site review.

(iii) Evaluating: The Division will annually evaluate program and fiscal year- end performances of each contract by:

(A) Requiring a written close-out report of each objective in the grant sixty (60) days after the end of the fiscal year; and

(B) Reviewing the fiscal reports for the year with the close-out report, to ensure that they are in compliance with the terms of the grant.

(iv) The Division will provide expertise to grantees/contractors through on-site visits, telephone calls, written correspondence or other material, in-office visits, referrals, training or research if:

(A) Requested; or

(B) Compliance issues indicate corrective action is needed; or

(b) If deficiencies or non-compliances are found, the Division will:

(i) Work with the grantee to determine the corrective steps and/or plan of action to be taken by the grantee;

(ii) Develop a written plan of action and/or corrective steps to be completed by a mutually agreed upon date, not later than ninety (90) days from the date of the agreed upon plan of action; and

(iii) Reassess or re-evaluate the grantee by at least the next annual assessment or evaluation, whichever comes first, for compliance with the plan of action.

Section 7. Review and Comment. The Division shall review and comment on all state plans, budgets and policies affecting the elderly by the following:

(a) The Division will develop procedures, in cooperation with appropriate State agencies, to receive for comment state plans, policies, budgets, and applications that may affect the elderly in Wyoming.

(b) Copies of comments will be sent to the entities developing such state plans, policies, and budgets affecting the elderly.

Section 8. Interagency Agreements. The Division will develop, and update periodically, interagency agreements regarding services for the elderly by the following:

(a) Developing current and projected coordinated activities at the state and local level by identifying services affecting the elderly;

(b) Reviewing the agreements at state and local levels for compliance with the terms of the interagency agreement; and

(c) Submitting proposed agreements, memoranda of understanding or similar undertakings, to the State Planning Coordinator's Office for clearance before execution and implementation thereof.

Section 9. Confidentiality. Records of the grantee/contractor pertaining to any client and/or person making a client referral under any program shall be kept confidential.

Section 10. Liability. Each grantee/contractor shall assure that liability for the service provided is insured through maintenance of a liability insurance policy or through a subcontract thereof.

Section 11. Public Meetings. The Division on Aging Advisory Council meeting will be open to the public.

History

Effective 2005-12-05

Chapter 3 Planning and Service Areas

Wyo. Code R. 048.0003.3.12052005 Planning and Service Areas

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 3

PLANNING AND SERVICE AREAS

Section 1. Designation. The Division shall divide the state into planning and service areas in the following manner:

(a) Applications for designation as a planning and service area shall be submitted to the Division only by officials of an eligible entity.

(b) The application must include a description of the following:

(i) The geographical region, population and number of elderly persons in the geographical region proposed for designation as a planning and service area;

(ii) How the administration of the proposed planning and service area will be more efficient and cost effective than the present single planning and service area administered by the Division;

(iii) The system by which services will be delivered in the proposed planning and service area; and

(iv) The budget for the administration of the proposed planning and service area.

(i) At the first quarterly meeting of the Advisory Council all applications will be considered.

(ii) Each application will be assigned to a subcommittee of council members, which shall evaluate the application by:

(A) Conducting an on-site evaluation/assessment of the management capabilities of the applicant, based upon an evaluation report submitted by the Division staff which includes fiscal and program performance reports of the applicant; and

(B) Formulating results of the on-site assessments into a written report of the subcommittee findings.

(iii) Copies of the subcommittee's written report and the original application will be disseminated to the full Council at the second quarter meeting.

(iv) The application will be considered for approval at the Advisory Council meeting during the third quarter.

(A) If approved, the report and application will be forwarded to the Division Administrator, the Director of the Department of Health, and the Governor for final approval.

(B) The applicant shall be notified within 30 days after the third quarter meeting of the Council, by certified mail, of the recommendation and/or approval.

(C) If the application is not approved by the Advisory Council at the third quarter meeting, the applicant will be notified of denial by certified mail within 30 days of the meeting.

(v) If the recommendation is to approve the application, legislation will be drafted, and the state plan will be amended, to provide for multiple planning and service areas in the state.

(vi) If the application is denied, the applicant may request an administrative hearing under Chapter 2, Section 4.

Section 2. Designation of an Area Agency on Aging.

(a) The Division shall designate an area agency on aging only after an approved planning and service area has been designated, as explained in Section 1.

(b) Application for designation as an area agency on aging must include, at a minimum:

(i) Name, address and telephone number of the applicant;

(ii) A description of the proposed area agency's methods for carrying out its functions and responsibilities under the Older Americans Act;

(iii) Written testimony of the units of general purpose local government within the planning and service area;

(iv) Written testimony of the local senior citizens boards of directors, advisory boards and project directors which are within the planning and service areas and are funded under the Division;

(v) A proposed staffing plan that identifies the number and types of staff assigned to carry out area agency responsibilities and functions; and

(vi) A proposed budget for services and administration for two (2) succeeding years of operation.

(i) Conduct an on-site assessment to determine whether the applicant has the capacity to perform all of the functions of an area agency, which will include:

(A) Review of fiscal and program performance records of the applicant; and

(B) Preparation of a written report on the finding to be disseminated to the Division Administrator and Advisory Council.

(d) The Division will act within sixty (60) days of receiving this report to approve or deny the application based on the written report and the recommendations of the Administrator and the Advisory Council. Notification to the applicant of the decision for designation will be made by certified mail within thirty (30) days of this decision.

(e) If an application is denied, the applicant may request an administrative hearing under Chapter 2, Section 4.

History

Effective 2005-12-05

Chapter 4 Older Americans Act Programs

Wyo. Code R. 048.0003.4.12052005 Older Americans Act Programs

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 4

OLDER AMERICANS ACT PROGRAMS

Section 1. General Provisions.

(a) Responsibilities of grantees include:

(i) Administration of grant in accordance with these Rules and Regulations and the Older Americans Act.

(b) Non-eligible participants' fees for services and meals:

(i) Non-eligible participants shall pay the cost for services as established by the grantee and approved by the Division.

(A) Failure to make such payment will result in termination of service provision.

(ii) Non-eligible participants shall pay the cost for meals as follows:

(A) Staff and guests under age sixty (60) may consume a meal only when it will not deprive an eligible older person of an opportunity to receive a meal. These individuals are required to pay the full cost of any meal received.

(I) The required fee for the meal will be established annually by the Division.

(B) Payment for non-eligible participants will be documented.

(C) Failure to make such a payment or to be documented by the grantee for non-eligible participants' meals will result in termination of the meal provision.

(iii) Grantees may offer a meal to nutrition services staff who directly produce the meals (i.e., cooks, cooks-helpers, dishwashers, bakers, can consume a meal at no-cost to them) as a non-taxable benefit.

(iv) Grantees may offer a meal to staff members involved in the delivery of meals (i.e., bus drivers that deliver home delivered meals and who are under sixty (60) may eat a meal) for the charge of the state average raw food cost.

(v) Grantees may offer a meal to the director or site manager who is responsible for the management of the program for the charge of the state average raw food cost.

(vi) Grantees may offer a meal to individuals providing volunteer services during the meal hours by giving the volunteer an opportunity to donate for the meal. Each Final Rule September 2005 grantee shall define the volunteers eligible for the meal. If the volunteer is over 60, he/she shall be counted as an eligible participant. If under the age of 60, donations shall be included in program income.

(vii) Grantees may offer a meal to other staff (i.e., bookkeeper, secretary, nurse, homemakers, and outreach workers) for the amount of the guest charge.

(viii) Grantees may offer a meal to children under the age of 12 accompanying their grandparents to the nutrition site for the charge of the state average raw food cost.

(ix) Grantees offering a meal to handicapped individuals under the age of sixty (60) will be charged according to eligibility criteria in Section 1.

(c) Program income generated by a grantee will revert to the grant fund as prescribed in the Financial Management and Accounting System of the Division.

(i) Such income shall be expended first, followed by federal, state and local funds utilizing the match requirements in Chapter 5, Section 8.

(d) Intake form:

(i) Each grantee shall record the following intake information at each site for each elderly individual:

(A) Participant's name, address and telephone number;

(B) Date of birth; if not known, estimate of age;

(D) Name, address, telephone of person to contact in case of emergency;

(E) Handicaps, or conditions, of which staff should be aware;

(F) Potential supportive service needs expressed by the participant and/or identified by staff;

(G) Race;

(H) Gender;

(I) Special dietary needs; and

(J) Information regarding income (e.g., is personal income over or under current poverty guidelines).

(ii) The personal record shall be obtained and kept in accordance with the following:

(A) Participants will be informally interviewed by appropriate staff Final Rule September 2005 person within four (4) weeks after they have begun receiving nutrition or social services.

(B) Personal information obtained from the interview shall be kept confidential and shall be released only with the prior written consent of participant. (A release of information form shall be developed by the Division.)

(iii) Personal record information will not be used as a pre-requisite to program participation. If participant refuses to provide any part of information requested, this will be recorded on the in-take form.

(e) Community focal points: A community focal point shall be identified in all grants, contracts, and agreements. A facility so designated must, at a minimum:

(i) Be open five (5) days a week, Monday-Friday; between 10:00 A.M. and 2:00 P.M.;

(ii) Provide information and assistance service;

(iii) Primarily provide services for the elderly; and

(iv) Preference for designation will be given to facilities that serve a meal.

(f) Contributions for meals and services:

(i) Each grantee must:

(A) Provide each older person with an opportunity to contribute voluntarily to the cost of the meal or service;

(B) Protect the privacy of each person with respect to these contributions;

(D) Use all nutrition services' contributions only to expand or improve these services under Section 3; and

(E) Develop a suggested contribution schedule for services and meals provided;

(I) Income ranges must be considered in the development of the schedule.

(II) A means test may not be used.

(ii) A grantee that receives AoA funds shall not deny any older person meals or services because the older person will not or can not contribute the cost of such meals or services.

Section 2. Supportive Services and Senior Centers.

(a) Supportive services which shall be considered for funding include:

(i) Health services, outreach, in-home services, caregiver training, education and training, information, assistance, recreation, counseling and referral services;

(ii) Transportation services to facilitate access to supportive and/or nutrition services;

(iii) Services designed to inform, encourage, and assist older individuals in accessing and utilizing the services and facilities available to them; and

(iv) Services designed to:

(A) Assist older persons with obtaining adequate housing, including residential repair and renovation projects designed to enable older individuals to maintain their home in conformity with minimum standards of safety;

(B) Adapt homes to meet the needs of older individuals with physical disabilities;

(C) Prevent unlawful entry into residences of elderly individuals, through installation of security devices or structural modifications;

(D) Assist older persons in avoiding institutionalization and in returning them to their communities;

(E) Counsel the elderly regarding legal, health and insurance issues and concerns;

(F) Enable older individuals to attain and maintain physical and mental well-being through programs of regular physical activity and exercise;

(G) Provide pre-retirement and second career counseling for older individuals;

(H) Provide health screening to detect or prevent illnesses that occur most frequently in older individuals;

(I) Meet the unique needs of older disabled individuals;

(J) Promote crime prevention and participation in victim assistance programs;

(K) Prevent abuse, neglect or exploitation of older individuals;

(L) Enable mentally impaired older individuals to attain and maintain emotional well-being and independent living through a coordinated system of support services;

(M) Provide facility in-service training and staff development; and Final Rule September 2005

(N) Develop and provide any other services which meet the standards prescribed by the Division and are necessary for the general welfare of older persons.

(b) Grantee will provide services with emphasis based on the following target populations:

(i) Provision of basic care for an eligible older person who is "at risk" of institutionalization;

(ii) Services targeted to meet the needs of elderly of greatest economic need;

(iii) Services targeted to meet the needs of elderly of greatest social need; and

(iv) Services targeted to meet the needs of minority elderly, with emphasis on low income minorities.

Section 3. Nutrition Services.

(a) Nutrition Responsibilities of State Aging Division:

(i) The Division will perform the following nutrition duties with the advice of a dietitian or an individual with comparable expertise:

(A) Assist in planning nutrition services;

(B) Coordinate nutrition services; and

(ii) The Division, when selecting a home-delivered meal provider, will consider the use of organizations which have demonstrated the efficient provision of home- delivered meal services.

(b) Eligibility and delivery of Congregate Meal Service:

(i) Congregate meals may be served to individuals who are:

(A) Sixty (60) years of age or over;

(B) The spouse (who may be less than sixty (60)) of an eligible participant;

(C) Handicapped/disabled less than age sixty (60) who reside in housing facilities occupied primarily by older individuals at which congregate nutrition services are provided;

(D) Disabled and who reside in a noninstitutional household with an older eligible participant and accompany the older participant to the meal site; or Final Rule September 2005

(E) Volunteers who are not sixty (60) years of age and provide services during the meal hours for the nutrition project.

(ii) Congregate meal sites shall comply with the following:

(A) Nutrition projects will be established and administered with the advise of a dietitian or an individual with comparable expertise, person competent in the filed of service in which the nutrition project is being provided, older participants, and other persons knowledgeable of older individuals' needs.

(B) Congregate meal sites will provide comprehensive supportive services in close proximity to the majority of eligible participants' residences as feasible, with particular attention upon a multipurpose senior center, a school, a church, or other appropriate community facility, preferably within walking distance where possible, and where appropriate, transportation to congregate meal sites is furnished.

(C) Grantees will administer, annually, a survey to formally assess the recipients satisfaction with food quality and delivery. Surveys will be kept on file by the grantees.

(i) Home delivered meals may be served to individuals who are:

(A) Sixty (60) years of age or over;

(B) The spouse (who may be less than age sixty (60)) of an eligible participant;

(D) Disabled and who reside at home with an older eligible participant.

(ii) The Division will develop nonfinancial criteria for eligibility to receive home delivered meal services and will periodically evaluate older participants of home delivered meal service to determine their continued eligibility.

(iii) Grantees/contractors demonstrating the ability of furnishing home- delivered meals efficiently and reasonably, shall be given consideration, where feasible. Home- delivered meals grantees/contractors shall maintain efforts to solicit voluntary support.

(iv) Grantees/contractors are required to provide home delivered meals to persons meeting the eligibility criteria established through an assessment form provided by the Division.

(A) Grantee/contractors shall make eligibility criteria available to all potential referral agencies, physicians and the general public.

(B) Grantees/contractors shall make eligibility determinations within five (5) working days of the initial request for home delivered meals. Meals will be delivered Final Rule September 2005 while determination is being made.

(C) Grantees/contractors or outreach workers will work with the recipient to determine if additional services are needed.

(D) Participants denied home delivered meals or who lose eligibility shall, upon written request, be granted an administrative hearing (in accordance with Chapter 2, Section 4.).

(E) Grantees/contractors will make arrangements for the availability of home delivered meal services to older persons in weather-related emergencies.

(v) Packaging and delivery of home delivered meals. Home delivered meals are required to be packaged and delivered in a manner that will maintain food safety by the following:

(A) Hot foods shall be delivered at 140 degrees F or higher. Cold foods shall be delivered at 45 degrees F or colder. Hot and cold foods shall be packaged separately.

(B) The time period between the end of cooking the food and delivery to the individual recipient shall not exceed two and one-half (2½) hours.

(D) Each grantee shall provide food safety information to the individual recipient. This may take the form of a handout or may be given verbally, and shall include washing hands before meals, eating the meals immediately upon receipt and refrigerating leftovers.

(E) Grantees will administer, annually, a survey to formally assess the recipients' satisfaction with food quality and delivery. Surveys will be kept on file by the grantees.

(d) Menu development:

(i) All menus served by the grantees, will provide hot or other appropriate meals and shall comply with the Dietary Guidelines for Americans, published by the Secretary of Agriculture.

(ii) A minimum of thirty-three and one-third percent (33-1/3%) of the Daily Recommended Dietary Allowances (RDA) must be provided by each project if providing one meal per day;

(iii) A minimum of sixty-six and two thirds percent (66-2/3%) of the RDA must be provided by each project which provides two meals per day; and

(iv) A minimum of one hundred percent (100%) of the RDA must be provided by each project which provides three (3) meals per day.

(v) The established meal pattern will be:

3 oz. of meat or meat alternative

2 (½ cup) servings of fruit and vegetables

1 serving of enriched bread or bread alternative

1 tsp. of low fat margarine

1 cup of low fat milk ½ cup serving of dessert

(vi) All menus must meet this meal pattern as a minimum.

(vii) Grantee directors may choose from Division approved menus or hire a local dietician or nutritionist to develop menus that meet the requirements of the Division. These menus shall be arranged into monthly menus and forwarded to the Division at least two (2) weeks prior to service to participants.

(viii) The Division shall review the menus and return comments to grantees prior to service. If meals contain deficiencies, grantees shall modify menus in accordance with the Division's comments in order to correct all deficiencies.

(ix) A copy of menus from each grantee shall be kept by the Division for a period of one (1) year.

(x) A copy of each month's menu shall be posted in a conspicuous place at each congregate site by the grantee.

(xi) Grantees shall maintain portion controls which follow the established meal pattern. Buffet style service is not an acceptable means of maintaining portion control.

(xii) Grantees shall use standardized recipes to assure consistent quality and quantity of the meal served.

(xiii) Grantees shall limit the substitution of foods on the monitored menus to those approved by the Division. Proper food purchases should be made, in advance, to reflect items on the menu.

(xiv) Meals are to be provided five (5) or more days a week, except where not feasible in rural areas. When meals are served less than five (5) days per week, prior approval must be obtained from the Division.

(e) Contribution of Food to Nutrition Projects:

(i) All food contributed to a grantee for use in meals provided by a project financed by federal or state funds shall be required to meet those standards of quality, sanitation and safety that apply to foods that are purchased commercially by the project in the following manner:

(A) Home canned or preserved foods shall not be accepted.

(B) Foods cooked or prepared in an individual's home shall not be accepted as meals providing one-third of RDA. Final Rule September 2005

(D) Donated wild game meat shall not be accepted; (State of Wyoming, food service code, Chapter III, Section 1, paragraph (a)).

(E) Grantee/contractor may only accept donated domestic animals that are state inspected meat products.

(F) Fruits and vegetables grown in personal gardens may be accepted if:

(I) They have been picked within the previous 24 hours.

(II) They are thoroughly washed to remove pesticides or herbicides that may have been used by the gardener.

(f) Sanitation & Food Safety:

(i) Grantees/contractors shall comply with all State and Local sanitation laws regarding food, safe and sanitary food handling, food storage, food preparation, food service equipment, supplies, and meal delivery.

(ii) Grantees/contractors shall provide the Division, Nutrition Program Manager with a copy of their sanitation inspection report.

(iii) Grantees/contractors shall substitute the words "hair net" for each reference to "hair restraints" in the Wyoming Food Service Regulations.

(g) Contributions:

(i) Home delivered meal organizations shall demonstrate an ability to provide home delivered meals efficiently and reasonably; and shall maintain efforts to solicit voluntary support and that OAA funds are not to be used to supplant funds from non-Federal sources.

(ii) Nutrition projects shall solicit voluntary contributions which may include food stamps.

(iii) Nutrition projects shall use contributions:

(A) To increase the number of meals served;

(B) To facilitate access to such meals; and

(iv) The privacy of each person's contribution shall be protected.

(v) Each project shall establish procedures to safeguard and account for all contributions. Final Rule September 2005

(h) Cash Assistance USDA Program:

(i) The Division has elected to receive cash assistance from United States Department of Agriculture (USDA) and shall administer the USDA cash-in-lieu program by the following:

(ii) The Division shall administer the USDA cash-in-lieu of commodities program to grantees who have received a "notification of grant award" to provide nutrition services to the elderly; and the Division will promptly and equitably disburse cash for the provision of eligible senior meals as follows:

(A) Authorizing and forwarding reimbursement amounts monthly to each grantee which shall be based on the number of meals served to eligible participants during the period.

(B) Grantees receiving cash-in-lieu of commodities must spend the cash by buying food produced and packaged in the United States or by purchasing contracted meals. Cash shall be sent to the grantees upon receipt of notification of cash authorization from USDA;

(C) The Division will provide final reimbursement claim of eligible meals, when USDA provides the adequate funding, within 90 days after the last day of the quarter for which reimbursement is claimed. Final reimbursement claims shall be adjusted to use the full amount appropriated by USDA.

(D) The Division will not reduce nutrition grants to reflect any USDA increase in the level of assistance.

(E) Grantees shall maintain a separate accounting of the cash-in-lieu funds and provide Division with a monthly food and production sheet with accompanying documentation of cash-in-lieu purchases.

(iii) Cash payments from USDA will be provided to nutrition projects that are in compliance of the rules and regulations administered by the State Unit on Aging. Nutrition projects not providing the correct eligible meal counts within ninety (90) days after the last day of service shall not be reimbursed for these eligible meals.

(i) Therapeutic Diets and Menus:

(i) Therapeutic diets and menus shall be provided in accordance with Section 3, (b) & (c), where feasible and appropriate, to meet the particular dietary needs arising from health requirements, religious requirements, or ethnic backgrounds.

(ii) For participants who have a physician's order, therapeutic diets shall be available, as feasible, in accordance with the following:

(A) Such participant shall have in his/her file a physician's order for the specified diet. If a written order cannot be obtained, verbal approval from the physician, documented by the director's/dietician's signature, will be acceptable.

(B) Such participant receiving a therapeutic diet and needing medical nutritional therapy shall be interviewed by a dietitian or nutrition professional responsible for planning the diet. Reassessment of need shall occur at minimum of every six (6) months and a current diet prescription shall be on file.

(j) Leftovers:

(i) Each grantee shall reduce the number of leftover meals to be no more than 5 percent of the total number of meals ordered or prepared per day.

(ii) No food shall be taken home by staff. Fresh fruit is the only food that may be taken home by participants.

(k) Outreach:

(i) Each grantee/contractor shall establish outreach activities which will assure maximum numbers of eligible participants.

(l) Nutrition Education:

(i) Grantees shall make available to all meals program participants in the congregate and home delivered meals program nutrition education targeted to those with nutritional risk and achieving optimum nutritional status, taking into account ethnic preferences, cultural factors and geographical and environmental limitations, and shall:

(ii) Provide a system of feedback from program participants regarding topics to be included in nutrition education;

(iii) Provide, through a dietitian or nutrition professional, the following:

(A) Group nutrition education programs on at least a semi-annual basis;

(B) Upon request, in-depth, one on one nutrition counseling; and

(iv) Maintain records of all group presentations, nutrition screening, and of one-on-one counseling.

(m) Food Stamps:

(i) Grantees shall assist all participants who desire food stamps to apply for such assistance and provide the opportunity for participants to use food stamps as their contribution toward the cost of the congregate and home delivered meal as follows:

(ii) Obtain authorization from the Division to accept food stamps;

(iii) Give a presentation on food stamp eligibility and application criteria at each congregate meal site at least twice during the budget period; and

(iv) Give written information on food stamp eligibility and application criteria to home delivered meal participants at least twice during the budget period.

(n) Information and Referral:

(i) Grantee/contractors will provide information and referral assistance, when necessary, to eligible meal participants.

Section 4. Long Term Care Ombudsman. The Division shall establish a long term care ombudsman program pursuant to W.S. 9-2-1301 through 9-2-1309 (2005) (1986 cum.supp).

(a) Definitions:

(i) "Complaint" is a concern brought to, or initiated by, the ombudsman for investigation and action:

(A) On behalf of one or more residents; and

(B) Relating to health, safety, welfare or rights of a resident.

(ii) "Consultation" is providing information and assistance to an individual or a facility.

(iii) "Long term care service" means any service, provided by an assisted living facility, adult day care facility, boarding home, home health agency, hospice, hospital swing bed, nursing care facility, personal care agency, or other type of service subject to regulation, certification or licensure by the Department, but not including habilitative care.

(iv) "Older Americans Act" means the federal Older Americans Act, as amended.

(v) "Resident" means any adult who is receiving a long term care service.

(b) Responsibilities of the Long Term Care Ombudsman include:

(i) In vestigation, advocacy and mediation on behalf of adults applying for or receiving long term care services to resolve complaints concerning actions or inactions that may adversely affect resident's health, safety, welfare, or rights and that do not involve determination of compliance for maintaining a license or certification;

(ii) Monitoring the development and implementation of federal, state and local laws, regulations and policies with respect to long term care services in the state;

(iii) Establishment of a statewide uniform reporting system to collect and analyze data relating to complaints and conditions in long term care facilities for the purpose of identifying and resolving significant problems, with provision for timely submission of such data to the state agency responsible for licensing or certifying long term care facilities and to the Division;

(iv) Providing information to public agencies about the problems of residents receiving long term care services and;

(v) Referring all complaints which involve conditions, actions or omissions which are reportable to Adult Protective Services pursuant to WS 35-20-101 through 35-20-116.

(i) The ombudsman shall conduct an appropriate inquiry into all complaints and shall notify any provider of a long term care service affected by the inquiry.

(ii) In conducting an inquiry, the ombudsman shall engage in appropriate actions including:

(A) Making inquiries of affected parties or those with the knowledge of matters necessary to establish, deny or resolve the complaint;

(B) Entering, at any reasonable time, the facility of a provider of any long term care service subject to regulation, certification or licensure by the Department; and

(iii) Any inquiry which requires the inspection of or obtaining of medical records or other resident records which are pertinent to the inquiry shall comply with all established privacy notification requirements.

(d) Resolution of complaints:

(i) The ombudsman shall attempt to resolve the complaint using mediation and negotiation whenever possible.

(ii) Following an investigation, the ombudsman shall report the findings and recommendations to the resident or the resident's guardian and may report the findings to any other entity deemed appropriate.

(iii) The provider of the long term care service complained against shall have

a reasonable opportunity to respond to the complaint.

(iv) If the problem seriously threatens the safety or well-being of a resident, the ombudsman shall refer the complaint to an appropriate agency.

(e) Retaliation. No person shall discriminate against any resident, relative or guardian of a resident, employee of a long term care service provider, or any other person because of making a complaint or providing information, in good faith, to the ombudsman.

(f) Grant applications and reports will be submitted annually in accordance with the specifications set by the Division.

Section 5. Legal Assistance. The Division shall establish a legal service network through the Legal Assistance Developer Program to provide and coordinate legal assistance to and in behalf of the elderly, including entitlement, insurance, and pension counseling, in accordance with the Older Americans Act.

(a) Grants and objectives will be submitted annually based on Division guidelines.

History

Effective 2005-12-05

Chapter 5 Grant Apps/Contracts under Older Americans Act

Wyo. Code R. 048.0003.5.12052005 Grant Apps/Contracts under Older Americans Act

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 5

GRANT APPLICATIONS/CONTRACTS UNDER THE OLDER AMERICANS ACT

Section 1. Public Notice to Accept Grant Applications/Contracts.

(a) The Division will provide written notice no later than April 30 on the process for accepting grant applications funded under the Older Americans Act covering a project period beginning October 1 through September 30 of the following year, which shall include:

(i) Thirty (30) days public notice of the process in at least one newspaper with statewide distribution; and.

(ii) Information regarding the submission of a letter of intent to make application.

Section 2. Letters of Intent.

(a) Letters of Intent shall be postmarked no later then May 30 of each year prior to the project period.

(b) Letters of Intent shall include at a minimum:

(i) Name, address and telephone number of Administrator of the Division;

(ii) Types of proposed services to be provided;

(iii) Type of funding source requested; and

(iv) Board chairman's signature.

Section 3. Grant Applications.

(a) Grant applications shall include at a minimum:

(i) The Division approved grant format with original notarized signature of the project board chairman on cover page;

(ii) Supporting budget pages and budget breakout according to the Division of Financial Management and Accounting Systems Manual;

(iii) Narrative including:

(A) Description of history and physical facilities of applicant agency and sites;

(B) Operation of project including services to be provided and an outline of services that will be coordinated through other agencies;

(C) Administration of project including staffing patterns, role of volunteers, and responsibilities of Board of Directors; and

(D) Project area geographic and demographic information including population, total number of elderly plus numbers of low income, minority and socially disadvantaged elderly.

(iv) Objectives shall be completed according to the guidelines provided by the Division.

(v) Appendices to the grant application shall include:

(A) Signed original contracts;

(B) An organizational chart of grantee agency;

(D) A map of proposed geographic area;

(E) Hearing appeals process for organization;

(F) Signed assurances as prescribed by the Division, in compliance with 42 U.S.C. 2000a (1964);

(G) Letters of support from local government agencies;

(H) Job descriptions for both paid and volunteer positions;

(I) Copy of public notice and minutes of public hearings on the proposed grant; and

(J) List of holidays to be observed and proposed method for providing meals not served due to holiday closure.

Section 4. Approval or Denial of Grant Applications.

(a) Grant applications will be received by the Division by July 30 of each year, for the project period to begin October 1.

(i) Grants postmarked after July 30 will not be accepted.

(b) Each application will be reviewed by the Division according to the following criteria:

(i) The grant shall be complete and accurate.

(ii) The grant shall meet the needs of the elderly in the proposed service area.

(d) If denied, the applicant agency will be informed of its right to an administrative hearing under Chapter 2, Section 4.

Section 5. Amendments to Grant Applications.

(a) A proposed amendment to an approved grant shall be submitted in writing by the applicant agency. If the amendment is approved, the Division will issue a revised Notification of Grant Award and the amendments shall be deemed incorporated into and become part of the terms of the grant.

Section 6. Contract Application.

(a) Contracts will be submitted in compliance with requirements of the Division and the Wyoming Attorney General's Office.

(b) Approval or Denial of Contracts:

(i) Contracts will be received by the Division from June 15 through July 30 of each year, to be processed for the project period beginning the following October 1.

(ii) Contracts will be reviewed by the Division according to the following criteria:

(A) Contract is complete and accurate.

(B) Contractor is the most appropriate provider in terms of cost effectiveness, access to the client, and quality of services provided.

(iii) If approved, the contractor will be notified by the Division.

(iv) If denied, the contractor will be informed to its right to an administrative hearing under Chapter 2, Section 4.

Section 7. Funding Formula. The Division shall develop and provide information on the anticipated funding level for the project period.

(a) Supportive services will be funded based, on but not limited to, such factors as:

(i) The number of elderly persons the grantee has served in the previous project period;

(ii) A base allocation;

(iii) The number of low-income elderly persons served in the previous period by grantee;

(iv) The number of minority elderly persons served in the previous grant period served by grantee; and

(v) Percentage of federal funds with which the geographic area was provided in the previous project period.

(b) Nutrition services will be funded based on, but not limited to, such factors as:

(i) The number of elderly meals served per site/per day in the previous project period.

(c) Supplemental grants will not be considered as part of the funding formula, but will be funded on, but not limited to, such factors as:

(i) Availability of funding; and

(ii) Priority of services to be funded.

(d) Discretionary grants will not be considered as a part of the funding formula, but will be funded on, but not limited to, such factors as:

(i) Availability of funding; and/or

(ii) Approval of program and/or services to be provided by the Division.

Section 8. Match Requirements.

(a) In each grant application, at least twenty-five percent (25%) of the non-federal share, as prescribed in the Older Americans Act, shall be in the form of allowable costs to the state and local public agencies or in the form of allowable third party contributions from local public agencies.

(i) At least five percent (5%) of the nonfederal share must be in the form of allowable costs to the state.

(ii) At least twenty percent (20%) of the non-federal share must be in the form of allowable costs to local public agencies.

(iii) Third party in-kind contributions shall count toward satisfying this matching requirement only if the payments would be allowable costs, such as when the party receiving the contributions were to pay for the goods received.

Section 9. Program Income Projections.

(a) Program income shall be estimated based on the amount of income reported in the previous project period.

(b) In the case of a new project, estimated program income will be determined by the Division.

Section 10. Equipment.

(a) Anticipated equipment will be considered in funding for supportive and nutrition services and shall be discussed with the Division prior to including the cost the equipment in the grant application.

(i) The funding of equipment shall be based on the availability of funds.

(b) Emergency equipment need will be considered as the need arises during the project period according to the following:

(i) If the grantee has raised more local funding than was approved in the grant application, the grantee may request approval to purchase the equipment with these funds in accordance with Section 10 (c).

(ii) If the grantee does not have the necessary funding for the equipment, the grantee may request emergency funds with which to purchase equipment.

(A) The funding of this equipment shall be based on the availability of funds.

(i) Any equipment purchase must have prior approval from the Division.

(A) All equipment requests shall be made in writing to the Division.

(B) All equipment requests shall be accompanied by three written bids in accordance with Section 11.

(I) Line item transfer; or,

(II) Part of an original grant application; or,

(III) Emergency fund.

(D) The Division will provide a written response within seven (7) working days of the request for approval/denial of the equipment purchase.

Section 11. Bid process. The grantee shall follow these bid processes :

(a) Equipment items costing over $500.00;

(i) Advertising for bids, must include, at a minimum:

(A) The specifications for the equipment to be purchased;

(B) A specific date and time at which the bidding will be closed; and

(ii) Bids shall be received sealed and remain sealed until the time and date specified for opening.

(iii) No preference will be given to in-state (as opposed to out-of-state) bids.

(iv) The low bid must be accepted unless the low bidder has not met the specifications and/or stipulations stated in the call for the bid, which can include, but need not be limited to:

(A) Quantity;

(B) Quality;

(D) Ability to service product in the state.

(I) Bids will not be rejected for the above reasons as an "after the fact" judgment.

(b) Equipment costing $500 or less and all other services:

(i) Advertisement for bids for equipment costing $500 or less and all other services must include:

(A) Specifications for the equipment or services to be purchased including:

(I) Public notice of the call for bids;

(II) Applicant's incorporation papers;

(III) Geographical and/or service area proposed to be served by the applicant;

(IV) Hearings appeals process;

(V) Assurances regarding provisions of services under Chapter 5, Section 3(d)(v)(F);

(VI) Definition of service units;

(VII) Per unit of service and total costs of the bid;

(VIII) Responsibilities of both parties;

(IX) Beginning and ending dates of the service provision;

(X) Termination clause; and

(XI) Severability clause.

(B) Specific time and date bidding will be closed.

(ii) No preference will be given to in-state (as opposed to out-of-state) bids.

(iii) The low bid must be accepted unless the low bidder has not met the specifications and/or stipulations stated in the bid.

(iv) The accepted bid shall be submitted to the Division for review.

(v) Criteria for acceptance/denial of bids shall be developed by the grantee with the approval of the Division.

History

Effective 2005-12-05

Chapter 6 Grant/Contract Fiscal Management

Wyo. Code R. 048.0003.6.12052005 Grant/Contract Fiscal Management

WYOMING DEPARTMENT OF HEALTH AGING DIVISION OPERATIONAL RULES

CHAPTER 6

GRANT/CONTRACT FISCAL MANAGEMENT

Section 1. Grant Fiscal Management. The Division shall manage all grants and contracts, and shall require:

(a) Compliance with the Wyoming Information Network and the Division Financial Management and Accounting System Manual;

(b) Submission of monthly and quarterly fiscal reports from each grantee, prepared in compliance with the above Manual; and

(i) Grantees will follow the bid process contained in the Division Financial Management and Accounting System Manual.

(ii) Two copies of the annual audits will be sent to the State Audit and Compliance Division.

(iii) Resolution of audit findings:

(A) Findings will be reviewed and, if necessary, discrepancies and/or compliance issues will be resolved by a plan of action mutually agreed upon by the Division and grantee within ninety (90) days after the audit report.

(B) Unallowable costs will be paid back to the Division by the grantee.

(I) Grantee may make payment to the Division; or

(II) The Division shall withhold funds of grantee; or

(III) The grantee may request an administrative hearing under Chapter 2, Section 4.

(d) Property and equipment shall be managed properly.

(i) All equipment/property purchased with state or federal funds shall be inventoried annually in accordance with the Financial Management and Accounting System of the Division.

(ii) If a piece of equipment becomes inoperable, the project shall make plans to repair or replace the equipment.

(iii) If the equipment has completely depreciated, the grantee may dispose of it when it becomes inoperable.

(iv) If the equipment is still usable, the project may request replacement and utilize the old item of equipment as trade-in.

(v) If the equipment is usable, but no longer needed by the grantee, the grantee may:

(A) Transfer the equipment to another project for which the recipient may be required to make payment;

(B) Advertise the equipment for sale to the highest bidder;

(I) The funds from the sale of the equipment shall be divided into the federal, state and local shares that were in force when the equipment was originally purchased. There shall be reimbursement of the federal and state funds to the grant.

(vi) Kitchen equipment:

(A) Grantee shall refer to "Equipment Guide for On-Site School Kitchens" when planning to purchase kitchen equipment.

Section 2. Suspension/Termination. The Division shall suspend\terminate funding under a grant in the following manner:

(a) Notify the grantee of the intention to suspend\terminate the grant by certified mail that suspension/termination will occur within thirty (30) days of receipt; this notice will include the basis for the decision.

(i) The grantee may propose a written agreement with the Division on mutual actions to be taken in a specified period of time to avoid suspension\termination.

(ii) If an agreement is reached on a plan of action to rectify the situation causing suspension\termination, the Division will notify the grantee, in writing, of its decision to continue funding of the grantee.

(iii) The grantee may, within fifteen (15) days from the receipt of the notice to suspend/terminate funding, make a written request to the Division for an administrative hearing in accordance with Chapter 2, Section 5.

(b) If commitments covered by the agreement are not met to the satisfaction of the Division, the Division shall notify the grantee, in writing, that funding has been suspended/terminated including reasons for the action and the effective date.

Section 3. Reduction of Grant Funds.

(a) A grant will be reduced if:

(i) A project closes a meal site.

(ii) A project is not serving the number of meals or clients as projected in the grant application.

(iii) An audit finding results in an exception.

(iv) A grantee fails to provide services as approved in the grant application.

(A) The Division will determine periodically, based on reports from the grantee, that the specified services are not being provided by that grantee.

(b) The Division will notify the grantee by certified mail that reduction of funds will occur, including the specific amount and an effective date.

(i) The grantee may request an administrative hearing by writing to the Division within fifteen (15) days from the receipt of the notice and requesting an administrative hearing in accordance with Chapter 2, Section 4.

History

Effective 2005-12-05

Chapter 7 Program Administration for Adult Day Care Facilities

Wyo. Code R. 048.0003.7.07201999 Program Administration for Adult Day Care Facilities

RULES AND REGULATIONS

FOR PROGRAM ADMINISTRATION FOR ADULT DAY CARE FACILITIES

CHAPTER 7

Section 1. Authority.

These rules are promulgated by the Department of Health pursuant to Article 12 of the Senior Citizens Act, W.S. §9-2-1201 et seq., W.S. §35-2-901 et seq., and are amended by Enrolled Act #0122, House Bill #0233, per W.S. §35-2-901(a)(xxiii) and the Wyoming Administrative Procedures Act at W.S. §16-3-101 et seq.

Section 2. Purpose.

These program administration rules have been adopted to provide criteria for the day-to-day operations of adult day care facilities.

(a) The purpose of the Program Administration Rules and Regulations for Adult Day Care Facilities is to protect aged, blind, or adults with disabilities who are away from their homes during a part of the day by:

(i) Ensuring that the activities and services of adult day care facilities are conducive to the well-being of the participants; and

(ii) Reducing risks in the caregiving environment.

(b) Adult day care is a community-based group program designed to meet the needs of adults with physical or mental disabilities through an individual activity care plan. It is a structured, comprehensive program that provides a variety of health, social, and related support services in a protective setting during any part of a day but less than 24-hour care.

(c) Individuals who participate in adult day care attend on a planned basis during specified hours.1 Adult day care assists its participants to remain in the community and prevents inappropriate or premature institutionalization, enabling families and other care givers to continue caring for an impaired individual at home.

Section 3. Definitions.

The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, gender pronouns are used interchangeably. 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 purpose of these regulations, the following shall apply:

(a) "ADAAG" means the Adult with Disabilities Act Accessibility Act Guidelines.

(b) "Administer medicine" means to read the label, to open the container of medicine, to remove the prescribed dosage, and to give it to the person for whom it is prescribed. State of Wyoming Nurse Practice Act states that only people authorized by state law may administer medicine. People authorized to administer medicine include licensed physicians, registered nurses, licensed practical nurses, physicians' assistants, and other individuals who meet the requirements of the law.

(c) "Adult" for the purposes of these rules means any person eighteen(18) years of age or older in accordance with W.S. §35-2-901(a)(xxiii).

(d) "Adult Day Care Center Facility" means any facility not otherwise certified by the Department of Health, engaged in the business of providing activities of daily living support and supervision services programming based on a social model, to four (4) or more persons eighteen(18) years or older with physical or mental disabilities.

(e) "Ambulatory" means the ability of a person who is physically and mentally able to make an exit from a building in an emergency without the assistance of another person or without the use of any device such as, but not limited to, a wheelchair, walker or leg prosthesis. The determination of whether a person is ambulatory shall be based on information contained in the report of the physical examination as required by Section 12(b)(iii) of these rules and regulations. NOTE: This is not a medical definition, but is related to the placement of elderly and impaired adults in buildings that are appropriate in terms of fire safety.

(e) "Care" means assistance with the activities/tasks of daily living provided to participants.

(f) "Certified Nurse's Aid (CNA)" means a person who has been certified by the Wyoming State Board of Nursing.

(g) "Complaint Investigation" means those investigations required to be performed by the Long- Term Care Ombudsman per W.S. §9-2-1305.

(h) "Conservator" means a person appointed by the court to have custody of the person of the ward.

(i) "Contrast" means a significant difference in diversity of adjacent parts by color, tone, and/or light.

(j) "Department" means the Wyoming Department of Health.

(k) "Department's Representative" means an employee of the Wyoming Department of Health who is acting as the authorized agent of the Division on Aging in carrying out responsibilities and duties of his/her position.

(l) "DFS" means the Department of Family Services.

(m) "Director" means the person who has been delegated responsibility for the programmatic and the administrative supervisory functions of the adult day care program.

(n) "Disabled" means the inability to perform some or all of the activities/tasks of daily living due to physical or mental disability(s), weakness, illness, or injuries.

(o) "Distribute medicine" means to give the container of medicine to the person for whom it is prescribed, which is distinguished from "administer medicine" as defined in Section 3(b) of these rules.

(p) "Division" means the Division on Aging.

(q) "Facility" means the adult day care facility.

(r) "Fire official having jurisdiction" means the Wyoming Department of Fire Prevention and Electrical Safety or designated representative.

(s) "Fire prevention and building construction" means the standards adopted by the Wyoming Department of Fire Prevention and Electrical Safety.

(t) "Guardian" means the person appointed by the court to have custody of the person of the ward.

(u) "License" means the authority granted by the Office of Health Quality, Planning and Program Evaluation to operate an adult day care facility pursuant to a survey performed by the Division on Aging.

(v) "Licensee" means any person, association, legal entity, partnership, or corporation to whom the adult day care license is issued.

(w) "Licensing Division Office" means the Department of Health, Office of Health Quality, Planning and Program Evaluation.

(x) "Licensed Practical Nurse (LPN)" means any individual who holds a current, valid license from the State of Wyoming as an LPN.

(y) "Long Term Care Home and Community-Based Services Waiver (LTC/HCBS Waiver) is the Wyoming waiver for the Elderly and Physically Disabled granted under the authority of Section 1915(c) of the Social Security Act.

(z) "LTC/HCBS Case Manager" means a person who meets the qualifications in performance of their duties of Case Manager for Long-Term Care Home and Community-Based Services waiver.

(aa) "MFCU" (Medicaid Fraud Control Unit) means the Medicaid Fraud Control Unit of the Attorney General's Office, its agent, designee, or successor.

(bb) "Nonambulatory" means the inability of a person, who because of physical or mental impairment, must be led, assisted, or carried by another person, or who is dependent on the use of a device such as, but not limited to, a walker, wheelchair or leg prosthesis to make an exit from a building in an emergency. The determination of whether a person is nonambulatory shall be based on information contained in the report of the physical examination as required by Section 12(b)(ii) of these rules and regulations. NOTE: This is not a medical definition, but is related to the placement of elderly and impaired adults in buildings that are appropriate in terms of fire safety.

(cc) "Nurse" means any individual who holds a current, valid license from the State of Wyoming Board of Nursing as a licensed practical nurse (LPN) or as a registered nurse (RN).

(dd) "Ombudsman" means the Long-Term Care Ombudsman as established in W.S. §9-2-1301 through 9-2-1309.

(ee) "Participant" means an elderly, blind or disabled adult who takes part in the program of care and receives services from the facility.

(ff) "Program Administration" means the rules and regulations promulgated by the Department of Health and developed by the program division for the day-to-day operations of adult day care facilities as per W.S. §9-2-1208(v).

(gg) "Program Division" means the Wyoming Department of Health, Division on Aging.

(hh) "Program Plan" means the activity plan developed on admission and updated periodically that addresses participants needs and strategies to meet those needs.

(ii) "Physician" means any individual licensed to practice medicine in any of the fifty (50) states or the District of Columbia.

(jj) "Protection" means the intent to prevent harm and to provide oversight of the participant.

(kk) "Recommended Daily Allowances" (RDA) are the levels of intake of essential nutrients considered to be adequate to meet the known nutritional needs of healthy persons, in the judgment of the Committee on Dietary Allowances of the Food and Nutrition Board, National Academy of Sciences, National Research Council on the basis of available scientific knowledge.

(ll) "Registered Nurse" means any individual who holds a current, valid license as an RN from the State of Wyoming.

(mm) "Responsible person" means the person who assumes the responsibility for arranging for care and services for the participant. The responsible person may or may not be the legal guardian for the participant, and may or may not be related to the participant.

(nn) "Snack" means a light meal or nutritious meal supplement.

(oo "Staff or staff person" means administrative, program, service, and volunteer personnel of the facility.

(pp) "Supplementary Care" means a part of the total care that is required by participants. Supplementary care augments the care that the family or other persons provide. Care provided by an adult day care facility is supplementary care.

(qq) "Supervision" means the general oversight of the physical and mental well-being of participants who are physically present in the adult day care facility.

(rr) "Survey" means an annual on-site evaluation conducted by the Division on Aging to determine compliance with Program Administration Rules and Regulations for Adult Day Care Facilities.

(ss) "Unit dose" means a packaged amount of medicine containing one dose of the medicine.

(tt) "Volunteer Personnel" means persons who provide services at the facility on a voluntary, non- paid basis. If these persons meet all the personnel and health requirements for staff pursuant to Section 9, Personnel, they may be counted in the staff-to-participant ratio.

Section 4. Program Goals.

(a) Promote the participant's maximum level of independence.

(b) Maintain the participant's present level of functioning as long as possible, preventing or delaying further deterioration.

(d) Foster socialization and peer interaction.

(e) Serve as an integral part of the community service network and the long-term care continuum.

Section 5. Applicability.

These Program Administration Rules and Regulations for Adult Day Care Facilities apply to any facility that provides supplementary care and protection for four (4) or more adults:

(a) Who are elderly, blind, or disabled;

(b) Who are in care for less than twenty-four (24) hours per day; and

Section 6. Severability.

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 7. Target Population.

(a) The target population consists of:

(i) Adults who require assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL);

(ii) Adults with physical problems that require health monitoring and supervision on a regular basis;

(iii) Adults with emotional problems that interfere with activities of daily living;

(iv) Adults with significant memory loss and cognitive impairment;

(v) Adults who require assistance in overcoming the isolation associated with functional limitations or disabilities; and/or

(b) A facility may refuse to serve adults with communicable disease, adults who are actively alcoholic or addicted to drugs, adults with a history of violence to self or others and/or whose behavior is not manageable within the group setting, adults whose need for care requires more time and skill than the individual program is able and qualified to provide. EXCEPTION: The following types of facilities are not subject to the Rules of Adult Day Care:

(i) A home or residence of an individual who provides care only for persons related to him by blood or marriage.

(ii) A facility or a portion of a facility which only conducts a socialization or recreation activity program for adults and which does not provide assistance with daily living tasks, support, and supervision services.

Section 8. Administration.

(a) Deceptive Representation or Advertisement.

(i) An adult day care facility shall not make, publish, disseminate, circulate, or place before the public, or cause, directly or indirectly, to be made an advertisement of any sort regarding services or anything so offered to the public, which contains any promise, assertion, representation, or statement of fact which is untrue, deceptive, or misleading.

(b) Operational Responsibilities.

(i) The provider shall be responsible for the overall planning of the program and services to be provided by the facility. The operational responsibilities of the provider shall include, but not be limited to, the following:

(A) To develop an internal policy manual including a written statement of the purpose and scope of the services to be provided by the center facility, a description of adults who may be accepted into the program as well as those whom the program cannot serve, and written policies under which the facility will operate;

(B) To ensure that the facility's activities, services, and buildings are maintained in compliance with the Program Administration Rules and Regulations for Adult Day Care Facilities, and with other relevant federal, state, or local laws and regulations;

(1) A copy of the facility's license and the Program Administration's survey report will be maintained in the facility for public inspection.

(2) A copy of the survey report will be sent to the Wyoming Long-Term Care Ombudsman office by the Program Administration staff.

(C) To appoint and identify in writing a director to be responsible for the day-to-day operation and management of the facility.

(D) To provide for qualified staff capable of carrying out the operation of the program;

(E) To develop a written organizational chart indicating lines of authority and a staffing plan which includes a staffing schedule;

(F) To establish sound policies under which the facility shall operate; and

(G) To ensure sound financial management of the facility.

(i) The applicant shall provide the Division on Aging with the following evidence of financial responsibility:

(A) A projected budget detailing income and expenses of the proposed facility for the first year of operation;

(B) A complete balance sheet showing separately the current assets committed to and current liabilities charged against the proposed facility; and

(ii) The facility shall maintain public liability insurance for bodily injury with a minimum limit of at least $500,000 each occurrence/ $500,000 aggregate. Evidence of insurance coverage shall be made available to the Division on Aging's representative upon request.

(d) Record-keeping Responsibilities.

(i) The provider shall ensure that the facility maintains an adequate system of record keeping to comply with these rules.

(ii) All participants' records shall be treated confidentially.

(iii) Records shall be updated and kept current as changes occur.

(iv) If the participant or legal guardian consents in writing, participant records shall be shared with other facilities/agencies upon referral or discharge.

(v) All records required by these rules both for participants and personnel shall be kept in locked cabinet or area and retained at the facility for six years after termination of enrollment or termination of employment, unless specified otherwise.

Section 9. Personnel.

(a) Qualifications.

(i) The following rules shall apply to all staff:

(A) No staff person shall have been convicted of a felony or a misdemeanor related to abuse, neglect, exploitation, or abandonment of adults or children. The facility shall have written verification of a Deparatment of Family Services central registry check or State Board of Nursing registry check, where applicable, on all employees hired at the time of or after the filing of these rules.

(ii) All staff persons who work directly with participants and who are counted in the staff- to-participant ratio shall be at least 18 years of age. EXCEPTION: Paid or volunteer assistants may be between 14 and 18 years of age provided that their immediate supervisor is an adult, but these individuals cannot be included in the staff to participant ratio.

(b) Personnel Records.

(i) Personnel records shall be kept at the facility for paid staff and volunteer personnel who begin work subsequent to the effective date of these rules.

(ii) Personnel records shall include the following:

(A) The original application for employment or other written material providing:

(I) Identifying information including name of staff person, beginning date of employment/volunteering, and job title;

(II) Any other information needed to demonstrate that the individual possesses the qualifications required for the position;

(B) Written documentation of at least two (2) character references and statement of competency from previous employers, if any, and/or other knowledgeable and objective sources prior to employment or volunteering (e.g., letters of reference; notations of telephone reference checks including the name of the person(s) contacted, the date(s) of contact, the firm(s) contacted, and the results);

(D) Date of termination of employment, when applicable.

(i) Health information required by these rules shall be maintained for all staff including the director and volunteer personnel.

(A) Initial Tuberculosis Examination and Report

(I) Each staff person and volunteer shall obtain a two-step skin test prior to working with program participants. EXCEPTION: When a staff person has been tested within the previous six months, the report of tuberculosis screening and the results may be accepted.

(II) A record of tuberculosis screening shall be maintained in the staff member or volunteer's personnel record and shall include the following:

(1.) The type(s) of test(s) used and the result(s);

(2.) The date of the testing; and

(3.) The signature of the person administering the test(s).

(B) Subsequent Evaluations.

(I) Each staff person and volunteer shall be retested on a yearly basis. The testing shall be recorded in accordance with Section 9(b) of these rules and regulations.

(II) Any staff person or volunteer who comes in contact with a known case of tuberculosis or who develops chronic respiratory symptoms shall receive a baseline evaluation with a follow-up evaluation within ten (10) to twelve (12) weeks of exposure.

(1.) At the request of the director of the facility or the Department of Health, a report of examination by a physician shall be obtained when there are indications that the safety of participants in care may be jeopardized by the physical or mental health of a specific participant.

(2.) Any participant who, upon examination or as a result of medical tests, shows indication of a physical or mental condition which may jeopardize the safety of other participants in care or which would prevent performance of duties:

a. Shall be removed immediately from contact with participants and food served to participants; and

b. Shall not be allowed contact with participants or food served to participants until the condition is cleared to the satisfaction of the examining physician as evidenced by a signed, dated statement from the physician.

(3.) Any individual who cannot adequately perform his duties or who may jeopardize the health or safety of the participants shall be relieved of his duties and removed from the facility.

(d) Staff Training.

(i) All staff shall be trained in the appropriate procedures for handling emergencies. Such training shall take place before job responsibilities are assumed and shall include at least the following:

(A) Individual responsibilities in the event of fire, including the location and operation of any fire extinguishers and fire alarm boxes;

(B) Individual responsibilities in the event of illness or injuries, including the location and use of the first aid emergency supplies; and

(ii) Before assuming job responsibility, all staff persons shall receive job orientation training. Items not covered in the training prior to beginning employment shall be completed within one week of the starting date of employment. The orientation shall include training specific to the staff's assigned responsibilities, as well as the following topics:

(A) The purpose of the adult day care facility;

(B) State of Wyoming procedures for detecting and reporting suspected abuse, neglect, exploitation, or abandonment of participants;

(I) Any person who becomes aware of suspected abuse, neglect, exploitation, or abandonment of participants, as defined in the Adult Protective Services Act, W.S. §35-20-102 and W.S. §35- 20-103, shall notify law enforcement, the Wyoming Department of Family Services, and if applicable, the appropriate legal guardian(s), within twenty-four (24) hours of discovery.

(D) The policy of the facility and the Program Administration Rules and Regulations for Adult Day Care Facilities, as they relate to the employee's responsibilities;

(E) Individual capabilities and special needs of the elderly and the disabled adult, including specific needs of participants in care;

(F) The schedule of activities; and

(G) Record keeping responsibilities.

(iii) All staff who are primarily responsible for the direct care of the participants shall attend at least eight (8) hours of staff development activities annually which shall consist of in-service training programs, workshops, or conferences related to adult day care or gerontology, provided that both subject areas are addressed during the year.

(e) Administrative Staff.

(i) During the facility's hours of operation, one (1) adult on the premises shall be in charge and responsible for the administration of the facility. This person shall be either the Director or an adult appointed or designated by the Director.

(ii) Program Director.

(A) There shall be one (1) person responsible for the program of the facility who shall:

(I) Be at least 21 years of age; and

(II) Meet one or more of the following requirements:

(1.) The director shall have completed at least forty-eight (48) semester hours or seventy-two (72) quarter hours of post secondary education in health care, elderly care, health case management, facility management, or other related field from an accredited college or institution;

(2.) Be a Certified Nursing Assistant (CNA) familiar with and follow these rules, and pass an open book test prepared by the Division on Aging on these rules with a score of at least eight-five percent (85%);

(3.) Have completed at least two (2) years experience working with elderly or people with disabilities. This experience may have been paid, full-time employment, or time equivalent in part-time employment or volunteer work that is directly involved with the elderly or handicapped;

(4.) Demonstrate knowledge, skills and abilities in the administration and management of the adult day care program including:

a. Knowledge and understanding of elderly and people with disabilities;

b. Supervisory and interpersonal skills;

c. Ability to plan and implement the program; and

d. Knowledge of financial management sufficient to ensure program development and continuity.

(5.) Demonstrate knowledge of supervisory and motivational techniques sufficient to:

a. Accomplish day-to-day work;

b. Train, support, and develop staff; and

c. Plan responsibilities for auxiliary staff to ensure that services are provided to participants.

(iii) Assistant Program Director.

(A) If the Program Director is present in the facility less than four (4) hours per day, there shall be an officially designated Assistant Program Director who shall:

(I) Meet the qualifications of the Program Director; and

(II) Assume responsibility in the absence of the Program Director.

(iv) Volunteer Personnel.

(A) All volunteer personnel shall be under the individual supervision of a Director, Program Director, Assistant Program Director, or designated staff person.

(B) The duties of volunteer personnel shall be clearly defined in writing.

Section 10. Supervision.

(a) At any time when there are two (2) or more participants at the adult day care facility, there must be at least one (1) adult staff and one (1) other person who is physically and emotionally able and willing to assist in an emergency situation. If this individual is not within a distance considered reasonable for voice travel from all parts of the facility, there must be an alternative system in place, such as an intercom system, to notify of needed assistance.

(b) Staff-to-Participant Ratio.

(i) There shall be a minimum of one (1) staff person on duty providing direct care and supervision for every six (6) participants in care; and

Note: Staff members who are under eighteen (18) years of age shall not be counted in the staff-to-participant ratio.

(ii) The number of any additional staff persons required shall depend upon:

(A) The program and services the facility provides; and

(B) The functional level of the participants.

Section 11. Physical Environment.

A facility must provide an environment which protects the participants from physical harm but is not so restrictive as to inhibit physical, intellectual, emotional, or social stimulation.

(a) Safety, Health, and Comfort.

(i) No adult day care facility shall be located where conditions exist that would be hazardous to the physical health and safety of participants.

(ii) Building Construction and Maintenance.

(A) If space used or planned for use by the facility is renovated or altered, the plans shall be in strict compliance with the Americans with Disabilities Act Accessibility Guidelines (ADAAG) and shall be submitted for review to the State of Wyoming Department of Administration and Information, Central Services Division for review prior to the expected change.

(B) Prior to becoming a provider and prior to use of newly constructed, renovated, remodeled, or altered buildings or sections of buildings, a facility shall provide written documentation of the following:

(I) Inspection and approval of the building(s) from the local building official, if applicable, or approval of a plan of correction; OR

(II) Inspection and approval of the building(s) from the Department of Fire Prevention and Electrical Safety, if applicable, or approval of a plan of correction; AND

(III) Inspection and approval from the Division, or approval of a plan of correction related to:

(1.) Sanitation and health;

(2.) Water supply;

(3.) Sewerage system; and

(4.) Food service.

(IV) Inspection and approval from the local fire department that the facility is free from fire hazards, or approval of a plan of correction.

(iii) Special Requirements for Nonambulatory or Physically Challenged Participants.

(A) If the facility is providing for nonambulatory participants, at least one (1) entrance shall be readily accessible and useable by nonambulatory participants so that participants can evacuate safely and independently in the event of fire or emergency.

(B) Before any participant who uses a wheelchair or a walker is accepted for care, doorways and passageways shall be wide enough to accommodate wheelchairs and walkers.

(iv) Grounds.

(A) The grounds shall be well maintained and free from safety hazards.

(B) An area shall be available, accessible, and useable for outdoor activities for all participants.

(v) Sanitation.

(A) Hot and cold water shall meet the requirements of the Uniform Building Code.

(B) Private water systems shall be tested and found safe and potable.

(D) The facility shall be free from insects, rodents, and other pests.

(E) Adequate kitchen facilities and equipment shall be provided for preparation and serving of meals.

(F) Sufficient working refrigeration shall be available to store perishable food and medicine. All refrigerators and freezers shall have a working thermometer. Freezers will be maintained at zero degrees (0°) Fahrenheit or less. Refrigerator temperature will be maintained at forty degrees (40°) Fahrenheit or less. Freezers and refrigerators shall be maintained, clean, and sanitized.

(G) Food shall be properly stored, prepared, and served to prevent food-borne illness.

(H) Drinking water shall be available to participants at all times.

(I) Drinking fountains, if used, shall be of a type approved by the County Health Department.

(J) Individual cups shall be provided for drinking water when fountains are not used.

(K) If disposable dishes, cups, and/or utensils are used, they shall be sturdy enough to prevent them from being a safety hazard. They shall be used once and then discarded.

(L) The kitchen and dining area shall be kept clean, sanitary, and provided with suitable furniture and adequate space to comfortably seat all residents.

(M) (I) Only dishes and utensils with the original smooth finishes shall be used. Cracked, chipped, scratched, permanently stained dishes, cups or glasses, damaged, corroded utensils, or cookware shall not be used.

(II) The cleaning and sanitizing of all items used in preparation and service of food shall comply with the State of Wyoming, Wyoming Food Service Regulations. Inspection of all items used for storage, preparation and service of foods may occur.

(1.) For manual washing, rinsing and sanitizing of utensils and equipment, three compartments or containers shall be used. Each compartment shall be large enough to accommodate the utensils or equipment. The first compartment shall contain a hot detergent that is kept clean. The second compartment shall contain hot, clear rinse water. The third compartment shall contain an approved sanitizing solution. All utensils and equipment shall remain in the final sanitizing rinse for at least one minute. Dishes and equipment shall then be air dried. When chemicals are used for sanitizing, a test kit or other device that accurately measures the parts per million concentration of the sanitizer shall be provided and used.

(2.) Cleaning and sanitizing of dishes and equipment may also be done by automatic dishwashers.

(N) Persons handling soiled tableware and/or kitchenware shall wash their hands before handling clean ware.

(O) No fly strips shall be allowed in the kitchen or dining area.

(P) Filters, exhaust hoods, ranges, deep fat fryers, ovens and other similar items shall be operable and maintained clean.

(Q) A fire extinguisher rated 2A-10B:C shall be available in the kitchen area.

(vi) Lighting.

(A) All areas of the facility shall be well lighted for the safety and comfort of the participants during all hours of operation according to the nature of activities. NOTE: Special lighting requirements relating to medications are under Section 12(h)(ii)(B) of these rules and regulations.

(B) Artificial lighting shall be by electricity or battery.

(C) Additional lighting, as necessary to provide and ensure presence of contrast, shall be available for immediate use in areas that may present safety hazards, such as but not limited to stairways, doorways, passageways, changes in floor level, kitchens, bathrooms, and basements.

(D) Hallways, stairwells, foyers, doorways, and exits utilized by participants shall be kept well lighted at all times participants are present in the building(s). Whenever natural light is not sufficient, artificial lighting shall be used.

(E) Glare shall be kept at a minimum in rooms used by participants.

(I) When necessary to reduce glare, windows shall be equipped with shades, curtains or other coverings.

(II) All lights, including fluorescent lights, shall be covered with shades or protective fixtures or specially equipped to reduce glare and ensure protection.

(F) If used, fluorescent lights shall be replaced if they flicker or make noise.

(G) All sources of light including windows, light fixtures, bulbs, etc., shall be kept clean.

(vii) Temperature and Ventilation.

(A) Areas used by participants shall be well ventilated to the outside and dry.

(B) The temperature of the rooms used by participants shall be maintained at a level safe and suitable for elderly, disabled, and impaired adults:

(I) The minimum inside temperature shall be sixty-eight degrees (68°) Fahrenheit.

(II) Fans and/or air conditioners shall be available for use when the inside temperature exceeds eight-four degrees (84°) Fahrenheit.

(III) Each adult day care facility shall have at least one (1) portable thermometer to assure correct temperature.

(IV) Fans and air conditioners shall be placed to avoid direct drafts on participants and to avoid safety hazards.

(viii) Equipment and Materials.

(A) All furniture and equipment inside and outside the facility shall be maintained in good repair and in safe condition.

(B) Cleaning products, pesticides, and all poisonous or harmful materials shall be stored separately from food and shall be kept in a locked place when not in use.

(I) Elevators shall be kept in safe running condition;

(II) Elevators shall have sturdy handrails installed;

(III) Elevators shall be inspected at least annually by the insurance company, the local housing authority, or the elevator company;

(IV) A copy of the elevator inspection report shall be retained by the facility; and

(V) An alternative exit shall be accessible for use in case of a fire and/or other emergencies.

(D) Sturdy handrails shall be installed at all stairs, ramps, and changes in floor levels.

(E) All interior and exterior stairways and ramps shall have nonslip surfaces or carpet.

(F) All interior and exterior stairways, changes of floor level, and ramps shall be indicated by a warning strip or contrast in color to aid the participants who have impaired vision.

(G) Floors shall not be slippery. If rugs or floor coverings are used, they shall be secured to the floor.

(H) Fireplaces shall be securely screened and glassed in. All fireplaces shall meet the Uniform Mechanical Code.

(b) Space, Furnishings, and Supplies.

(i) Activity Areas.

(A) In addition to hallways, office space, bathrooms, storage space, or other rooms or areas that are not normally used for program activities, the facility shall provide at least forty (40) square feet of indoor floor space for each participant.

(B) There shall be sufficient and suitable space that may be interchangeable or adaptable for a variety of planned program activities.

(I) There shall be enough space for the participants to gather together for group activities.

(II) There shall be rooms or areas appropriate for small group activities and individual activities.

(I) Furniture shall be sturdy, safe, and appropriate for elderly and impaired adults.

(II) All facilities shall have:

(1.) Table and chair space adequate for all participants, excluding people who remain in wheelchairs throughout the day, to take part in activities at the same time; and

(2.) Recliners, lounge chairs, rockers, or other seating to allow participants to relax and rest.

(ii) Private Space.

(A) Space shall be available to allow total privacy for participants during interviews, visits, telephone conversations, counseling, therapy, and other similar activities.

(iii) Toilet Rooms.

(A) There shall be a minimum of one (1) toilet available for every eight (8) participants in attendance.

(B) If eight (8) or fewer participants are in attendance, there shall be at least one toilet or toilet stall large enough to accommodate a participant who needs personal assistance or who uses a walker or wheelchair.

(I) There shall be separate bathrooms for men and women to allow for privacy; and

(II) If the facility is providing for nonambulatory participants and the separate bathrooms are not accessible to nonambulatory participants, there shall be one (1) unisex bathroom that provides privacy and shall be on an accessible route and shall meet the lavatory facility requirements of 4.22 of the ADAAG.

(D) In bathrooms equipped with more than one (1) toilet, each toilet shall be enclosed for privacy.

(E) Sturdy grab bars or safety frames shall be installed adjacent to all toilets used by participants.

(F) There shall be a minimum of one (1) sink for every two (2) toilets located close enough together to ensure washing of hands after each toileting procedure.

(G) There shall be an adequate supply of toilet tissue, soap, and disposable hand towels in each bathroom at all times.

(H) Housekeeping practices and procedures shall be employed to keep the facility free from offensive odors, accumulations of dirt, and dust.

(I) Floors shall be maintained clean.

(iv) Dining Area.

(A) The dining area shall be large enough to provide sufficient table space and chair access to accommodate the participants.

(B) If the facility is providing for nonambulatory participants, the dining area shall be large enough to provide sufficient table space and floor space to accommodate participants in wheelchairs.

(v) Storage.

(A) Sufficient space shall be provided for coats, sweaters, umbrellas, toilet articles, and similar personal possessions of participants and staff.

(B) Sufficient space shall be available for equipment, materials, and supplies used in the program.

(vi) Telephones.

(A) At least one (1) private, nonpaying, wheelchair-accessible telephone shall be provided in each building.

(B) If the facility is providing for nonambulatory participants, the telephone shall be easily accessible and shall meet the telephone accessibility requirements of 4.31 of the ADAAG.

(C) If the facility is providing for hearing impaired participants, at least one hearing aid compatible and volume control telephone shall be provided. Telephones shall comply with telephone- accessibility requirements 4.31 of the ADAAG.

(vii) Rest Area.

(A) A rest area shall be available for participants who become ill, need to rest, or need to have privacy.

(I) The rest area shall be equipped with at least one (1) bed or comfortable cot for every eight (8) participants. EXCEPTION: In facilities that are open for evening care, beds shall be available for participants as necessary.

(II) Additional beds or comfortable cots shall be available to accommodate all participants who are scheduled for rest periods.

(III) A minimum of one (1) pillow covered with a pillow case, two (2) sheets, and one (1) blanket, spread, or covering per bed or cot shall be provided.

(IV) Additional covering or blankets and pillows shall be added as required.

(V) All sheets and pillow cases shall be laundered before being used by another person.

(VI) All blankets, spreads, and coverings shall be laundered or dry cleaned, as needed.

Section 12. Programs and Services.

(a) Admission Policies.

(i) The adult day care facility shall have written admission policies consistent with the program statement.

(ii) The admission policies shall be discussed with each person entering the program, as well as with any family member, responsible party, guardian, or conservator who enrolls the participant. A copy of the admission policies shall be available upon request.

(iii) Only those participants whose needs can be met by the facility's program shall be admitted to the facility.

(iv) All participants shall be eighteen (18) years of age or older.

(b) Assessment Policies.

(i) The facility staff shall be responsible for developing a written admission assessment of each participant based upon the information presented by the applicant, family members, friends or responsible party, guardian, or conservator and the report of any physical examination.

(ii) The assessment shall be used to identify the participant's strengths and needs to determine if and how the program can serve the participant.

(iii) The assessment shall include at minimum a description of the participant's:

(A) Physical condition, including:

(I) Ambulatory ability or limitations; and

(II) Ability to perform activities of daily living, such as eating and toileting.

(B) Social situation, including living arrangements and the availability of family, friends, and other people and organizations in the community to provide services to the participant; and

(v) The initial written assessment shall be reviewed and updated on a scheduled basis, but at least every six months, or if there are changes in participant's needs.

(i) Prior to admission, a beginning/preliminary program plan, based upon the assessment, shall be developed in writing for each participant. The plan shall be updated and completed within thirty (30) days of admission.

(ii) The plan shall be designed to improve the functional capabilities of the participant when possible, or to prevent further deterioration. The plan shall include:

(A) A description of the participant's needs;

(B) The participant's activities and services;

(D) The time by which the goals should be achieved.

(iii) The written program plan and personal information shall be reviewed and updated on a scheduled basis as needed, but at least every six (6) months. The revised program plan shall be in writing.

(iv) The revised plan shall conform to the requirements of the initial plan as specified in Section 11(c)(ii) of these rules and regulations.

(d) Agreement.

(i) There shall be a written agreement between the participant and the facility. The agreement shall be signed by the participant, his/her legal guardian and/or conservator, and the center facility representative.

(ii) The agreement shall specify the services to be provided by the facility; conditions for dismissal or discharge; and financial arrangements.

(iii) A copy of the agreement (or appropriate portion of the agreement) shall be given to the participant; and a copy shall be kept at the facility.

(iv) The agreement shall be reviewed and updated whenever there is any change in the services or the financial arrangements.

(v) There shall be given thirty (30) days prior written notice to any financial changes. A copy of notice shall be kept in each participant's file.

(e) Personal Information for Each Participant.

(i) The following personal information shall be kept current for all participants, to be used for the initial and ongoing assessments and program plans, as well as in the event of an emergency:

(A) Full names of participant, address, and telephone number; Medicaid number, if applicable; social security number; sex; date of birth;

(B) Names, addresses, and telephone numbers of at least two family members, friends, or other designated people to be contacted in the event of illness or an emergency; and

(C) Names, addresses, and telephone numbers of the participant's personal physician, dentist, any clinics where the participant receives treatment, the name of the preferred hospital in the event of an emergency, and the LTC/HCBS case managers, if applicable.

(ii) Individual records shall be kept for participants containing all information, reports, and documents required by these rules and regulations. These records will be written in ink, signed, and dated.

(iii) Written records shall be kept of all accidents, injuries and illnesses occurring on the premises.

(f) Physical Examinations/Medical Information.

(i) Screening for tuberculosis and a physical examination by or under the direction of a licensed physician shall be obtained either within thirty (30) days prior to acceptance for admission or within thirty (30) days prior to admission.

(ii) The report of the required physical examination shall include:

(A) The date of the physical examination;

(B) All diagnoses and/or significant medical problems;

(I) A list of medicines including dosages and time medicines are to be administered;

(II) Any special diet or dietary restrictions;

(III) Any allergies and/or any food intolerance;

(IV) Any therapy the participant is undergoing or should receive; and

(V) Any restrictions or limitations on physical activities or program participation.

(D) A statement that the participant is or is not capable of administering his own medications without assistance;

(E) A statement that the participant is or is not physically and mentally able to make an exit from the building in an emergency without the assistance of another person or without the use of a device such as, but not limited to, a wheelchair, walker or leg prosthesis.

(F) A statement that the individual does not have tuberculosis in a communicable form, including the date of the test, type(s) of test(s) used and the results;

(G) The signature of a licensed physician, the physician's designee or an official of a county health department; and

(H) A statement that financial responsibility for conducting physical examinations and/or tests does not lie with the adult day care facility.

(g) Medical Reports After Admission.

(i) Any individual who comes in contact with a known case of tuberculosis or who devel- ops chronic respiratory symptoms shall, within thirty (30) days after exposure/development, receive an evaluation in accordance with Section 9(c)(B) of these rules and regulations.

(ii) When there are indications that the adult day care facility can no longer provide appropriate or safe care because of changes in the participant's physical or mental health, a report of exami- nation by a physician shall be obtained.

(A) The written report of the physical examination shall be dated and signed by the physician.

(B) The report of the physical examination shall be used in evaluating the participant's continued suitability for adult day care.

(iii) All medical reports shall be kept at the facility.

(h) Medication Management.

(i) Participants may keep and take their own medicine provided that:

(A) Their physicians have deemed them capable of administering medicine to themselves by written authorization; and

(B) The facility ensures that other participants do not have access to another participant's medicine.

(ii) If a physician has deemed a participant incapable of administering medicine to himself, the following rules apply:

(A) The medicine shall be kept in a locked compartment or area;

(B) The medicine shall be kept in a darkened area, free from dampness and high temperatures, and refrigerated, if required;

(C) The area in which the medicine is administered or prepared for distribution shall have sufficient light so that the labels can be accurately read and the correct dosage can be clearly determined;

(D) Each staff person who administers the medicine shall be authorized by the Wyoming Nurse Practice Act; and

(E) A written record shall be kept of all medicine administered or distributed to the participants while at the adult day care facility. This record shall be retained at the facility for six (6) years and shall include:

(I) Date;

(II) Name of participant;

(III) Name of medication or prescription number;

(IV) Time medication is administered;

(V) Name of person administering; and

(VI) Any adverse or unusual reaction to the medicine.

(i) Health Care Supervision.

(i) Changes in a participant's physical or mental health, behavior, attitude or other signifi- cant changes, shall be discussed with the participant, family, physician or clinic, LTC/HCBS case manager, or other responsible party, guardian, or conservator, as appropriate. A written notation in the participant's record shall document the change and the person to whom it was reported.

(ii) If a participant suffers an illness or accident requiring medical attention:

(A) The facility shall ensure that the participant receives immediate access to medical attention;

(B) The family or other responsible party, guardian, and the participant's personal physician shall be notified immediately; and

(C) The notification shall be documented in the participant's record along with the details of the incident and action taken.

(j) Health Care Needs.

(i) If facility staff identify a need for health care services, this need shall be discussed with the participant, family members, or other responsible party, guardian, or conservator, as appropriate. The discussion shall be documented in the participant's record and included in the update of the program plan.

(k) Participants.

(i) A participant who is acutely ill shall not enter the adult day care facility without written approval from a physician.

(ii) If a participant becomes ill during the day:

(A) He shall be separated from all other participants in care;

(B) The responsible person shall be notified immediately in order that the partici- pant may be returned home, if necessary; and

(C) The ill participant shall be checked on at least every fifteen (15) minutes, or more frequently as necessitated by the condition, until leaving the facility.

(l) Discharge Policies.

(i) When the participant's needs can no longer be met by the program of care, plans shall be made for the participant's discharge.

(ii) The participant shall be informed of and participate in discharge planning, unless clearly impossible.

(iii) In the event that the facility initiates the discharge, the written plan of discharge shall outline the services needed by the participant upon discharge. The plan shall be discussed with the participant and family members or other persons responsible for participant's care. Although primary responsibility for the location and delivery of these services falls upon the participant and family members, or other responsible people, adult day care staff shall assist when possible.

(m) Planning the Activities and Services.

(i) Activities and services shall be planned to support the program plan for the partici- pants, and shall be consistent with the program statement and the admission policies.

(ii) Activities and services shall be planned under the supervision of the director who shall encourage involvement of participants and staff in the planning.

(iii) Schedule of Activities.

(A) There shall be planned activities and programs whenever the facility is in operation.

(B) A written schedule of activities shall be developed at least monthly.

(I) Group activities for all participants or small groups of participants;

(II) Personalized options for participants with varying interests; and

(III) The name or type, date and hour of the activity.

(D) If an activity is substituted for another, the change shall be noted on the schedule.

(E) The current month's schedule of activities shall be posted in a conspicuous place or otherwise made available to participants.

(F) The schedule of activities for the past six (6) months shall be kept at the facility.

(G) If a participant requires an individual schedule of activities, that schedule shall be a part of the program plan and shall be kept in the participant's record.

(iv) The activities shall be varied to appeal to the different interests, abilities, and needs of the participants.

(v) All activities shall:

(A) Support the physical, social, mental, and emotional abilities and skills of participants;

(B) Promote or maintain the participant's highest level of independence or func- tioning; and

(vi) Physical activities shall be encouraged to the extent recommended by each participant's physician.

(n) Rights of Participants.

(i) The participant shall be encouraged and supported in maintaining his highest level of independence.

(ii) The participant shall be encouraged to participate in planning for his care, when appropriate.

(iii) The participant shall be accorded dignity and treated with courtesy and respect at all times.

(iv) The participant shall not be required to perform services for the adult day care facility.

(v) The privacy of participants shall be fully respected, including unrestricted communica- tion and private use of the telephone.

(vi) The participant shall not be abused, neglected, exploited, punished, coerced, or threat- ened in any way.

(vii) The participant shall be protected from solicitation, harassment and unwanted visitors.

(viii) The participant shall be allowed to participate in activities of social, religious, and community groups.

(ix) Confidentiality of health and personal records will be maintained.

(x) The participant shall be provided an opportunity to read the aforementioned rights. The rights shall be read to those participants who are unable to read. All attempts shall be made to answer questions a participant has regarding his rights.

(xi) A signed and dated copy of the participant's rights shall be kept in the participant's record.

(o) Nutrition and Food Service.

(i) Meals and snacks shall be provided by the facility. Payment for such food services will be made to the adult day care facility in addition to the daily fee and at the standard rate outlined for home delivered meals.

(ii) Serving of Meals and Snacks.

(A) Facilities which open before 7:00 a.m. shall serve breakfast.

(B) Facilities shall serve appropriate meals and snacks, depending on the hours of operation; i.e.,

(I) A facility open during the hours of 7:00 a.m. to 1:00 p.m. must serve a morning snack and a midday meal;

(II) A facility open during the hours of 8:00 a.m. to 5:00 p.m. must serve a morning snack, a midday meal, and an afternoon snack;

(III) A facility open during the hours of 2:00 p. m. to 6:00 p.m. must serve an afternoon snack;

(IV) A facility open after 6:00 p. m. to 9:00 p.m. must serve an evening meal; and

(V) A facility open after 9:00 p. m. shall serve an evening snack.

(iii) There shall be at least two (2) hours between snacks and meals.

(iv) Each meal, including the morning meal, the midday meal, and the evening meal, shall provide at least one-fourth (¼) of an adult's daily recommended dietary allowance (RDA); or any one meal and any one snack combined shall provide at least one-third ( ) of the RDA.

(v) Meals and snacks served to the participants shall be attractive in appearance, consist of variety of foods, and conform to the following meal patterns:

(A) Minimum Amount

(I) BREAKFAST

Milk ½ cup Juice* or fruit or vegetable ½ cup

Bread or bread alternate** 1 slice

(including cereal) ½ cup cooked or ¾ cup dry

(II) SNACKS (Select at least two of these four components)

Milk ½ cup

Juice* or fruit or vegetable ½ cup

Bread or bread alternate** (including cereal)

Meat, poultry, fish or seafood, or meat alternate***

1 slice, ½ cup cooked, ¾ cup dry, or 1 oz.

(III) MIDDAY AND EVENING MEALS

Meat, poultry, fish or seafood, or meat alternate*** 2 oz.

Vegetables and/or fruits (two or more) ½ cup each

Bread or bread alternate** 1 slice

NOTE: Other foods and additional servings may be served to enhance the meals or meet energy needs.

*Juice: Full strength juices made from fruits or vegetables or frozen concentrate according to directions for full strength Juice.

**Bread alternates: ½ cup rice, grits, or pasta; cereal; 4 crackers, etc.

***Meat alternates: 1 egg, 1 oz. cheese, ½ cup cooked dry beans or dry peas, or 2 tablespoons peanut butter.

(B) At least one (1) source of Vitamin C must be served per day.

(vi) Meals shall be planned in accordance with the needs of the age group in care (i.e., energy needs are less and nutritional needs are higher, special diets may be necessary, participants might have poorly fitting dentures, etc.).

(vii) If a participant needs to follow a special or modified diet recommended by a physician, the adult day care facility shall ensure that the diet is provided in accordance with the physician's orders.

(viii) Assistance in eating shall be provided for participants opening containers, cutting foods, etc.

(ix) The facility shall either prepare the food or have it catered. If catering or contract food service is selected, the alternative food service source used shall be approved by the County Health Depart- ment or appropriate entity. The adult day care facility is responsible for negotiating a contract with and providing payment for services received from the alternative food service source.

(x) Menus.

(A) A menu listing all meals and snacks to be served by the facility during the current one-week period shall be dated and posted in a location conspicuous to participants.

(B) Posted menus shall indicate substitutions.

(p) Assistance with Personal Care.

(i) Staff shall provide special attention, additional supervision, and assistance in activities of daily living, such as feeding and toileting, to participants who require it.

(q) Transportation Services. NOTE: If transportation is not provided by the adult day care facility, the following standards do not apply.

(i) The driver must have an appropriate Wyoming driver's license for that vehicle. The vehicle must be equipped with a manual for first aid, a first aid kit, and a fire extinguisher.

(ii) The vehicle shall be accessible and appropriate for the people using it, considering any physical impairments they might have.

(iii) Every person must have a seat in the vehicle, except those people who remain in their wheelchairs.

(iv) Wheelchairs shall be secured when the vehicle is in motion.

(v) Every person shall be seated while the vehicle is in motion.

(vi) Every seat shall be equipped with a seat belt or shoulder harness. Every person shall be directed to use them.

(vii) Participants shall not be left unattended and/or unsupervised while in a vehicle.

(viii) Adequate liability insurance coverage with a minimum limit of at least $500,000 each occurrence/$500,000 aggregate shall be maintained according to the size of the vehicle and the number of participants being transported.

Section 13. Fire Protection, Emergency, and Evacuation Plans.

(a) Specialized Staff Training.

(i) At least one (1) staff person on the premises at all times during the hours of operation shall have certification by an appropriate provider in first aid (multimedia, Personal Safety, or Standard First Aid Modular) issued within the past three (3) years. NOTE: Adult day care facilities operating on the date these rules become effective shall comply with this standard within six (6) months of the effective date of these rules.

(ii) At least one (1) employee or staff member on the premises at all times during the hours of operation shall have current certification in cardiovascular pulmonary resuscitation (CPR) issued through the American Red Cross or the American Heart Association. The CPR certificate must be renewed every (2) two years. NOTE: Adult day care facilities operating on the date these rules become effective shall comply with this requirement within six (6) months of the effective date of these rules.

(b) Buildings and Equipment.

(i) Each building of the facility and each vehicle shall contain a first aid kit which shall include but not be limited to:

(A) Scissors;

(B) Tweezers;

(D) Adhesive tape;

(E) Band-aids, assorted sizes;

(F) Triangular bandages;

(G) Flexible gauze;

(H) An antiseptic cleansing solution;

(I) An antibacterial ointment;

(J) Bee sting swabs or preparation;

(K) Ice pack or ice bag;

(L) Thermometer; and

(M) Small flash light.

(ii) The first aid kit shall be stored so that it is not accessible to participants but is easily accessible to staff.

(iii) A first aid instructional manual shall be kept with each first aid kit at all times.

(iv) Heating Units.

(A) Gas stoves, coal stoves, wood stoves, oil stoves, portable electric heaters, kerosene heaters, and portable heating units of a similar nature shall not be used in areas used by participants, except in an emergency such as a power outage in cold weather.

(B) When any of the above heating sources are used in an emergency, care shall be taken to protect participants from injuries.

(C) Any heating units used in an emergency shall have been previously inspected and approved by the appropriate fire safety official.

(v) Portable Fire Extinguishers.

(A) The proper type and number of fire extinguishers shall be approved by the fire official having jurisdiction. Rating of the fire extinguishers shall not be less than 2A-10 B:C.

(B) Fire extinguishers shall be inspected and serviced annually by an individual certified by the State of Wyoming. New and serviced fire extinguishers shall have service tags attached showing date of purchase or date of service.

(C) Fire extinguishers shall be mounted to the wall at a location near an exit. The top of the fire extinguisher shall not be more than five (5) feet from the floor level. Extinguishers shall not be stored or mounted in cupboards or broom closets.

(vi) Storage.

(A) Combustible storage under exit stairways shall be prohibited unless such spaces are protected on the enclosed side by one (1) hour fire-resistive construction.

(vii) Smoke Detectors.

(A) Approved smoke detectors shall be installed in facilities. Such detectors shall be installed in accordance with their installation instructions and in accordance with the Uniform Building Code.

(viii) Emergency numbers shall be located near the telephone.

(ix) There shall be an evacuation plan for the removal of participants in case of fire or other emergencies.

(A) The plan shall be posted in a conspicuous place in the building.

(B) Evacuation plans shall be discussed with each participant at the time of admis- sion, and periodically for familiarity.

(x) Furnaces shall be approved and shall be cleaned (including filters) as often as neces- sary to prevent the accumulation of lint and dust.

(xi) Electrical.

(A) Special protective covers for electrical outlets not in use shall be installed in all areas occupied by participants.

(B) Electrical wiring, outlets, switches, etc. shall be installed so there is no fire or shock hazard.

(C) Multi-plug adapters, such as multi-plug extension cords, cube adapters, strip plugs, extension cords, and other devices, that do not comply with the National Electric Code shall not be used.

(i) Plan for Medical Emergencies.

(A) The plan shall include written instructions for handling medical emergencies such as:

(I) Calling the rescue squad;

(II) Calling an ambulance service, and/or participant's physician; and

(III) Providing first aid and CPR, when appropriate.

(B) A licensed physician, registered nurse, licensed practical nurse, or other health professional shall be consulted in preparing the plans.

(C) In medical emergencies, pertinent medical information and history shall be made available to rescue staff and/or sent with the participant if hospitalized.

(ii) Plan Review, Fire Safety, and Emergency Evacuation.

(A) Fire safety and plan review shall meet the requirements of the fire official having jurisdiction and authority.

(I) The plan shall include written procedures to be followed in the event of fire or other emergency. The local fire department or fire prevention bureau shall be consulted in preparing the fire plan, if possible; and

(II) The plan shall include a drawing showing exits, telephones, fire extin- guishers, and fire alarm boxes, if any, in large numbers and letters so that participants can read.

(B) A copy of the fire and emergency plan shall be posted in a conspicuous place on each floor of each building used by participants.

(iii) Exits.

(A) The fire official shall determine the number, placement, and adequacy of exits and other fire safety measures relating to exits in accordance with the Uniform Codes.

(B) Floors above and below the level of the first story shall not be used for adult day care facilities. Basements shall not be used for adult day care facilities.

(D) Exits shall not be obstructed in any manner and shall remain free of any material or matter where its presence would obstruct or render the exit hazardous.

(E) Exit doors shall be able to open from the inside without the use of a key or any special knowledge or effort (i.e., dead bolts, chains, night latches, etc. are unacceptable).

(iv) Porches, steps, stairs, landings, walkways, ramps, and lifts shall be maintained and in good repair and safe condition.

(v) Emergency Evacuation Drills.

(A) Fire drills shall be conducted at least once each month of operation. All fire drills shall be documented to include time, date, name of the person conducting the drill, and the time re- quired for participants and staff to go to an approved location and/or evacuate the building.

(B) A record of the required evacuation drills shall be kept in the facility for one year. The record shall include:

(I) The date of the drill;

(II) The amount of time required to evacuate;

(III) The total number of staff and participants involved;

(IV) Problems encountered, if any; and

(V) The names of all participants who were present in the facility who did participate in the drill, and the reasons for non-participation.

(vi) Other Emergency Plans.

(A) There shall be written plans and procedures to meet other emergencies, includ- ing severe weather, loss of utilities, and missing persons.

(vii) Procedures to Meet Emergencies.

(A) The telephone numbers of the fire department, the rescue squad or ambulance service, the police, and the regional poison control center shall be located in a conspicuous place near each telephone. They shall be written in large enough numbers so that participants can use them.

(B) A written record shall be made and kept on file of all emergencies such as, but not limited to, fires, severe weather emergencies, injuries or sudden illnesses requiring medical treatment.

The record shall include:

(I) Date;

(II) Kind of emergency;

(III) Names of any participants requiring medical treatment;

(IV) Description of the results of the emergency; and

(V) Date and time other persons or agencies were contacted, utilized and/or notified.

(C) Approved numbers or addresses of the adult day care facility shall be placed in such a position as to be plainly visible and legible from the street and/or road fronting the property. Numbers should contrast with their background.

Section 14. Program Evaluation.

(a) Each adult day care program shall have a written plan for internal evaluation of its operation and services. The plan shall include the timetable for initiating and completing the annual evaluation, the parties to be involved, the areas that will be addressed and the methods to be used in conducting the evalua- tion.

(b) A formal evaluation shall be conducted at least annually at the end of the State of Wyoming fiscal year.

(i) Governing body;

(ii) Program director;

(iii) Staff;

(iv) Participants;

(v) Families of participants and/or guardians; and

(vi) Outside agencies/organizations.

(d) In the following four areas, in addition to any others the program may wish to address, the evaluation shall focus on the extent to which the program:

(i) Achieve its goals (the specified goals shall be translated into measurable indicators of performance);

(ii) Assists participants and their families and other caregivers;

(iii) Is efficient and effective in its operation, including the extent to which the program is cost-effective;

(iv) Relates to the community service network and the long-term care continuum; and

(v) Ensures that people with disabilities are not excluded, segregated, or restricted in any way as a result of communication or structural barriers.

(e) A written report of the program evaluation and findings shall be made and kept on file.

Section 15. Grievance and Complaints.

(a) Every participant in an adult day care facility shall have the right to:

(i) Upon admission, review with the day care staff the grievance complaint process and receive updated information at six (6) month intervals.

(ii) Voice grievances on behalf of themselves or others without discrimination or reprisal.

Such grievance includes those with respect to services furnished as well as which have not been furnished.

(iii) Have available in a conspicuous place the telephone numbers and address of the Long- Term Care Ombudsman offices, the Protection and Advocacy office, the local Department of Family Adult Protective Services office, the Medicaid Fraud Control Unit, and the facility's complaint representative.

Section 16. Investigations.

(a) Each adult day care facility shall establish a system of reviewing complaints and allegations of violations of participant's rights and develop internal operating procedures for reporting and resolution of grievances.

(i) In order to ensure that participants continue to be aware of these rights and responsi- bilities outlined in Section 15, a written copy is to be prominently posted in a location that is available to all participants.

(ii) Be informed in writing that the services of the Wyoming Ombudsman are available if participants have concerns regarding the services provided by the adult day care facility.

(iii) Prompt efforts must be demonstrated by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.

Section 17. Licensure.

(a) Shall be in accordance with the current licensure Rules and Regulations for Adult Day Care Facilities promulgated by the Wyoming Department of Health.

(b) Licensure Rules and Regulations are available at a nominal fee from the Office of Health Quality, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, 307-777-7123.

Section 18. Hearings.

(a) Except in matters concerned with the spread of communicable disease, the Division on Aging Program Administrator shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a resolution. Any request for a hearing by the facility shall adhere to the time frames of (b) below.

(b) Any Adult Day Care Facility aggrieved by a decision of the Division on Aging may request a hearing by submitting a written request within ten (10) days of the date of the adverse action at Room 139, Hathaway Building, Cheyenne, WY 82002.

(c) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer shall present the preliminary decisions and reasons to the parties concerned and provide an opportu- nity for a hearing. Any request for a hearing by the facility shall adhere to the time frames of (b) above.

(d) Hearings requested under the terms of these rules and regulations shall be held by the Division on Aging in accordance with the provisions of the Wyoming Administrative Procedures Act and with the contested case rules and regulations of the Wyoming Department of Health.

¹ It is understood that individuals may participate on an infrequent drop-in basis.

History

Effective 1999-07-20

Chapter 8 Program Administration for Boarding Homes

Wyo. Code R. 048.0003.8.12111998 Program Administration for Boarding Homes

RULES AND REGULATIONS

FOR PROGRAM ADMINISTRATION FOR BOARDING HOMES

CHAPTER 8

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to W.S. §9-2-1204 et seq.and the Wyoming Administrative Procedure Act W.S.§16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the day to day operation of boarding homes.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions.

(a) Abuse means any physical or mental injury or sexual assault inflicted on a resident.

(b) Adult means a person who is 18 years of age or older.

(c) Boarding Home means a dwelling or rooming house operated by any person, firm or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal care, but not nursing care, for persons not related to the owner.

(d) Chief Administrative Officer means the Director, Department of Health per W.S.§9-2-101(e), or the designated licensure representative.

(e) Complaint Investigations means those investigations required to be performed by the Long Term Care Ombudsman per W.S. §9-2-1301 through §9-2-1309.

(f) LSC means NFPA 101 Life Safety Code, as promulgated by the Wyoming Department of Health, Construction Rules for Health Facilities, Chapter III.

(g) Licensing Division means the Department of Health, Office of Health Qual- ity, Planning and Program Evaluation.

(h) Neglect means failure to provide care necessary to insure the health, safety, and well-being of a resident; failure to make reasonable effort to discover what care is necessary for the well-being of a resident; or failure to provide a safe and sanitary environment (whether inten- tional, careless, or due to inadequate experience, training, or skill.

(i) HACCP means the Hazard Analysis Critical Control Point.

(j) NFPA means the National Fire Protection Association.

(k) Ombudsman means the Long Term Care Ombudsman as established in W.S. §9-2-1301 through 9-2-1309.

(l) Manager or Operator means the person responsible for the overall operation of the boarding home.

(m) Resident Services means those services a boarding home provides for each resident which include, but are not limited to:

(i) Meals;

(ii) Housekeeping and laundry services;

(iii) Supervision of self administration of medications; and

(iv) A safe and sanitary living environment.

(n) Program Administration means the rules and regulations promulgated by the Department of Health as developed by the Program Division for the day-to-day operation of Board- ing Homes per W.S. §9-2-1208.

(o) Program Division means the Department of Health, Division of Aging.

(p) Resident means a person 18 years or older, unrelated to the provider, who provides compensation for residing in the boarding home.

(q) Survey Division means the Department of Health, Office of Health Quality, Planning and Program Evaluation.

Section 5. Management.

(a) Manager shall:

(i) Be a responsible adult at least 21 years of age or a couple, each of whom is at least 21 years of age;

(ii) Be familiar with and follow these rules;

(iii) Be responsible for the daily operation of the boarding home and for the safety and well-being of residents. In the managers absence, there shall be a responsible designee at least 21 years of age (who is not a resident of the facility) to assume the responsibility of the boarding home;

(iv) Provide orientation to all new employees which shall include resident rights, evacuation and emergency procedures, training in policies and procedures, and competent supervision designed to improve resident care;

(v) Have a current tuberculin skin testing prior to licensure. The staff shall have tuberculin skin testing prior to employment and annually thereafter;

(vi) Provide verification of a Department of Family Services central registry check on self and/or manager, and all employees hired at the time or after the filing of these rules. The manager is responsible for initiating and following this process to completion.

(vii) Not act as, or become, the legal guardian of or have power of attorney for any resident.

(b) Staffing.

(i) There shall be an adequate number of personnel on duty to maintain order, safety, and cleanliness of the premises, to prepare and serve meals, to keep an adequate supply of clean linens, to assist the residents in personal needs, recreational activities, and to meet the operational needs of the home.

(ii) No person with a reportable communicable, contagious or infectious disease shall be employed.

(iii) A file for each employee shall be maintained and available to the sur- veyor containing at least the following information:

(A) Name, current address and telephone number;

(B) Social Security Number;

(D) Work experience;

(E) Date of employment;

(F) Job description;

(G) Documentation of tuberculin testing; and

(H) Employee training, orientation, and emergency procedure check- list.

(i) There shall be written policies and procedures available to residents, their families or legal representatives, staff, and the public. The policies and procedures shall include, but not be limited to:

(A) Residents Rights;

(B) Admission, transfer, and discharge of residents;

(D) Departure from and return to facility;

(E) House rules, to include freedom permitted and limitations neces- sary to protect the rights of others;

(F) Visiting hours;

(G) Religious services;

(H) Notifications in change in resident status;

(I) Resident records;

(J) Emergency care, disaster plans;

(K) Smoking policy;

(L) Fire plan;

(M) Personnel policies;

(N) Reporting of all complaints to the Long Term Care Ombudsman;

(O) Grievance policy; and

(P) Quality Assurance Plan.

(d) Admission, Transfer, and Discharge.

(i) The written admission policy shall include restrictions to admission to a boarding home.

(ii) Residents shall not be accepted, nor retained, if:

(A) Their condition indicates the need for assisted or skilled nursing care;

(B) They have reportable communicable diseases or infectious con- ditions;

(C) They have physical limitations preventing ambulation. Persons requiring wheelchairs or walkers shall be able to exit the building without staff assistance;

(D) They require assistance in transferring to and from a wheelchair;

(E) They have mental defects which interfere with their ability to understand and follow instructions relating to rules of the boarding home;

(F) They require intravenous therapy;

(G) They are incapable of self-administration of medications; or

(H) They are wanderers, or have destructive, aggressive or violent behavior toward self or others.

(iii) Each resident shall designate a personal physician and dentist to be called in case of an emergency. The boarding home shall make necessary arrangements to secure the services of a licensed physician if the residents own physician is not available.

(iv) In the event of illness or injury of a resident, the residents personal physician and the residents designated representative shall be called.

(e) Transfer and Discharge.

(i) A resident may not be moved, transferred, discharged or asked to leave without fourteen (14) days written notice to the resident, or the residents legal representative, guardian or conservator, stating the reasons for the request. Residents shall have the right to ob- ject to the request, except where undue delay might jeopardize the health, safety or well-being of the resident or others.

(ii) The written notice shall include the name, address, and telephone num- ber of the person giving the notice; the date of the notice; the residents name; the reason for the transfer or discharge; the effective date; the location to which the resident is being transferred or discharged; and the name and telephone number of the State Long Term Care Ombudsman.

(f) Resident Records and Reports.

(i) Residents records shall be current, organized and maintained in indi- vidual folders which shall be available on the premises. Resident records shall be made available to the resident and the Long Term Care Ombudsman, Program Division and the Licensing Division upon request and include the following:

(A) The residents history and physical and the current physicians statement or certificate of residents health and suitable placement. The physicians statement or certificate of residents health shall be updated annually.

(B) Individual admission form shall contain, but not necessarily be limited to, the following information:

(I) Full name of resident and former address;

(II) Date of admission;

(III) If applicable, name, home address, telephone number of interested family member, designated representative, power of attorney, or guardian;

(IV) Medicare number or other medical insurance; and

(V) Sex, race, date of birth, social security number, and former occupation.

(ii) Written records of all accidents, injuries and illnesses, and subsequent treatment occurring after admission.

(iii) The boarding home shall notify the Program Division within Seventy-Two (72) hours of an unusual death, serious injury or accident, fire or other emergency situations. All such occurrences shall be documented.

(iv) A written account of all personal possessions and funds deposited with the boarding home.

(v) A signed copy of the residents rights.

(vi) The resident shall be assured of confidential treatment of all informa- tion in his/her records, and his/her written consent (or consent of family or guardian) shall be required for the release of information to persons not otherwise authorized to receive it.

(vii) All residents records shall be retained for a minimum of six (6) years after the resident has left the home and may be disposed of after that time, unless litigation is pending.

(viii) All records shall be protected from damage by fire, water and other hazards.

Section 6. Complaint Investigations.

(a) Formall complaints and problems of residents shall be referred in writing to the Long Term Care Ombudsman.

(b) The office of the Ombudsman shall complete all complaint investigations within an appropriate time frame depending upon the seriousness of the allegations.

(c) Written reports of investigations and the status of resolutions shall be pro- vided to the Departments Director designee, which is the Licensing Division, within thirty (30) days after the investigation.

Section 7. Grievance Procedure.

(a) The written grievance procedure shall establish a system of reviewing com- plaints and allegations of residents right violations to include, but not limited to:

(i) Resident method to voice grievances;

(ii) Documentation of the providers response to verbal and written resi- dent grievances;

(iii) List of agencies, with address and telephone numbers for residents to contact if grievances are not addressed satisfactorily (e.g. State Long Term Care Ombudsman); and

(iv) Written reports of the grievances and resolutions shall be provided to the Department Directors designee, which is the Licensing Division, within ten (10) days after the grievance is filed.

Section 8. Residents Rights.

(a) Every resident in a boarding home shall have the right to:

(i) Private and unrestricted communication. This right shall include, but is not limited to:

(A) Receive, send and mail sealed, unopened correspondence. No residents incoming or outgoing correspondence shall be opened, delayed, held or censored;

(B) Reasonable access to a telephone for private communications; and

(ii) Present grievances on his/her own behalf or others to the staff or public officials or to any other person without justifiable fear of reprisal and to join with other residents or individuals within or outside of the facility to work for improvements in resident care.

(iii) Manage his/her own financial affairs, unless the resident delegates, in writing, someone else of the residents choosing and that person accepts the responsibility.

(iv) Be fully informed, prior to or at the time of admission, and during stay, of services available in the boarding home and of related charges including any charges for services not covered by the boarding homess basic per diem rate.

(v) Physical and emotional privacy in treatment, living arrangements and in caring for personal needs, including, but not limited to:

(A) Privacy for visits by spouse. If both spouses are residents of the boarding home, they shall be permitted to share a room unless medically contraindicated as docu- mented by the residents physician in the residents record.

(B) Privacy concerning health care.

Persons not directly involved in the residents care shall require the residents permission to authorize their presence.

(C) Confidentiality of health and personal records, and the right to approve or refuse their release to any individual outside the boarding home except in the case of the residents transfer to another facility or as required by law.

(vi) Not be required to perform services for the boarding home except for therapeutic purposes.

(vii) Meet with, and participate in activities of social, religious and commu- nity groups at the residents discretion.

(viii) Retain and use personal clothing and effects and to retain, as space permits, other personal possessions in a reasonably secure manner.

(ix) Be transferred or discharged, and be given reasonable advance notice of any planned transfer or discharge, and an explanation of the need for and alternatives to such transfer or discharge. The facility to which the resident is to be transferred must have accepted the resident for transfer, except in a medical emergency.

(x) Be free from mental and physical abuse.

(xi) Receive adequate and appropriate care within the capacity of the boarding home.

(b) The manager shall give every resident a copy of his or her rights upon admis- sion.

(c) The rights shall be read to those residents who are unable to read, and any questions a resident may have shall be answered.

(d) A copy of the residents rights shall be kept in the residents record, signed and dated by the resident.

(e) Each boarding home shall establish a system of reviewing complaints and allegations of violations of residents rights. The boarding home shall designate a specific individual who, for the purpose of effectuating this system shall report to the manager.

(f) In order to ensure that residents continue to be aware of these rights and responsibilities outlined in this Section, a written copy shall be prominently posted in a location that is available to all residents.

Section 9. Infection Control.

(a) The provider shall maintain a safe and sanitary environment for residents and staff. This shall include but not be limited to:

(i) Staff shall practice judicious handwashing when there is direct contact with residents or their food.

(ii) Bathrooms shall have soap and toilet paper. Paper towels or a hand blower or rack space adequate for each resident using the bathroom to hang his/her personal towel. Use of a common towel is prohibited.

(iii) Clean drinking glasses shall be available for the residents. Common drinking glasses are prohibited.

(iv) Each resident shall have an individual comb, toothbrush, towels and washcloths.

(v) Housekeeping practices and procedures shall be employed to keep the home free of offensive odors and accumulations of dirt and dust.

(vi) Floors shall be maintained clean.

(vii) Garbage and trash shall be stored in tightly covered containers.

(viii) The home shall be maintained free of insects, rodents and other ver- min.

(ix) Private water systems shall be tested and found to be safe and potable before a license will be granted. Subsequent testing for safety and potability will be done monthly and records retained for at least two (2) years.

(x) Linens and laundry. Laundry service for residents personal clothing shall be provided. Two complete changes of clean bed linen shall be on hand for each licensed bed. The use of torn or unclean bed linen is prohibited. Measures will be taken to ensure that residents clothing is not lost or misplaced in the process of laundering.

(A) Bed linen will be changed as necessary but at least weekly. Additional blankets or pillows will be provided as the need arises. Rubber or water protective sheets shall be used if needed.

(B) All linens and laundry shall be bagged or placed in a hamper before being transported to the laundry area.

(C) Soiled linens shall not be transported through, sorted, processed or stored in kitchens, food preparation areas or food storage areas.

Section 10. Food Service and Nutrition.

(a) A minimum of three (3) meals in a twenty-four (24) hour period shall be pro- vided each resident. When a resident refuses food, substitutes of the same nutritional value shall be offered.

(b) Individuals with food preparation responsibilities shall be in good health and shall practice safe food handling techniques in accordance with the current edition of Food Code published by the U.S. Public Health Service, Food and Drug Administration.

(i) Such food handling techniques include preparing, holding, and storing food at safe temperatures.

(ii) Reheating potentially hazardous leftover foods shall meet HACCP (Haz- ard Analysis Critical Control Point) temperature guidelines for safety.

(c) If a resident requires a special diet, a copy of the diet shall be obtained from the residents physician. A copy of the diet order shall be kept in the residents file and a copy of the diet shall be kept in the kitchen.

(d) Residents for whom such diets cannot be supplied shall not be accepted or retained in residence.

(e) There shall be enough food on hand to meet at least a weeks menus.

(f) Menus shall be prepared at least a week in advance and posted in the kitchen. Written menus shall be corrected to show the food actually served and the corrected copy kept on file for three (3) months.

(g) The kitchen and dining area shall be kept clean, sanitary and provided with suitable furniture and adequate space to comfortably seat all residents.

(h) Only dishes and utensils with the original smooth finishes shall be used. Cracked, chipped, scratched, permanently stained dishes, cups or glasses, damaged, corroded utensils or cookware shall not be used. Equipment shall be easily cleanable.

(i) Cleaning and sanitizing of dishes and silverware shall be done by automatic dish washers.

(j) Persons handling soiled tableware and/or silverware shall wash their hands before handling clean ware.

(k) No fly strips shall be allowed in the kitchen or dining area.

(l) Filters, exhaust hoods, ranges, deep fat fryer, ovens and other similar items shall be operable and maintained clean.

Section 11. Furnishings.

(a) Provisions shall be made for privacy in all bath and toilet rooms.

(b) Automatic deodorizers or aerosol freshener shall not be used except in bath- rooms.

(d) Married residents shall be allowed to occupy the same room and the use of a double bed, if so desired. This is subject to limitations provided in Section 8(a)(v)(B).

(e) No room shall be used for a residents bedroom which can only be reached by passing through another residents room.

(f) Bedrooms shall be clean, well lighted, ventilated and equipped with the follow- ing:

(i) All bedroom windows shall have drapes, curtains, shades or blinds to assure privacy;

(ii) Beds shall be a standard size in width (39"), (rollaway-type beds, cots and folding beds shall not be used), equipped with comfortable, clean mattresses and pillows. Mattresses shall be professionally renovated or replaced as needed. Extra long beds shall be used to accommodate tall residents;

(iii) Cabinet or bedside table;

(iv) Noncombustible wastebasket;

(v) Chair; and

(vi) Common closets utilized by two (2) or more residents shall be provided with dividers for separation of each residents clothing. All closets shall be equipped with doors. Free-standing closets shall be deducted from the square footage in the sleeping room.

(g) Residents shall be permitted to bring personal items and furnishings for their rooms if they desire and space is available.

(h) There shall be at least one (1) bedside screen available to provide resident privacy when needed.

Section 12. Medications.

(a) Drugs shall be self-administered.

(b) The manager or staff shall be responsible for providing necessary assistance to the resident in taking his medications; including but not limited to:

(i) Reminding the resident to take medications;

(ii) Removing medications containers from storage;

(iii) Assisting with the removal of the medication cap;

(iv) Assisting with the removal of the medication from a container for resi- dents with a disability which prevents independence in this act; and

(v) Observing the resident take the medication.

(c) The facility shall maintain a record of medication, for a period of one year, doses not taken by any resident in the facility.

(d) The medication record shall indicate the reason for the omission of any dose of medication.

(e) A record of medications taken on a P.R.N, basis shall be kept for a period of one year.

(f) Prescription drugs shall be from a licensed pharmacy, labeled with the name, address, and telephone number of the pharmacist, name of the resident, name and strength of the drug, directions for use, date filled, prescription number and name of physician. Controlled sub- stances shall have a warning label on the bottle.

(g) There shall be locked storage space provided for residents medications.

(h) The manager shall destroy all discontinued prescriptions other than controlled substances by flushing down the toilet. An appropriate notation of disposition noting quantity, name of drug and prescription number shall be documented on the residents record and signed by the person disposing of the medication.

(i) Controlled substances shall be destroyed by the State Board of Pharmacy -contact (307) 234-0294.

Section 13. Building and Physical Plant.

(a) There shall be an adequate supply of hot and cold water available at each lavatory, bathtub/shower, kitchen sink, dishwasher, and laundry equipment.

(i) All plumbing shall be maintained in good repair and in accordance with the requirements of the Uniform Plumbing Code.

(b) Fireplaces shall be securely screened and glassed in.

(c) The home shall be maintained so that it is free of hazards, such as loose or broken window glass, loose or cracked floors or floor coverings, cracked or loose plaster on walls or ceilings.

(d) At least one primary grade level entrance to the building shall be freely acces- sible for wheelchairs.

Section 14. Evacuation Capability, Emergency Procedures and Fire Safety.

(a) Evacuation Capability.

(i) Fire safety and evacuation review shall meet the requirements of Chap- ter 23 of the NFPA Life Safety Code 101, 1994 edition.

(b) Emergency Procedures.

(i) Disaster and Emergency Preparedness.

(A) The facility shall have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents.

(B) The facility shall train all employees in emergency procedures when they begin work in the facility. The facility shall review the procedures with existing staff at least once in each 12 month period.

(i) Portable Fire Extinguishers.

(A) Fire Extinguishers shall be inspected and serviced annually by an individual certified by the State of Wyoming. New and serviced fire extinguishers shall have service tags attached showing date of purchase and/or date of service.

(B) Fire Extinguishers shall be mounted to the wall at a location near an exit. The top of the fire extinguisher shall not be more than five (5) feet from the floor level. Extinguishers shall not be obstructed or obscured from view. Extinguishers shall not be stored or mounted in cupboards or broom closets.

(ii) Emergency numbers shall be located near the telephone in large print.

(iii) There shall be an evacuation plan for the removal of residents in case of fire or other emergencies.

(A) The evacuation plan shall be posted in a conspicuous place in the building.

(B) The evacuation plan shall be discussed with each resident at the time of his/her admission.

(C) The new resident shall be conducted through the entire proce- dure, including the location of all exits, during his first day in the boarding home. This shall be documented in the resident record.

(iv) A simulated drill shall be performed every month at irregular hours, and all residents shall participate. A written record of each drill shall be kept on file.

(d) Furnaces shall be approved and shall be cleaned (including filters) as often as necessary to prevent the accumulation of lint and dust. No stove or combustion heater shall be so located as to block escape in case of fire arising from malfunction.

Section 15. Licensing.

(a) Shall be in accordance with the current licensure rules and regulations for Boarding Homes as promulgated by the Department of Health.

(b) Copies of the licensure rules can be obtained from the Licensing Division, Office of Health Quality, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, Telephone: (307)777-7123

History

Effective 1998-12-11

Chapter 9 Program Administration of Home Health Agencies

Wyo. Code R. 048.0003.9.10152001 Program Administration of Home Health Agencies

WYOMING DEPARTMENT OF HEALTH

AGING DIVISION

RULES

For

PROGRAM ADMINISTRATION OF HOME HEALTH AGENCIES

CHAPTER 9

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Senior Citizens Act, W.S. §9-2-1201 et seq., and the Wyoming Administrative Procedures Act at W.S. §16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the day-to-day operation of home health agencies.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions.

The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, gender pronouns are used interchangeably. The drafters have attempted to utilize each gender pronoun in equal numbers, in ran- dom distribution. Words in each gender shall include individuals of the other gender.

For purpose of these rules, the following shall apply:

(a) "Age of majority." The age at which a child becomes an adult, which is currently de- fined by W.S. §14-1-101 as the age of eighteen (18) years.

(b) "Central Registry." The registry maintained by the Wyoming Department of Family Services pursuant to W.S. §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults. The registry information is available by call- ing 307-777-5894.

(c) "Certified Nurse Assistant (CNA)." An individual who is currently certified by the Wyoming State Board of Nursing and his/her certification has been verified by the home health agency Administrator or his/her designee.

(d) "Chief Administrative Officer." The Director, Department of Health as per W.S. §9-2-101(e), or the designated Licensure representative.

(e) "Client." A person who is served by, or uses the services of a home health agency, either with or without charge.

(f) "Complaint." A formal allegation of injustice or perceived harm referred to an outside party or agency.

(g) "Complaint Investigations." Those investigations required to be performed by the State Long Term Care Ombudsman as per W.S. §9-2-1301 through W.S. §9-2-1309 or by the State Survey Agency as per the agreement dated June 18, 1985 between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming.

(h) "Days." Calendar days.

(i) "Dietitian." A person who is registered by the American Dietetic Association and pro- vides nutritional and dietary consultation services to the home health agency and individual clients.

(j) "Fidelity bond." A contract of fidelity insurance, in which there is an agreement to insure another against loss arising from the want of honesty, integrity or fidelity of an employee of the home health agency.

(k) "Governing Body." The individual(s), group, or agency that has ultimate authority and responsibility for establishing client care policies, personnel policies, and providing for organization, management and planning of the home health agency.

(l) " Grievance." A concern of inequitable or inaccurate action that is handled through the agencies internal grievance procedure.

(m) "Health Care Services." Includes, but is not limited to, nursing, physical therapy, speech pathology, occupational therapy, respiratory therapy, medical social work, home health aide, and di- etary services. All staff shall be licensed/certified in accordance with the Wyoming State Statutes.

(n) "Homemaker." A person who assists with environmental services such as housekeep- ing, basic meal preparation, shopping and laundry. Homemakers provide no personal care.

(o) "Home Health Agency." Any group, public agency, private organization, or any indi- vidual person who is primarily engaged in arranging for and directly providing two or more health care services to persons at their residence.

(p) "Home Health Aide." A nursing assistant certified by the Wyoming Board of Nursing who has received sixteen (16) hours of additional training on home health issues, approved by the Wyoming Board of Nursing.

(q) "Licensing Division." The Department of Health, Office of Health Quality.

(r) "Licensed Practical Nurse (LPN)." A person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(s) "Occupational Therapy Assistant." A person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Certified Occupational Therapy Assistant pursuant to W.S. §33- 40-102 (a)(ii).

(t) "Occupational Therapist." A person who is licensed by the Wyoming Board of Occupa- tional Therapy to practice as a Registered Occupational Therapist pursuant to W.S. §33-40-102(a)(iv).

(u) "Occupational Therapy." The use of purposeful activity with individuals who are lim- ited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities or the aging process in order to maximize independence, prevent disability and to maintain health. The practice encompasses evaluation, treatment and consultation. Occupational therapy is provided by an occupational therapist or by a certified occupation therapy assistant under the supervision of an occu- pational therapist.

(v) "Personal Care." Activities such as, but not limited to, bathing, grooming, feeding, ambulating, exercising, oral hygiene, and skin care.

(w) "Physical Therapy Assistant." A person who is licensed to practice in the State of Wyoming as a physical therapy assistant pursuant to W.S. §33-25-101(a)(v).

(x) "Physical Therapy." The evaluation, instruction or treatment of a human being to pre- vent, correct, alleviate or limit physical disability due to injury, disease or any other physical or mental condition by the utilization of physical measures such as exercise, massage, heat, cold, air, light, water, electricity or sound, and rehabilitative procedures including training in functional activities and the performance and interpretation of tests and measurements of bodily functions as an aid in the examina- tion, evaluation or treatment of any human conditions for the purpose of correcting or alleviating an individual's physical or mental disability. Physical therapy also includes the supervision of physical therapy activities, physical therapy consultation and the establishment and modification of physical therapy programs, but physical therapy shall not include radiology or electro-surgery or authorize the diagnosis of disease. Treatment by physical therapy shall be rendered subject to W.S. §33-2-102.

(y) "Physical Therapist." A person who is licensed to practice physical therapy in the State of Wyoming pursuant to W.S. §33-25-101.

(z) "Plan of Care." An individualized plan developed for each client which, at a minimum addresses: diagnoses, medications, types of services, equipment, visit protocol, functional limitations, activity level, nutrition requirements, treatments and safety issues, and any other information necessary to care for the client.

(aa) "Primarily Engaged." A relationship between a provider of services and a client whereby provider offers to arrange for or directly provide health care services at a client's residence and the client accepts the offer. When this relationship is agreed upon, the provider becomes primarily en- gaged in providing health care services to the client.

(bb) "Program Administration." The rules and regulations promulgated by the Department of Health and developed by the Program Division for the day-to-day operation of a home health agency per W.S. §9-2-1208.

(cc) "Program Division." The Department of Health, Aging Division.

(dd) "Provider." A licensed home health agency.

(ee) "Registered Nurse (RN)." A graduate of an approved school of professional nursing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120 et. seq.

(ff) "Respiratory Care." The health specialty responsible for the treatment, management, diagnostic testing, control, and care of clients with deficiencies and abnormalities associated with the cardiopulmonary system.

(gg) "Skilled Services." Professional services provided by a Registered Nurse, Licensed Practical Nurse, Physical Therapist, Occupational Therapist, Speech Language Pathologist, Respira- tory Therapist, Social Worker, or Registered Dietitian.

(hh) "Speech Language Pathologist." A person who is licensed in the State of Wyoming to practice speech language pathology as per W.S. §33-33-101 through W.S. §33-33-309.

(ii) "Speech Pathology." The application of principles, methods, and procedures for the evaluation, monitoring, instruction, habilitation, or rehabilitation related to the development and disor- ders of speech, voice, or language for preventing, identifying, evaluating and reducing the effects of such disorders and conditions.

(jj) "Social Worker." Those services provided by a qualified social worker or by a qualified social service assistant under the supervision of a qualified social worker as per W.S. §33-38-106, and according to the client's plan of care.

(kk) "State Survey Agency." The Department of Health, Office of Health Quality which has the primary responsibility to determine whether health care providers/suppliers do or do not meet fed- eral certification standards to participate in the Medicaid and/or Medicare programs as per the agree- ment dated June 18, 1985 between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming.

(ll) "Survey." An on-site evaluation conducted by the Survey Division or its designated representative to determine compliance with State rules and regulations for Home Health Agencies.

(mm) "Survey Division." The Department of Health, Office of Health Quality.

(nn) "Therapy services." Include physical therapy, occupational therapy, and speech lan- guage therapy.

(oo) "Unskilled Services." Any service provided by the agency that is not skilled services.

Section 5. Organization and Administration.

(a) Governing Body. The home health agency shall have a governing body which has legal authority and responsibility to operate the home health agency. The governing body shall:

(i) Obtain a fidelity bond for client protection arising from the want of honesty, integrity or fidelity of any employee. The bond shall consist of no less than $2500 and shall be aug- mented in relation to the number of employees.

(ii) Provide verification of a central registry check on all employees hired at the time of, or after, the filing of these rules. The individual, agencies or corporations are responsible to initiate and follow this process to completion.

Central Registry information can be obtained by contacting the Department of Family Services at 307-777-5894. (This number may be subject to change.)

(iii) Adopt, revise, and approve personnel policies; including;

(A) Frequency and content of evaluations; and

(B) Assurance of confidentiality of information obtained from the Central Registry.

(iv) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client level.

(v) Appoint a qualified administrator who is designated in writing as responsible and available for all aspects of agency operation.

(A) A qualified administrator is:

(l) A licensed physician, registered nurse, or college graduate with a bachelor's degree who has a minimum of three (3) years of health care management experience; or

(ll) A person without a college degree may qualify by obtaining and documenting the equivalent of six (6) years of supervisory experience in health care management.

(B) The administrator and supervisory nurse may be the same individual if the individual is dually qualified.

(C) The administrator must identify in writing an individual who is qualified and authorized to act on behalf of the administrator when the administrator is not available.

(vi) Employ a supervisory nurse who is a registered nurse and who has at least one (1) year home health experience. The supervisory nurse must be available during the normal hours of operation. In lieu of the one (1) year home health experience requirement, a consultation agreement shall suffice when the agreement:

(A) Is in writing and signed by all parties involved;

(B) Enables the supervisory nurse to have immediate contact, seven (7) days week, twenty-four (24) hours per day with a registered nurse who has at least one (1) year of home health experience;

(D) Requires the consultations to be documented and on file at the location of the supervisory nurse.

(vii) Develop an effective, ongoing, agency-wide, written quality management pro- gram which ensures and evaluates quality of care provided to all clients in accordance with W.S. §35- 2-910.

(viii) Grievance Procedure.

(A) The written grievance procedure shall establish a system of reviewing complaints and allegations of clients' rights violations to include, but not be limited to:

(I) Client method to voice grievances;

(II) Documentation of the home health agency's response to verbal and written client grievances;

(III) List of appropriate agencies, with addresses and telephone num- bers for clients to contact if grievances are not addressed satisfactorily; and

(IV) Written reports of all unresolved grievances shall be provided to the Licensing Division within ten (10) days after the grievance is filed with the home health agency. (If the ten (10) day requirement cannot be met the Licensing Division should be contacted.)

(V) Resolved grievances and the resolutions shall be kept on file in the agency office.

(ix) Complaint Investigations.

(A) Clients' complaints and problems shall be referred in writing to the State Long Term Care Ombudsman.

(B) The Office of the Ombudsman shall complete all complaint investiga- tions within an appropriate time frame depending upon the seriousness of the allegations.

(C) Written reports of investigations and the status of resolutions completed by the home health agency shall be provided by the State Long Term Care Ombudsman to the Licensing Division, within thirty (30) days after the completion of the investigation.

Exception: Those complaints or problems reported directly to the State Survey Agency or referred by the State Long Term Care Ombudsman to the State Survey Agency shall be investigated by the State Survey Agency as per the Agreement between the Secretary of the U.S. De- partment of Health and Human Services and the State of Wyoming dated June 18, 1985.

(x) Employee Personnel Records.

(A) There shall be one (1) person designated responsible for maintaining confidentiality.

(xi) Employee Health.

(A) The home health agency shall develop policies and procedures for em- ployee health including a policy that identifies communicable diseases that could put the client popula- tion at risk.

(B) The home health agency must document that the employee is free of communicable diseases that could be a risk to the client population.

(xii) Advanced Directives.

(A) The home health agency shall adopt policies which assure that it pro- vides information on advanced directives to clients. If the client's advanced directives are known, they shall be followed by the home health agency.

(xiii) Clients' Rights.

(A) A home health client has the right to:

(l) Be treated with dignity, consideration and respect.

(ll) Have his/her property treated with respect,

(lll) Receive a timely response to his/her request for service.

(lV) Be fully informed upon admission of the care and treatment that will be provided, how much it will cost, and how payment will be handled.

(V) Be informed in advance of any changes in care to be furnished.

(Vl) Be informed in advance if he/she will be responsible for any pay- ment.

(Vll) Receive care from professionally trained personnel. Be informed of the names and responsibilities of care providers, and to have the right of choice in care providers.

(Vlll) Participate in designing a care plan, and periodically updating it as his/her condition changes. Refuse treatment and to be told the consequences of his/her actions.

(lX) Expect confidentiality of all information related to his/her care, within required regulations.

(X) Be informed within a reasonable time of anticipated termination of service. Be referred elsewhere, if he/she is denied services based solely on his/her ability to pay.

(Xl) Authorize discontinuation of treatment which will be respected in accordance with the home health agency's policy.

(Xll) Know how to make a complaint or grievance or recommend changes in agency policies and services, and have the freedom to do so.

(Xlll) Call the home health agency administration during regular office hours.

(XlV) Call a home health hotline number as provided by the provider.

(xiv) Notification.

(A) Prior to admission all prospective clients shall be notified if the home health agency is not Medicare and/or Medicaid certified.

(B) The responsible party shall be notified of the service charges at the time of admission and notified of changes in the charges at least thirty (30) days in advance of the changes.

Section 6. Home Health Aide.

(a) Must be a CNA and have completed training to ensure competency in the home setting. This training must be documented and retained in the employee personnel record.

(b) If the client requires skilled services in the home, the home health aide must be super- vised by a RN or LPN at least every thirty (30) days.

(d) Instructions based upon written care plans shall be provided to home health aides by the supervisory nurse at least every sixty (60) days or as the client's condition warrants.

Section 7. Homemaker.

(a) If homemaker services are provided, they may be furnished directly by the home health agency or through contract agreement with a vendor.

(b) The homemaker assists with instrumental activities of daily living, such as housekeep- ing and homemaking services, in order to preserve a safe, sanitary home and to enhance family life. The homemaker does not provide any personal care.

(i) Examples of duties include but are not limited to:

(A) Housekeeping;

(B) Shopping;

(D) Essential errands;

(E) Basic meal preparation;

(F) Meal planning (except for clients on therapeutic diets); and

(G) Maintaining a safe and sanitary environment.

(ii) Written service plan instructions to the homemaker shall be provided by the supervising professional.

(iii) The written instructions shall be reviewed by the homemaker and the supervis- ing professional as frequently as the client's condition requires, but at least once every ninety (90) days.

(A) The homemaker shall be present during the supervisory visit.

(B) The supervisory visits shall occur at the client's home.

(C) The supervisory visits shall be conducted by an RN or LPN no less than every ninety (90) days for unskilled services.

(i) The following training areas shall be incorporated into home health agency policy and completed before any client assignment.

(ii) Training shall be a minimum of eight (8) hours, and shall be documented in the homemaker's personnel record. Training shall include:

(A) Orientation to homemaker services;

(B) Understanding and working with various client populations;

(D) Communication;

(E) Practical knowledge and skill in homemaking;

(F) Maintaining a clean, safe, and healthy environment;

(G) Universal precautions;

(H) Emergency procedures; and

(I) Client Rights and obligations.

(d) Homemaker Service Plan.

(i) If homemaker services are the only service provided, a service plan shall be developed by a supervisor and shall consist of the following:

(A) The specific procedures to be done;

(B) The number of times per week the procedures are to be completed, and appropriately spaced during the week;

(D) Procedures to be followed in an emergency situation.

Section 8. Client Records.

(a) Must be maintained for every client receiving services.

(b) Client records must be retained for a period of six (6) years by the agency.

Section 9. Licensing.

(a) Shall be in accordance with the current Licensure Rules and Regulations for Home Health Agencies as promulgated by the Department of Health.

(b) Copies of the Licensure rules can be obtained from the Licensing Division.

Office of Health Quality

2020 Carey Avenue, 8th Floor Cheyenne, WY 82002

Telephone: (307) 777-7123

Fax: (307) 777-7127

History

Effective 2001-10-15

Chapter 10 Program Administration of Hospice Programs

Wyo. Code R. 048.0003.10.04012016 Program Administration of Hospice Programs

State of Wyoming

Department of Health

Healthcare Licensing and Surveys

Rule for Hospice Programs

CHAPTER 10

Section 1. Authority. This rule is promulgated by the Wyoming Department of Health pursuant to W.S. §9-2-1204 et seq., W.S. §35-2-901 et seq., and the Wyoming Administrative Procedure Act, W.S. §16-3-101 et seq.

Section 2. Purpose. This rule has been adopted for the day-to-day operation of Hospice Programs and to protect the health, safety, and welfare of hospice program patients and hospice program employees.

Section 3. Severability. If any portion of this rule is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

(a) "Acceptable Plan of Correction" means the State Survey Agency approved hospice plan to correct deficiencies following a survey conducted by the State Survey Agency or its designated representative. The plan of correction shall be a written document and shall provide, but not necessarily be limited to, the following information:

(i) Who is responsible for the correction;

(ii) What was done or will be done to correct the problem;

(iii) How systemic improvement action will be implemented into a Quality Improvement and Performance Program in order to prevent the likelihood of the deficient practice from reoccurring;

(iv) Who will monitor to ensure the situation does not develop again; and

(v) An appropriate date, not to exceed forty-five (45) days after the last day of survey, for the correction of deficiencies.

(b) "Central Registry" means the registry operated by the Wyoming Department of Family Services pursuant to W.S. §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation, or abandonment of disabled adults. The registry information is available by calling 307-777-5894.

(c) "Complaint Investigations" means those investigations required to be performed by the Long Term Care Ombudsman per W.S. §9-2-1301 through W.S. §9-2- 1309 or by the State Survey Agency per W.S. §35-2-901 through W.S. §35-2-910.

(d) "Day Care Center" is an optional part of the hospice program which provides health and social services to a hospice patient on a regularly scheduled basis. The hospice day care center is governed by the licensed hospice program.

(e) "Employees" means a paid or volunteer members of the hospice team.

(f) "Family" means those individuals who are closely linked with the patient including, but not limited to, the immediate family, the primary caregiver, and individuals with significant personal ties. The patient and family is considered the unit of care.

(g) "Hospice Patient" means a person diagnosed as terminally ill. This person, alone or in conjunction with a family member or members, has voluntarily requested admission and been accepted in the hospice program.

(h) "Hospice Volunteer" is a professional, paraprofessional, or lay person trained in providing support, patient care, or companionship to the patient and family.

(i) "Inpatient Respite Care" means the care provided to patients who temporarily reside in hospice to allow for caregiver respite.

(j) "Interdisciplinary Team" means a group of individuals who collectively have expertise in meeting the special needs of the hospice patient and his/her family. Appropriate staff/volunteers are included as needed. Coordination and communication among team members is carried out on a regular basis.

(k) "License" means the authority granted by the State Survey Agency to operate a hospice program.

(l) "Life Safety Code" means National Fire Protection Association 101 Life Safety Code cited in the Wyoming Department of Health, Chapter 3 Construction Rules and Regulations for Healthcare Facilities.

(m) "Medical Director" means an individual who is a doctor of medicine or osteopath, licensed by the State of Wyoming, and who is designated by the hospice as having overall responsibility for the medical component of the hospice program.

(n) "Non-Hospice Respite" means the care provided to a chronically ill adult in an approved facility to allow for caregiver respite not to exceed thirty (30) continuous days in duration.

(o) "Non-Hospice Respite Client" means an adult who has a long-term or chronic illness requiring caregiving by another person.

(p) "Nursing Services" means those services provided by or under the direction of a Registered Nurse based on a plan of care developed by the interdisciplinary team. These services may be provided by Licensed Registered Nurses, Licensed Practical Nurses, or Certified Nursing Assistants/Home Health Aides as appropriate.

(q) "Palliative Care" means comfort care rather than curative care with an emphasis on pain and symptom control so a person can live the last days of life with dignity and comfort at home or in a home-like setting. Palliative care:

(i) affirms life and dying as a normal process;

(ii) neither hastens nor postpones death;

(iii) provides relief from pain and other distressing symptoms;

(iv) integrates the psychological and spiritual aspects of patient care; and

(v) offers a support system to help the family cope during the patient's illness and in their own bereavement.

(r) "Psychosocial Services" means those counseling and casework services which address the social, economic, psychological, and emotional needs of patients and families. Psychosocial services include, but are not limited to, psychosocial assessment of the patient and family, counseling to assist with the stress of terminal illness, assistance in planning for care, and coordination of community resources.

(s) "Spiritual Services" means those services that help patients and/or caregivers to integrate the dying experience into his/her life; to find meaning and purpose in what remains of life, and to further his/her appreciation of spiritual values that give support and hope in coping with the changes that are taking place.

(t) "State Survey Agency" means the Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, which has the responsibility to determine whether healthcare providers/suppliers meet federal certification standards to participate in the Medicare and/or Medicaid programs per the agreement between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985. The State Survey Agency also determines whether providers/suppliers meet state licensure requirements per W.S. §35-2-901 through §35-2-910.

(u) "Survey" means an evaluation conducted by the State Survey Agency or its designated representative to determine compliance with this Rule.

(v) "Volunteer Services" means those services provided by trained hospice volunteers who have agreed to provide service under the direction of a hospice program.

(i) Hospice volunteers may be used to provide support, patient care, and companionship to the patient and the patient's family during the remaining days of the patient's life and to the surviving family following the patient's death.

(ii) Volunteers may also provide supportive services to the hospice staff in areas such as, but not limited to, assisting in the office, public relations, and other hospice activities.

Section 5. Organization and Management.

(a) Governing Body. The hospice program shall have a governing body which has the legal authority and responsibility to operate the hospice program. The governing body shall:

(i) Obtain employee dishonesty coverage through a general liability insurance policy, fidelity bond, or surety bond. This coverage is for patient protection due to dishonesty, integrity, or fidelity on behalf of an employee. The coverage shall be no less than five thousand dollars ($5,000).

(ii) Provide verification of a central registry check on all employees hired at the time of or after the filing of these rules. The individual agencies or corporations are responsible for obtaining central registry verifications. Central Registry information can be obtained by contacting the Department of Family Services at 307- 777-5894 (this number may be subject to change).

(iii) Insure that all staff successfully complete, at a minimum, a full fingerprint-based National Criminal Background Check before unsupervised direct patient contact. If there are any flags on the background check and the facility employs the individual, the facility must document in the individual's personnel file that prior to hire the flagged issue was thoroughly investigated and it was determined the individual is appropriate to provide services to vulnerable adults.

(iv) Adopt, revise, and approve personnel policies, including:

(A) Frequency of evaluations; and

(B) Insuring confidentiality of central registry information and criminal background checks.

(v) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the patient level.

(vi) Ensure that all services provided are consistent with accepted standards of practice.

(vii) Ensure adequate staffing numbers of qualified staff to provide quality hospice care and volunteer services, and, if offered, non-hospice respite care.

(viii) Develop and implement policies and procedures for services offered which shall be reviewed annually by the medical director and either the governing body or appropriate administrative representative.

(ix) Develop an effective, ongoing, agency-wide written quality improvement program which ensures and evaluates quality of care to all patients in accordance with W.S. §35-2-910.

(x) Develop a written grievance procedure.

(A) The grievance procedure shall establish a system of reviewing complaints and allegations of patients' rights violations to include, but not be limited to:

(I) Patient method to voice grievance;

(II) The Hospice Program's written response to patient grievances;

(III) List of agencies, with addresses and telephone numbers, for patients to contact if grievances are not addressed satisfactorily; and

(IV) Written reports on all grievances and resolutions shall be provided to the State Survey Agency, within ten (10) days after the grievance is filed.

(xi) Refer Complaint Investigations.

(A) Patient complaints and problems shall be referred in writing to the Long Term Care Ombudsman.

(B) The office of the Ombudsman shall complete all complaint investigations within an appropriate time frame depending upon the nature of the allegations.

(C) Written reports of an investigation and the status of resolutions completed by the hospice shall be provided by the Long Term Care Ombudsman to the State Survey Agency within thirty (30) days after the completion of an investigation.

(I) Exception: Complaints or problems reported directly to the State Survey Agency or referred by the Long Term Care Ombudsman to the State Survey Agency shall be investigated by the State Survey Agency.

(xii) Maintain employee Personnel records. There shall be one (1) person designated responsible for maintaining confidentiality of personnel records.

(xiii) Develop policies and procedures with regard to Employee Health.

The hospice program shall at a minimum:

(A) Include a policy listing communicable diseases that put the patient population at risk. In addition, the hospice shall report communicable diseases or conditions as required by W.S. §35-4-107 through W.S. §35-4-108 and;

(B) Document that the employee is free of communicable diseases that could be a risk to the client population.

(xiv) Adopt Advanced Directives. The hospice program shall adopt policies which assure that information on advanced directives is provided to all patients. If the patient's advanced directives are known, they shall be followed by the hospice program.

(xv) Make specific notifications:

(A) Prior to admission, all prospective patients shall be notified if the hospice program is not Medicare/Medicaid certified.

(B) Each hospice program will notify its prospective patients, or the responsible party, of the services it provides and the charges for those services.

Section 6. Patients Rights and Responsibilities.

(a) Each hospice patient/family shall receive a copy of the Hospice patient bill of rights and responsibilities and each non-hospice respite client/family shall receive a copy of the non-hospice patient bill of rights and responsibilities.

(b) The hospice program shall keep written documentation that each patient has received a copy of the patient rights and responsibilities.

(i) The right to be informed of the hospice concept, admission criteria, services to be provided by an interdisciplinary team, options available, and any charges which may be incurred;

(ii) The right to participate in developing the individual's plan of care;

(iii) The right to expect that all records will be confidential;

(iv) The right to refuse service or withdraw from the hospice program at any time;

(v) The responsibility to provide accurate information which may be useful to the hospice in delivering appropriate care;

(vi) The right to express a grievance without fear of reprisal;

(vii) The right to be free of any verbal or physical abuse of any kind; and,

(viii) The right to unrestricted visitation.

(d) By written declaration the hospice shall affirm the following non-hospice client rights and responsibilities:

(i) The right to be informed of the respite care concept, admission criteria, services to be provided, options available, and any charges which may be incurred;

(ii) The right to participate in developing the individual's plan of care;

(iii) The right to expect that all records will be confidential;

(iv) The right to refuse service or withdraw from the program at any time;

(v) The right to express a grievance without fear of reprisal;

(vi) The right to receive a timely assessment and intervention for a change in condition;

(vii) The responsibility to provide accurate information useful to the hospice in delivering appropriate care which would include the primary physician's name and contact information;

(viii) The right to be free of verbal or physical abuse of any kind;

(ix) The responsibility of the caregiver or designee to be available at prearranged time of discharge;

(x) The responsibility of the caregiver to provide the hospice program with accessibility, via telephone, to caregiver or designee, for use in case of emergency;

(xi) The responsibility of the caregiver to provide the hospice program with an adequate supply of labeled medications in the containers they were dispensed in and personal supplies. The hospice shall verify authenticity of caregiver-provided medications;

(xii) The responsibility of the caregiver to provide a copy of the non- hospice respite client's current medical record;

(xiii) The responsibility of the hospice to admit and provide care with physician's orders; and,

(xiv) The right to unrestricted visitation.

(e) Hospice responsibilities shall include, but are not limited to:

(i) Provide quality care and psychosocial services to patients regardless of race, religion, sex, age, and/or physical or mental disabilities;

(ii) Train all staff and volunteers adequately for the level of services they provide;

(iii) Provide care which is:

(A) Ethical;

(B) In the best interest of the patient/client;

(D) Privacy in treatment and personal needs.

(iv) Provide special attention to the patient's/client's right to privacy, choice, and dignity, including infants, small children, and adolescents.

Section 7. Admission Criteria.

(a) Admission criteria shall be clearly defined in the hospice program policies and shall include physician's orders.

(b) Decisions regarding admission shall follow the established criteria of the program.

Section 8. Hospice Day Care Services for Hospice Patients.

(a) The Hospice Day Care Center shall be staffed with qualified personnel, to include nursing services and any additional disciplines needed to ensure adequate care and services are provided.

(b) The services shall include, but not be limited to:

(i) emergency services;

(ii) assistance in the development of self-care capabilities;

(iii) personal hygiene;

(iv) social support services;

(v) provision of meals and nourishments appropriate to the hours in which the patient is receiving service; and

(vi) medication administration and monitoring.

(i) Provide a clean environment, free of obstacles that could pose a hazard to client health or safety;

(ii) Provide easily accessible toilet facilities, handwashing facilities, and paper towel dispensers, and

(iii) Be accessible to patients with supportive devices for ambulation and wheelchairs.

(d) The Hospice Day Care Center shall have written policies and procedures relevant to its operation. Such policies and procedures include, but are not necessarily limited to:

(i) Admission criteria that qualify patients to be appropriately served in the Hospice Day Care Center;

(ii) Meals and nourishments, including special diets, that will be provided; and

(iii) Hours and days of the week services will be available in the Hospice Day Care Center.

(e) The patient or responsible party and the hospice day care center shall have a written, signed agreement outlining the respective rules and responsibilities.

Section 9. Non-Hospice Inpatient Respite Care Services.

(a) Accepting clients for non-hospice respite care under this subsection is voluntary.

(b) Hospice facilities that elect to provide non-hospice respite care services shall:

(i) Provide medication administration in accordance with federal and state physician's orders;

(ii) Provide activities and care in accordance with a plan of care developed by primary caregivers and hospice staff prior to admission.

(c) The hospice providing non-hospice respite care services shall be staffed with qualified personnel including a registered nurse and any additional disciplines needed to ensure adequate care and services are provided.

(d) The services shall include, but not be limited to:

(i) assistance with activities of daily living;

(ii) personal hygiene;

(iii) provision of nourishments;

(iv) appropriate recreational activities; and

(v) medication management.

(e) Non-hospice inpatient respite care services shall meet the following standards:

(i) provide a clean environment free of obstacles that could pose a hazard to client health or safety;

(ii) provide easily accessible toilet facilities, handwashing facilities, and paper towel dispensers in common areas; and

(iii) be accessible to patients with supporting devices for ambulation and wheelchairs.

(f) Non-hospice respite care services shall have written policies and procedures relevant to its operation. Such policies and procedures shall include, but not be limited to:

(i) Admission criteria and physician's orders that qualify patients to be appropriately served in the hospice facility that include the primary physician's name and contact information;

(ii) Meals and refreshments, including special diets that will be provided;

(iii) Handling of medical emergencies and subsequent transfer to acute care facility;

(iv) Infection control procedures;

(v) Recordkeeping of all medications administered and any adverse events occurring;

(vi) Safety interventions regarding potential elopement or wandering;

(vii) Assessment and interventions for patients with behaviors, including wandering;

(viii) Medication administration and monitoring; and

(ix) Activities program to meet the needs of the patients.

(g) The patient or responsible party and the hospice shall have a written, signed agreement outlining the respective rules of the hospice and responsibilities of each party.

Section 10. Staff In-Service Training.

(a) The hospice program shall provide an initial training and orientation program as well as continuing in-service education programs. The programs offered shall be appropriate to the services provided by the Hospice offering non-hospice respite care including dementia care.

Section 11. Fire Safety and Emergency Procedures.

(a) Fire Safety.

(i) The Hospice shall meet the Life Safety Code provisions.

(b) Emergency Procedures.

(i) Disaster and Emergency Preparedness.

(A) The Hospice shall have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire and severe weather.

(B) The Hospice shall train all employees in emergency procedures when they begin work. The Hospice shall review the procedures with existing staff at least once in each twelve (12) month period.

(D) The hospice shall inform all cognitive patients on the first day of admission regarding emergency preparedness, to include emergency exit from the facility.

Section 12. Licensing.

(a) Licensing Procedure.

(i) For an initial license to be issued, the State Survey Agency shall receive:

(A) A completed application on the form supplied by the State Survey Agency, including the completed items identified on the Hospice Licensure Checklist supplied by the State Survey Agency.

(B) Each completed application shall be accompanied by the required licensure fee identified in the Wyoming Department of Health Aging Division, Healthcare Licensing and Surveys Chapter 1, Rules for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one (1) year beginning July 1, and unless suspended or revoked, expiring on June 30 of the following year, the State Survey Agency shall receive:

(A) A completed application form submitted no later than the date indicated in the renewal notice posted on the State Survey Agency website at: http://www.health.wyo.gov/ohls; and

(B) The licensure fee required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The State Survey Agency shall consider:

(i) Initial re-licensure and complaint survey deficiencies cited by the State Survey Agency;

(ii) Life Safety Code deficiencies cited by the State Survey Agency;

(iii) Complaint investigations and resolutions;

(iv) Compliance with all laws and standards relating to communicable and reportable diseases, as required by the Wyoming Department of Health, State Health Officer, and Public Health Division; and

(v) The effectiveness of the quality management program to evaluate and improve patient care and services.

(i) Transfer or assignment of a hospice license is prohibited. The hospice shall comply with licensure requirements in paragraph (d) of this section in the event of a change in the ownership of a hospice.

(d) Change of Ownership.

(i) A change in ownership of a hospice occurs when there is a change in the legal entity responsible for the operation of the hospice, whether by lease or by ownership.

(ii) For a Medicare and/or Medicaid certified hospice, the change of ownership determination by the Centers for Medicare and Medicaid Services will also be used to determine the licensure change in ownership.

(iii) The new owner shall submit no later than sixty (60) calendar days prior to the event the following items:

(A) A change in ownership application for licensure with the appropriate fee, as required in paragraph (a)(i)(B) of this section.

(B) The checklist items required for an initial applicant.

(iv) Within twenty-four (24) hours of the event, the new owner shall submit a copy of the signed bill of sale or lease agreement that reflects the effective date of the sale or lease.

(e) Other changes. A licensure application and appropriate fee, as required in paragraph (a)(i)(B) of this section, shall be required for any of the following changes to be processed:

(i) Name change of hospice.

(ii) The number of licensed beds increased or decreased.

(iii) Change in the main hospice address or ancillary locations.

(f) Provisional License.

(i) A provisional license is a temporary license that may be issued in the following instances:

(A) For a new licensed provider.

(B) For a change in ownership, if deemed appropriate by the State Survey Agency.

(C) Following a successful licensure construction inspection for space that has not previously been occupied by patients. During the aforementioned inspection, there can be no deficiencies cited that could potentially result in harm to the patients.

(D) Following a successful licensure construction inspection for space that has undergone expansion and remodel to the extent that significant structural, mechanical, plumbing, or fire safety changes have been made to the space occupied by patients.

(E) Whenever deficiencies are cited that are serious and have resulted in harm or potential harm to patients.

(F) Whenever the facility fails to satisfactorily correct cited deficient practice.

(G) Whenever the facility fails to comply with any requirement of this rule.

(ii) The state Medicaid office will be notified by the State Survey Agency whenever a provisional license is issued or reissued.

(iii) A provisional license will be issued with an expiration date to be determined by the State Survey Agency at the time of issuance.

(iv) A provisional license may be reissued for additional extended time, if deemed appropriate by the State Survey Agency.

(v) If the provisional license is issued in lieu of a regular license, the facility must return the regular license to the State Survey Agency by return mail or hand delivery within five (5) calendar days of receipt of the provisional license. The provisional license must be posted in a public place in the facility.

(g) Conditions for denying, revoking, or suspending a license. Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of this rule.

(h) Suspension of Admissions. The State Survey Agency may suspend new admissions or readmissions to the hospice when conditions are such that patient needs cannot be met. Conditions in a hospice shall not jeopardize the patient's health or safety.

(i) Monitoring. The State Survey Agency shall place a Wyoming Department of Health approved monitor, at the hospice's expense, when conditions are such that patients' needs are not being met by the hospice. The monitor shall insure that neither the health nor the safety of the patients is jeopardized.

(j) Hearings.

(i) Any hospice aggrieved by a decision of the State Survey Agency may request a hearing by submitting a written request to the State Survey Agency within ten (10) calendar days of receipt of the notice of adverse action.

(ii) The State Survey Agency (or designee) shall provide an opportunity for a hearing, if requested, and shall present at the hearing the evidence supporting any preliminary licensure decision(s) and reason(s) to the parties concerned.

(iii) In matters concerned with the spread of communicable disease that may require the utilization of quarantine or isolation, the Wyoming State Health Officer or designated representative shall provide an opportunity for a hearing as outlined in W.S. §35-4-112.

(iv) Hearings requested under the terms of this rule shall be held in accordance with Chapter 2 – Uniform Rules for Contested Case Practice and Procedure, adopted by the Office of Administrative Hearings.

(k) Posting of License.

(i) The current license issued by the State Survey Agency shall be displayed in a public area within the hospice.

(l) Surveys for Licensure.

(i) The State Survey Agency or its designated representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Rule for Hospice Programs as promulgated by the Wyoming Department of Health.

(B) The State Survey Agency shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the hospice.

(C) The hospice shall provide an acceptable plan of correction to the State Survey Agency for all cited deficiencies within ten (10) calendar days after receipt of the deficiencies.

(ii) At the time of survey, all records, including patient medical records, pertaining to matters involved in the survey shall be made available to members of the survey team as requested. Surveys may be conducted as focused, off-site administrative reviews, in which case specific records or categories of records will be requested by the State Survey Agency for review. The results of all surveys, including complaint investigations and administrative reviews, will be shared with the hospice administrator and other pertinent staff.

(m) Voluntary Closure.

(i) If a hospice voluntarily ceases to operate, it shall notify the State Survey Agency in writing at least sixty (60) working days prior to closure.

(ii) The first working day after closure, the hospice's license shall be hand carried or sent by certified mail to Healthcare Licensing and Surveys, 6101 Yellowstone Rd., Ste. 186C, Cheyenne, WY 82002.

Section 13. Construction/Remodeling. Wyoming Department of Health, Chapter 3 Construction Rules and Regulations for Healthcare Facilities apply.

Section 14. Life Safety and Electrical Safety. Wyoming Department of Health, Chapter 3 Construction Rules and Regulations for Healthcare Facilities apply.

Section 15. Incorporation by Reference.

(a) Any code, standard, rule, or regulation incorporated by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section.

(b) Each rule incorporated by reference is further identified as follows:

(i) Chapter 2 - Uniform Rules for Contested Case Practice and Procedure, adopted by the Office of Administrative Hearings, effective on October 17, 2014, found at: http://soswy.state.wy.us/Rules/RULES/9644.pdf.

History

Effective 2016-04-01

Chapter 11 Program Administration of Nursing Care Facilities

Wyo. Code R. 048.0003.11.07012020 § 1 Authority

These rules are promulgated by the Department of Health pursuant to the Health Facilities Act at W.S. §9-2-1204 et seq. and the Wyoming Administrative Procedures Act at W.S. §16-3-101 et seq.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 2 Purpose

. These rules have been adopted for the day-to-day operation of Nursing Care Facilities.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 3 Severability

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 4 Definitions

(a) Except as otherwise specified, the terminology used in these rules is the standard terminology and has the standard meaning used in healthcare, including nursing care facilities.

(b) The following definitions shall apply in the interpretation and enforcement of these Rules.

(i) "Certified Occupational Therapist Assistant (COTA)" means a person licensed in Wyoming to assist in the practice of occupational therapy, and who works under the supervision of a Registered Occupational Therapist.

(ii) "Chief Administrative Officer" means the Director, Department of Health per W.S. §9-2-101(e), or the designated licensure representative.

(iii) "CNA" means a person who is certified to practice as a Certified Nursing Assistant by the Wyoming Board of Nursing.

(iv) "Complaint" means a formal allegation of injustice or perceived harm referred to an outside party or agency.

(v) "Complaint Investigations" means those investigations required to be performed by the Long Term Care Ombudsman as established in W.S. §9-2-1301 through 1309 or by the State Survey Agency as per the Agreement between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

(vi) "Consultant Dietitian" means a dietitian who provides dietary consultation on a frequent and regularly scheduled basis.

(vii) "Dietitian" means a person who is registered by the American Dietetic Association and provides nutritional and dietary services.

(viii) "Dietetic Service Supervisor" means an individual who has at least a high school education or equivalent and has completed courses in food service supervision, but is not a Registered Dietitian.

(ix) "Facility" means a Nursing Care Facility.

(x) "Governing Body" means the individual(s), group, or corporation that has the ultimate authority and responsibility for establishing resident care policies, personnel policies, and shall designate a Wyoming licensed Nursing Home Administrator for the Nursing Care Facility.

(xi) "Grievance" means a concern of inequitable or inaccurate action that is handled through the facility's internal grievance procedure.

(xii) "Health Care Services" includes but is not limited to nursing, physical therapy, speech pathology, occupational therapy, respiratory therapy, social work, certified nurse assistant services, and dietary services. All staff shall be certified, licensed or registered in accordance with Wyoming State Statutes.

(xiii) "License" means the authority granted by the Licensing Division to operate a Nursing Care Facility.

(xiv) "Licensee" means any person, association, partnership, or corporation holding a Wyoming Nursing Care Facility license.

(xv) "Licensing Division" means the Department of Health, Office of Health Quality.

(xvi) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a Licensed Practical Nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(xvii) "Nosocomial Infection" means an infection acquired in the Nursing Care Facility.

(xviii) "Nursing Care Facility" means an institution which is a skilled nursing facility (SNF) or a nursing facility (NF) which is currently licensed and meets the requirements of these rules and regulations.

(xix) "Nursing Home Administrator" means a person who operates, manages, supervises, or is in charge of a Nursing Care Facility; and is licensed by the Wyoming Board of Nursing Home Administrators.

(xx) "Occupational Therapist" means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Registered Occupational Therapist pursuant to W.S. §33-40-102(a)(iv).

(xxi) "Ombudsman" means the Long Term Care Ombudsman as established in W.S. §9-2-1301 through 9-2-1309.

(xxii) "Pharmacist" means a person who is licensed by the Wyoming Board of Pharmacy to practice pharmacy.

(xxiii) "Physical Therapy Assistant" means a person who is licensed by the Wyoming Board of Physical Therapy to practice as a Physical Therapy Assistant pursuant to W.S. §33-25-101(a)(ii).

(xxiv) "Physical Therapy" means the evaluation, instruction or treatment of a human being to prevent, correct, alleviate or limit physical disability due to injury, disease or any other physical or mental condition by the utilization of physical measures and rehabilitative procedures including training in functional activities and the performance and interpretation of tests and measurements of body functions as an aid in the examination, evaluation or treatment of any human condition for the purpose of correcting or alleviating an individual physical or mental disability. Physical therapy is provided by a Physical Therapist or by a Physical Therapy Assistant under the supervision of a Physical Therapist.

(xxv) "Physical Therapist" means a person who is licensed to practice physical therapy in the State of Wyoming pursuant to W.S. §33-25-101(a)(v).

(xxvi) "Program Administration" means the rules and regulations promulgated by the Department of Health as developed by the Program Division for the day-to-day operation of a nursing care facility.

(xxvii) "Program Division" means the Department of Health, Aging Division.

(xxviii) "Registered Nurse (RN)" means a person who is a graduate of an approved school of professional nursing, who is currently licensed to practice as a Registered Nurse by the Wyoming Board of Nursing pursuant to W.S.§33-21-120 et. seq.

(xxix) "Respiratory Care" means the health specialty responsible for the treatment, management, diagnostic testing, control, and care of residents with deficiencies and abnormalities associated with the cardiopulmonary system.

(xxx) "Resident" means an individual residing in and receiving care in a Nursing Care Facility.

(xxxi) "Social Services" means those services provided according to the resident's plan of care by a Social Worker, or by a Social Service Associate with appropriate supervision as required by the Wyoming Mental Health Professions Licensing Board.

(A) "Social Worker" means a person who is licensed to practice as a Clinical Social Worker (LCSW) or certified to practice as a Social Worker (CSW) by the Wyoming Mental Health Professions Licensing Board.

(B) "Social Service Associate" means a person who has a degree in social work or closely related field and has at least one (1) year of social services experience in a health care setting; or,

(I) A person who has at least two (2) years of experience in social services in a health care setting and receives regular consultation from a social worker or recognized social service agency.

(xxxii) "Speech Language Pathologist" means a person who is licensed in the State of Wyoming to practice speech language pathology.

(xxxiii) "Speech Pathology" means the application of principles, methods, and procedures for the measurement, testing, evaluation, prediction, counseling, instruction, habilitation or rehabilitation related to the development and disorders of speech, voice, or language for the purpose of preventing, evaluating, modifying, or ameliorating such disorders and conditions in individuals or groups or individuals.

(xxxiv) "State Survey Agency" means the Department of Health, Office of Health Quality which has the primary responsibility to determine whether or not health care providers/suppliers meet federal certification standards to participate in the Medicaid and/or Medicare programs as per the Agreement between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

(xxxv) "Survey" means an on-site evaluation conducted by the Survey Division or its designated representative to determine compliance with State rules and regulations for Nursing Care Facilities.

(xxxvi) "Survey Division" means the Department of Health, Office of Health Quality.

(xxxvii) "Therapy Service" includes physical therapy, occupational therapy, and speech language therapy.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 5 Organization and Administration

(a) Governing Body. The Nursing Care Facility shall have a governing body which has the legal authority and responsibility to operate the Nursing Care Facility. The governing body shall:

(i) Appoint a full-time, on premise, administrator qualified by education, training and experience as established by the Wyoming Board of Nursing Home Administrators.

(A) The administrator shall have a current license as a Wyoming Licensed Nursing Home Administrator.

(ii) Temporary License. A temporary license may be granted by the Wyoming Board of Nursing Home Administrators:

(A) To fill a position of Nursing Home Administrator that unexpectedly becomes vacant;

(B) For a period not to exceed six (6) months;

(D) To an individual who does not meet all the licensing requirements under the Act, but who is of good character and meets the educational requirements as stated.

(iii) A temporary license may be renewed for good cause for one (1) time if requested thirty (30) days prior to the termination of the initial temporary license.

(iv) The administrator of a hospital with a connecting nursing care wing can serve as the administrator and shall be licensed as a Wyoming Nursing Home Administrator.

(v) The administrator shall enforce the rules and regulations relative to the level of health care and safety of residents and for the protection of their personal and property rights.

(vi) The administrator shall plan, organize, and direct those responsibilities delegated to him by the governing body or its equivalent.

(vii) An employee of the facility shall be authorized in writing to act on the administrator's behalf during his/her absence.

(b) Personnel policies and procedures. The governing body or its equivalent, through the Nursing Home Administrator, shall be responsible for implementing and maintaining written personnel policies and procedures that support sound resident care and personnel practices.

(i) Personnel records for each employee shall be current and available and shall contain sufficient information to support placement in the position assigned.

(A) References from former employers and evidence of current certification, licensure, or registration.

(B) An evaluation of the employees work performance shall be done yearly.

(ii) Written employee policies shall be available covering job descriptions, functions and special procedures.

(iii) Written policies shall be in effect to ensure that newly hired and current employees do not spread a communicable disease that could be transmitted through usual job duties.

(iv) Written policies shall ensure a safe and sanitary environment for residents and personnel.

(A) Tuberculin testing shall be accomplished for each employee upon employment and before resident contact begins and annually thereafter.

(B) Employees having known positive skin tests shall provide a certificate of noninfectiousness from a physician, recommendations, if any, for treatment, and evidence that they have complied with such recommendations.

(C) Individuals providing documentation of negative skin tests administered within the last year need no physician follow-up at this time.

(D) Individuals never having had a skin test or who do not have written proof of skin test results, shall have an intradermal Mantoux using 5TU PPD. This shall be accomplished via the two (2) step procedure. If the first test is negative and the employee is asymptomatic, the employee may engage in resident contact prior to the results of the second skin test.

(I) A negative reaction requires no follow up by a physician at this time.

(II) A positive reaction (10mm induration using 5TU PPD) requires a referral to a physician for x-ray and certification of noninfectiousness and appropriate treatment if needed. Follow-up shall comply with the recommendations of the attending physician.

(E) If symptoms occur, a new certificate of noninfectiousness is required from the physician.

(c) Resident Care Policies. The Nursing Care Facility shall have written policies to govern nursing care and related medical or other services provided.

(i) The policies shall be available to admitting physicians, sponsoring agencies, residents and the public.

(ii) The policies shall reflect awareness of and provision for meeting the total medical and psycho-social needs of the residents.

(iii) The policies shall include provisions to protect residents' personal and property rights.

(iv) Medical records and minutes of staff and committee meetings shall reflect that resident care is being rendered in accordance with the written resident care policies.

(v) The medical director or director of nursing shall be designated in writing to be responsible for the execution of resident care policies.

(A) If the director of nursing is delegated the responsibility for day-to-day execution of resident care policies, the medical director shall serve as the advisory physician from whom the director of nursing receives medical guidance.

(vi) Policies shall state if specialized rehabilitative services are provided by or available in the facility. Residents who require rehabilitative services not offered by the facility shall not be admitted.

(A) Specialized rehabilitative services include physical therapy, speech and hearing therapy and occupational therapy.

(vii) The facility shall have individualized means of resident identification other than the resident's medical record.

(viii) There shall be an administrative policy relative to resident smoking.

(ix) The individual in charge of the facility on each work shift shall have in his/her possession, or be able to immediately obtain, keys to all doors pertaining to resident care and safety.

(A) No resident shall be locked in his/her room.

(x) The facility shall cooperate in submitting periodic reports requested by the Licensing Division.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 6 Physical Environment

(a) The building(s) of the Nursing Care Facility shall be constructed, arranged and maintained to ensure the health and welfare of all residents.

(i) An employee shall be designated responsible for services and for the establishment of policies and procedures in each of the following areas:

(A) Plant maintenance;

(B) Laundry operations; and

(ii) There shall be written rules and regulations governing the handling and storing of oxygen, and maintenance of oxygen equipment. Only labeled Medical Grade USP Oxygen shall be used.

(iii) Approved incineration facilities shall be provided and maintained or other approved procedures shall be used for disposal of resident wastes, as well as sanitary disposal of all other wastes.

(A) These facilities, location and methods shall be in accordance with recommendations of the Centers for Disease Control and Prevention, the National Institutes of Health and in compliance with air pollution standards.

(iv) The facility shall ensure hot water temperatures are adjusted for resident comfort and safety. The water temperature for showers and baths must not exceed 120 degrees Fahrenheit. Hand wash sinks must not exceed 110 degrees Fahrenheit.

(v) The water source of an emergency potable supply shall be identified and shall be sufficient in volume to meet facility needs.

(b) Sanitary Environment. The Nursing Care Facility shall establish policies and procedures for investigating, controlling and preventing infections.

(i) Policies, procedures, and techniques shall be regularly reviewed, particularly those concerning food service, laundry practices, and the disposal of environmental and resident wastes.

(ii) A facility policy shall be developed for reporting and monitoring employees with an infection that could be transmitted through usual job duties to residents, their food or laundry.

(iii) The facility shall report the required diseases/conditions to the Wyoming Department of Health, Epidemiology Unit as per W.S. §35-4-107. In addition, those conditions classified as nosocomial where two (2) or more persons, either residents or employees, are affected shall be reported immediately to the State Health Officer, the County Health Officer, and the Licensing Division. The Nursing Care Facility Administrator or his/her designated representative shall furnish all available pertinent information related to such disease or condition to the Licensing Division.

(iv) Inservice education shall be provided for all employees. This shall include the practice of aseptic techniques, such as: handwashing/universal precautions, proper grooming, masking and gowning procedures (for isolation), disinfection and sterilizing techniques, and the handling and storage of resident care equipment and supplies plus decontamination methods.

(A) Continuing education shall be provided to all employees on the cause, effect, transmission, prevention and elimination of infections.

(v) Animals, birds, and other pets shall be allowed in the Nursing Care Facility with the approval of the resident council and:

(A) The pet has had an examination prior to entering the Nursing Care Facility and annually thereafter, or more frequently if required by the pet's health condition;

(B) The pet's vaccinations are current;

(D) Someone must be designated as the primary caretaker of the pet, other than a resident of the facility.

(E) Aquariums and enclosed aviaries are excluded from the above requirements provided they are properly secured and are maintained in an approved sanitary manner. Aquariums must be protected to prevent spillage or breakage.

(vi) Humidifiers and all oxygen equipment shall be maintained according to the manufacturer's recommendations and acceptable standards of practice.

(i) Non-dietary personnel shall be excluded from the dietary area and the traffic pattern shall be strictly controlled;

(ii) Employees shall not eat or use tobacco products in any food preparation area;

(iii) A written policy shall be developed and adhered to for the cleaning and sanitizing of all ice machines; and

(iv) Equipment and work areas shall be clean and orderly. Effective procedures for cleaning all equipment and work areas shall be followed consistently to safeguard residents' health.

(d) Laundry.

(i) All soiled linens shall be transported in closed bags. Isolation linen shall be handled according to current acceptable standards of practice.

(ii) There shall be separate carts (with a positive designation) or methods for transportation of clean and soiled linen. Carts for clean linen transport shall be labeled, cleaned and sanitized daily prior to such usage.

(e) General Facilities.

(i) Sewage disposal, when not on a municipal system, shall be approved by the Wyoming Department of Environmental Quality.

(ii) Water supply, when not on a municipal system, shall be approved by the Wyoming Department of Environmental Quality.

(iii) Measures shall be taken to prevent and control insects, rodents and other environmental hazards affecting the residents and the premises.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 7 Housekeeping, Laundry, and Maintenance Services

(a) Housekeeping and Maintenance Services. Sufficient numbers of adequately trained housekeeping and maintenance personnel shall be available to maintain the interior and exterior of the facility in a safe, clean, orderly and attractive manner.

(i) Personnel shall follow approved practices and procedures and use approved products.

(ii) The facility shall be free from offensive odors, accumulations of dirt, rubbish, and dust.

(iii) Janitor closets shall be kept locked.

(iv) Floors shall be cleaned regularly by approved methods.

(A) Polishes on floors shall provide a nonslip finish; throw or scatter rugs shall be prohibited, unless they have been tested by the facility and found to be non-skid, and are safe for resident use.

(B) Household straw brooms shall be used only at entrances and exits of the building.

(C) Cleaning procedures shall include frequent water changes and the use of an approved chemical disinfectant for medical facilities.

(v) Deodorizers or aerosol air fresheners shall not be used except in extraordinary circumstances. Routine usage of these items shall be prohibited to cover up poor cleaning practices.

(vi) The grounds shall be kept free from refuse and litter. Areas around buildings, sidewalks, gardens and patios shall be kept clear of dense undergrowth.

(b) Linens. The facility shall have available at all times, a quantity of linens essential for the proper care and comfort of residents.

(i) Clean linens and clothing shall be stored in clean, dry, dust-free areas.

(ii) Soiled linens shall be stored in separate well-ventilated areas, and shall not be permitted to accumulate in the facility. Soiled linens and clothing shall be stored separately from non-soiled articles in suitable bags or containers.

(iii) Soiled linens shall not be sorted, laundered, rinsed, or stored in bathrooms, resident rooms, kitchens, food storage areas or general storage areas.

(iv) If linens are commercially laundered, approved methods shall be used by such laundry. Approved methods shall include controlled temperatures, rinse cycles, souring processes, ironing, and protection of the processed linens. Proof of this compliance shall be provided upon request by the Licensing Division.

(A) All linens shall be totally laundered in accordance with the recommendations of the National Institute of Laundering. (Permanent press linens shall be subjected to all requirements as listed in (iv).

(v) Resident clothing shall not be laundered with the facility's linen.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 8 Physician Services

(a) There shall be available to the facility, prior to or at the time of admission, resident information which includes current medical findings, diagnoses, and orders from a physician for the immediate care of the resident.

(i) If the resident information is not immediately available, the facility shall be responsible for contacting a physician to obtain temporary medical orders.

(b) Emergency Care of Residents. The facility shall arrange for necessary medical care in case of emergency.

(i) There shall be established procedures to be followed in an emergency, which cover immediate care of the resident, persons to be notified, and reports to be prepared.

(ii) A list of physicians to be called in case the resident's physician or his designated substitute cannot be found shall be posted at every nursing station. Such roster shall include telephone numbers of the physicians.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 9 Nursing Services

(a) The facility shall have sufficient nursing staff to meet the needs of the residents.

(i) Director of Nursing Services. The facility shall designate a Registered Nurse to be a full-time director of nursing services, and he/she shall have experience in areas such as nursing service administration, rehabilitation nursing, psychiatric or geriatric nursing. The director of nursing services shall be responsible for:

(A) Developing policies and procedures for the nursing department, participating in the implementation of resident care policies and bringing patient care problems requiring changes in policy to the attention of the administrator.

(B) Recommending to the administrator the number and levels of nursing personnel to be employed, participating in their recruitment and selection, and recommending termination of employment when necessary.

(D) Participating in planning and budgeting for nursing service.

(E) Establishing written procedures to ensure that nursing personnel, for whom licensure or certification is required, have a valid and current license or certification to practice in Wyoming. Documentation shall be by a photostatic copy of each license or certificate.

(F) Insuring daily nursing rounds are conducted to ensure each resident receives adequate care to meet his/her needs.

(ii) Twenty-four (24) Hour Nursing Service.

(A) Duties assigned nursing personnel shall be consistent with their education, experience, licensure and/or certification. Nursing personnel includes Registered Nurses, Licensed Practical Nurses, and Certified Nursing Assistants.

(B) Full-time or part-time members of the nursing staff shall be primarily engaged in providing nursing services and only in rare and exceptional circumstances shall be involved in food preparation, housekeeping, laundry or maintenance services. Proper infection control procedures shall be adhered to at all times.

(C) Time schedules for each nursing station shall be planned in advance and shall indicate the name and classification of nursing personnel working on each unit for each tour of duty.

(D) A person employed in the facility to give nursing care shall be at least sixteen (16) years of age.

(iii) Restorative Nursing Care. There shall be an active program of restorative nursing care directed towards assisting each resident to achieve and maintain his/her highest level of self care and independence. This program shall include:

(A) Maintaining good body alignment and proper positioning of the bedfast resident, wheelchair resident and the resident in a chair;

(B) Encouraging and assisting dependent residents, as appropriate, to change position at least every two (2) hours, day and night, to stimulate circulation and prevent decubitus and deformities;

(C) Making every effort to keep residents active and out of bed for reasonable periods of time, except when contraindicated by physician's orders, and encouraging residents to achieve independence in activities of daily living by teaching self care, transfer, and ambulation activities; and

(D) Assisting residents to carry out the prescribed therapy regimen between visits of the physical, occupational, and speech therapists.

(iv) Dietary Supervision. Nursing personnel shall be aware of the dietary needs, food and fluid intake of residents.

(A) Nursing personnel shall determine that residents are served diets as prescribed.

(B) Residents needing help in eating shall be assisted promptly upon receipt of meals.

(D) Food and fluid intake of residents shall be observed and deviations from normal shall be reported to the charge nurse.

(E) Nursing personnel who participate in food delivery to residents and feeding of residents shall observe strict hygienic practices.

(v) Staff Development. There shall be a continuing staff development program for all nursing personnel in addition to a thorough job orientation for new personnel.

(A) Planned staff development shall be held at least monthly to review and evaluate the quality of nursing care, to teach nursing techniques and procedures, to discuss nursing problems and ways of improving nursing service, and to review and interpret administrative and nursing policies.

(I) Minutes of all meetings and a list of personnel attending shall be maintained in sufficient detail to document proceedings and actions, and shall be available to all staff members.

(B) All nursing personnel shall be instructed and supervised in the care of emotionally challenged and cognitively impaired residents and trained to understand the social aspects of resident care.

(C) Skill training shall include demonstration, practice and supervision of nursing procedures applicable in the individual facility. It shall also include restorative nursing procedures. Documentation shall be maintained on all skill training given to an employee and retained in his/her personnel files.

(D) Orientation of new personnel shall include a review and practice of the procedures to be followed for evacuating residents in emergencies, and the policies and procedures of the facility. Documentation shall be maintained on all individuals and kept in their respective personnel file.

(vi) Administration of Drugs. Drugs shall be administered in compliance with federal and state laws, and in accordance with accepted professional principles.

(A) Drugs shall be administered only by licensed nursing personnel in accordance with the Wyoming Nurse Practice Act.

(B) Drugs prescribed for one (1) resident shall not be administered to any other resident.

(D) Drugs shall be released to residents upon discharge for temporary outside visits. A notation of such drugs taken with the resident shall be entered in the resident's clinical record.

(vii) Storage of Drugs and Biologicals. Drugs and biologicals shall be stored in locked rooms, cabinets, or carts. Procedures for storing and disposing of medications at the nurses' station shall be established in consultation with the pharmacist.

(A) Drugs for external use and poisons shall be kept separate from other medications and under lock.

(B) Antiseptics, disinfectants, and germicides shall be issued in containers that bear clear, legible, distinctive labels that identify the contents, strength and shall include instructions for use.

(C) The refrigerator in which drugs and biologicals are stored shall not be accessible to residents, shall be used only for the storage of drugs and biologicals, and shall be in a locked refrigerator or a locked box in a refrigerator or in a protected area. The refrigerator shall be maintained at the proper temperature.

(D) An emergency medical kit approved by the Pharmaceutical Committee shall be readily available.

(viii) Director of Nursing.

(A) Hospital - Nursing Wings.

(I) A nursing wing with a total occupancy of sixty (60) residents or less shall be allowed to share the director of nursing with the hospital.

(1.) The director of nursing shall not act in a charge nurse capacity except on rare occasions with extraordinary circumstances.

(B) A nursing wing with a total occupancy of over sixty (60) residents shall be allowed to share the director of nursing with the hospital.

(I) An assistant or supervisor shall be employed for the nursing wing and shall not function as a charge nurse except on rare occasions with extraordinary circumstances. The assistant or supervisor shall be responsible to the hospital director of nursing.

(I) The director of nursing shall not function as a charge nurse, in facilities over sixty (60) beds except in rare instances with extraordinary circumstances.

(ix) Staffing.

(A) Each nursing station shall be staffed with a Registered Nurse or qualified Licensed Practical Nurse, who is the charge nurse on the day tour of duty seven (7) days a week.

(I) All other tours of duty shall be staffed with a Registered Nurse or a Licensed Practical Nurse.

(B) Each nursing station shall be staffed separately and shall have a separate staffing pattern.

(C) Each nursing station shall be staffed with sufficient non-licensed nursing personnel to give adequate nursing care to the residents twenty-four (24) hours a day, seven (7) days a week.

(D) Each facility shall have awake and on duty sufficient nursing personnel for the night tour of duty. Additional staff may be needed, depending on condition of residents, and to assure resident safety in case of fire or disaster.

(x) Nursing Care Hours (minimum).

(A) Nursing care hours shall be two and one quarter (2.25) hours for each skilled resident in a Nursing Care Facility in each twenty-four (24) hour period, seven (7) days a week, and one and one half (1.50) for each resident who is not skilled in each twenty-four (24) hour period, seven (7) days a week.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 10 Discharge Planning

(a) The facility shall maintain a centralized, coordinated program to ensure that each resident has a planned program of continuing care which meets the post discharge needs.

(i) The administrator shall delegate responsibility for discharge planning, in writing, to one (1) or more members of the facility's staff, with consultation, if necessary, or arrange for this service to be provided by a health, social or welfare agency.

(ii) The facility shall have in operation an organized discharge planning program.

(A) This program shall include the resident, physician(s), nurses, social services personnel, dietitian, and therapists to identify problems and goals thus preparing the resident for the next level of care and arranging for placement in the appropriate care environment.

(iii) The facility shall maintain written discharge planning procedures which describe:

(A) How the discharge coordinator will function, and his/her authority and relationship with the facility's staff.

(B) The time period in which each resident's need for discharge planning is determined (preferably within seven (7) days after the day of admission).

(D) Local resources available to the facility, the resident, and the attending physician to assist in developing and implementing individual discharge plans.

(E) Provisions for periodic review and reevaluation of the facility's discharge planning program.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 11 Dietetic Services

(a) The facility shall provide dietetic services that meet the nutritional needs of residents according to the science of nutrition. The dietetic service shall operate with safe food handling practices from receipt through service in accordance with the most current edition of the FOOD CODE from the U. S. Department of Health and Human Services, Public Health Service, Food and Drug Administration.

(i) Dietary Supervision. Overall supervisory responsibility for the dietetic service shall be assigned to a full-time qualified dietetic supervisor.

(A) If the qualified supervisor is not a Registered Dietitian, she/he shall be a graduate of a dietetic technician program approved by the American Dietetic Association or a dietary managers' educational program approved by the Certifying Board for Dietary Managers. Training and experience in food service supervision and nutrition equivalent in content to the approved educational programs are acceptable.

(B) Visits of the consultant dietitian shall be scheduled to assure that the professional dietetic service needs of the facility are met. These visits shall be:

(I) For at least eight (8) hours every other week, so that adequate time is allowed for observation of more than one (1) meal per visit; or,

(II) For at least four (4) hours every week so that adequate time is allowed to observe the preparation and serving of food at meal time. The weekly visits shall be scheduled to allow for observation of different meals.

(III) Visits shall not be limited to evenings and weekends only.

(C) Reports of the consultant dietitian shall be made verbally and in writing to the Administrator or his/her designee. The reports shall be kept on file with notations made of actions taken by the facility. The report shall include dates, length of time on-site, functions performed and recommendations.

(D) The consultant or staff dietitian shall develop written plans and conduct or supervise inservice programs for dietary personnel on a monthly basis.

(E) The consultant or staff dietitian shall participate in the development of policies and procedures, as well as the development or approval of all menus.

(F) The consultant dietitian is to provide assistance and advice, as needed, regarding the dietary department budget.

(G) The consultant or staff dietitian shall maintain interdisciplinary communication and act as the dietetic service's chief liaison to the medical and nursing staffs.

(H) The dietetic supervisor shall be responsible for department orientation, training, scheduling, and work assignments for all dietetic service personnel.

(I) The dietetic supervisor shall be responsible for menu planning, ordering or recommending the purchase of supplies, monitoring the department budget, controlling costs, maintaining associated records, etc.

(J) The dietetic supervisor shall be responsible for the development of policies and procedures. These polices shall be maintained in a manual and reviewed at least annually. Reviews and revisions shall be dated and signed by the supervisor and the consultant or staff dietitian.

(K) If the dietetic supervisor also has responsibility for cooking, adequate time shall be allowed for supervisory management.

(ii) Hygiene of Dietary Department. Food service personnel shall be in good health and shall practice safe food handling techniques in accordance with the current edition of FOOD CODE published by the U. S. Department of Health and Human Services, Public Health Services, Food and Drug Administration.

(A) Personnel having a communicable disease that can be expected to be transmitted through food shall not be permitted to work until the disease is no longer communicable or medical clearance is received from a physician or an advanced practitioner.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 12 Specialized Rehabilitative Services

(a) Facilities admitting patients in need of specialized rehabilitative services shall provide such services by qualified personnel.

(i) Rehabilitative care initiated in the hospital shall be continued immediately upon admission to the facility.

(ii) The facility that does not employ qualified personnel to provide a specialized service shall have a written agreement with the outside resource.

(iii) Facilities that do not provide specialized rehabilitative services shall not admit or retain residents in need of specialized rehabilitative services.

(iv) A report on the resident's progress shall be communicated to the attending physician within two (2) weeks of the initiation of the specialized rehabilitative service.

(v) The resident's progress shall be reviewed regularly thereafter and the plan of rehabilitative care shall be reevaluated at least every thirty (30) days by the physician and therapist.

(vi) Safe and adequate space and equipment shall be available if the facility provides specialized rehabilitative services.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 13 Pharmaceutical Services

(a) The Nursing Care Facility shall provide appropriate methods and procedures for the dispensing and administering of drugs and biologicals. Whether drugs and biologicals are obtained from community pharmacists or stocked by the facility, the facility shall be responsible for providing such drugs and biologicals for its residents and for ensuring that pharmaceutical services are provided in accordance with acceptable professional principles and appropriate federal, state and local laws.

(i) Supervision of Services. The pharmaceutical services shall be under the general supervision of a licensed pharmacist.

(A) The pharmacist, if not a full-time employee, shall devote a sufficient number of hours, based upon the needs of the facility, during regularly scheduled visits to carry out his/her responsibilities.

(ii) Pharmaceutical Services Committee.

(A) Pharmaceutical Services committee or its equivalent shall be responsible for developing policies and procedures for safe and effective drug therapy, distribution, control and use.

(I) The committee shall be comprised of at least the pharmacist, the director of nursing service, the administrator and one (1) physician.

(II) The committee shall oversee the pharmaceutical service in the facility, make recommendations for improvement and monitor the service to ensure accuracy and adequacy.

(III) The committee shall meet at least quarterly and document its activities, findings and recommendations.

(B) The pharmacist shall submit a written report at least quarterly to the pharmaceutical services committee on the status of the facility's pharmaceutical services and staff performance.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 14 Dental Services

(a) The facility shall have an advisory dentist who shall provide consultation, develop and participate in inservice education, and recommend policies concerning oral hygiene. Records of in-service education meetings shall be in writing.

(b) Nursing personnel shall assist the resident to carry out the dentist's recommendations.

(c) All dental examinations and dental treatments shall be entered on a dental record and made a part of the resident's medical record.

(d) Oral hygiene shall be a part of each resident's care daily.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 15 Social Services

(a) The medically related social and emotional needs of the resident shall be identified and services shall be provided to meet them, either by qualified staff (a social worker or social service associate), or through written procedures for referral to appropriate social agencies.

(i) Facilities shall offer social services regardless of the size of the facility.

(A) An individual on the facility staff shall be designated in writing to maintain liaison with social, health and community agencies.

(B) As appropriate, there shall be arrangements with qualified social workers or recognized social agencies for consultation and assistance on a regularly scheduled basis.

(ii) Current records and pertinent social data concerning personal and family problems medically related to the resident's illness and care shall be maintained in each resident's record by the social service personnel.

(A) Up-to-date progress notes of relevant psycho-social issues and interventions shall be maintained in each resident's record by social service personnel.

(iii) Policies and procedures shall be established for ensuring confidentiality of residents' social information.

(iv) There shall be space provided to ensure privacy for interviews by social service personnel with the resident.

(v) Provision shall be made for in-service training to facility staff directed toward understanding emotional problems and social needs of residents and the means of taking appropriate action in relation to them, and the necessity of confidentiality.

(vi) Arrangements shall be made promptly when financial assistance is indicated or personal finances are depleted, i.e., private paying residents no longer able to pay for care in the facility.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 16 Medical Records

(a) Maintenance of Clinical Records. The facility shall maintain a separate and complete medical record for each resident admitted with all entries kept current, dated and signed.

(i) The medical record shall include:

(A) Identification and summary sheet(s) including resident's name, social security number, marital status, age, sex, home address, and religion; name, address, and telephone number of referral agency (including hospital from which admitted), personal physician, dentist, and next of kin or other responsible person; admitting diagnoses, final diagnoses, category of care, condition on discharge and disposition, source of payment, and any other information needed to meet State requirements.

(B) Initial medical evaluation including medical history, physical ex- amination and diagnosis.

(C) Authentication of hospital diagnoses, in the form of a hospital discharge summary, or a written report from the physician who attended the resident in the hospital, or a transfer form used under a transfer agreement.

(D) Physician's orders, including all medications, treatments, diet, rehabilitative and special medical procedures required for the safety and well-being of the resident.

(E) Physician's progress notes describing significant changes in the resident's condition, dictated or written at the time of each visit.

(F) Nurses' notes which shall include but not be limited to the following:

(I) Concise and accurate record of nursing care administered.

(II) Record of pertinent observation of the resident including psycho-social as well as physical manifestations.

(III) Name, dosage and time of administration of medications and treatments, route of administration except if by oral medication.

(IV) Record of type of restraint and time of application and removal. The time of application and removal shall be necessary for all restraints prescribed by the physician for the support and protection of the resident.

(G) Medication and treatment record including all medications, treatments and special procedures performed for the safety and well-being of the resident.

(I) Laboratory and x-ray reports.

(II) Consultation reports.

(III) Dental reports.

(IV) Social service notes.

(V) Resident care referral reports.

(VI) Activity reports.

(b) Retention of Records.

(i) The facility shall have policies providing for the retention and safe- keeping of residents' medical records by the governing body for the required period of time in the event that the facility discontinues operation.

(ii) A copy of the resident's clinical record or an abstract thereof shall accompany the resident who is transferred to another facility.

(c) Staff Responsibility. An employee of the facility shall be assigned the responsibility for assuring that records are maintained, completed, and preserved if the facility does not have a full or part time medical record librarian.

(i) The designated individual shall be trained by and receive regular consultation from a person skilled in record maintenance and preservation.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 17 Residents Activities

(a) Resident Activity Program. An on-going program of meaningful activities ap- propriate to the needs and interests of residents shall be provided.

(i) The program shall be designed to promote opportunities for residents to engage in normal pursuits, including religious activities of their choice, if any.

(ii) Activities shall be designed to promote the physical, social and mental well-being of each resident.

(iii) The facility shall make available adequate space and a variety of sup- plies and equipment to satisfy the individual interests of residents.

(iv) Residents shall not be required to participate in activities if they do not desire.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 18 Transfer Agreement

(a) Resident Transfer. The transfer agreement shall provide reasonable assurance that the transfer of residents will be effected between the hospital and the facility whenever such transfer is medically appropriate as determined by the attending physician.

(i) The agreement shall be with hospitals close enough to the facility to make the transfer of residents feasible.

(b) Where the transfer agreement specifies restrictions with respect to the types of services available in the hospital or the facility and/or the types of residents or health conditions that will not be accepted by the hospital or the facility, or includes any other criteria relating to the transfer of residents (such as priorities for persons on waiting lists), such restrictions or criteria shall be the same as those applied by the hospital or facility.

(c) Execution of Agreement. The transfer agreement shall be in writing and shall be signed by individuals authorized to execute such agreements on behalf of the facilities, or, in case the two (2) facilities are under common control, there shall be a written policy or order signed by the person or body which controls them.

(i) The terms of the transfer agreement shall be established jointly by both facilities when the hospital and the facility are not under common control.

(ii) Each facility participating in the agreement shall retain a current copy of the agreement.

(d) Specification of Responsibilities. The transfer agreement shall specify the responsibilities each facility assumes in the transfer of residents and information between the hospital and the facility.

(i) The agreement shall establish responsibility for notifying the other facility promptly of the impending transfer of a resident, arranging for appropriate and safe transportation, and arranging for the care of residents during the transfer.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 19 Grievances and Complaints

(a) Every resident in a Nursing Care Facility shall have the right to:

(i) Upon admission, review the Nursing Care Facility grievances and com- plaint process and receive updated information at six (6) month intervals.

(ii) Voice grievances and complaints on behalf of themselves or others without discrimination or reprisal.

(iii) Have available in a conspicuous place telephone numbers and addresses of the Long-Term Care Ombudsman, Protection and Advocacy, the local Department of Family Services Adult Protection office, the Medicaid Fraud Control Unit, the Wyoming State Survey Agency, and the facility's grievance/complaint representative.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 20 Grievance Investigations

(a) Each Nursing Care Facility shall establish a system of reviewing allegations of violations of residents' rights and develop internal operating procedures for reporting and resolution.

(i) In order to ensure that residents continue to be aware of these rights and responsibilities, a written copy is to be prominently posted in a location that is available to all residents.

(ii) Prompt efforts must be demonstrated by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents and the services provided by the facility.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 21 Complaint Investigations

(a) Residents' unresolved grievances and/or complaints shall be referred to the Long-Term Care Ombudsman.

(b) The Office of the Ombudsman shall complete all complaint investigations within an appropriate time frame depending upon the seriousness of the allegations.

(c) Written reports of investigations and the status of resolutions completed by the Nursing Care Facility shall be provided by the Long-Term Care Ombudsman to the Licensing Division within thirty (30) days after the completion of the investigation.

Exception: Those complaints or problems reported directly to the State Survey Agency or referred by the Long-Term Care Ombudsman to the State Survey Agency shall be investigated by the State Survey Agency as per the Agreement between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 22 Hearings

(a) The Program Division Administrator shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for resolution. Any request for a hearing by the facility shall adhere to the time frames of (b) below.

(b) Any Nursing Care Facility aggrieved by a decision of the Program Division may request a hearing by submitting a written request to the Program Division within ten (10) days of the date of the adverse action at 6101 Yellowstone Road, North Building, Room 259B, Cheyenne, WY 82002.

(c) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing. Any request for a hearing by the facility shall adhere to the time frames of (b) above.

(d) Hearings requested under the terms of these rules and regulations shall be held by the Program Division in accordance with the provisions of the Wyoming Administrative Procedures Act at W.S. §16-3-101 et. seq.

History

Effective 2020-07-01

Wyo. Code R. 048.0003.11.07012020 § 23 Licensure

Shall be in accordance with the current Rules and Regulations for Licensure of Nursing Care Facilities adopted by the Department of Health.

History

Effective 2020-07-01

Chapter 12 Program Administration of Assisted Living Facilities

Wyo. Code R. 048.0003.12.08242020 § 1 Authority

These rules are promulgated by the Department of Health pursuant to W.S. 9-2-1204 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 2 Purpose and Applicability

(a) These rules have been adopted for the day-to-day operation of assisted living facilities.

(b) The Department may issue provider manuals, provider bulletins, or both, to interpret the provisions of these rules and regulations. Such provider manuals and provider bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in provider manuals or provider bulletins shall be subordinate to the provisions of these rules and regulations.

(c) 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 these rules and regulations.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 3 Severability

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 4 Definitions

(a) The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, 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.

(i) For the purpose of these rules, the following shall apply:

(A) "Abuse." The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. Abuse may include, but is not limited to the following: physical, verbal, mental, neglect, misappropriation of resident property, corporal punishment, sexual exploitation, sexual abuse, or any other adverse action.

(B) "Activities of Daily Living (ADLs)." An individual's performance of feeding, bathing, dressing, use of toilet, transfer, mobility and continence.

(D) "ALF 102 Form". The required screening tool as defined by the Program Division and performed by a registered nurse. Training regarding the utilization of this form will be the responsibility of the Program Division.

(E) "Assistance Plan." A written description of the type, frequency and duration of the assistance to be provided, and the expected outcome.

(F) "Assisted Living Facility (ALF)." A non-institutional dwelling operated by a person, firm, or corporation engaged in providing limited nursing care, personal care and boarding home care, but not habilitative care, for persons not related to the owner of the facility.

(G) "Bed." A piece of furniture on or in which a resident, or two residents lie and sleep. Single-bed means one piece of furniture in which to lie and sleep. Multiple-beds means two (2) or more pieces of furniture in a sleeping room in which to lie and sleep.

(H) "Boarding Home." A non-institutional dwelling or rooming house operated by any person, firm, or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative, or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided.

(I) "Certified Dietary Manager." A Certified Dietary Manager is a person with education, training, and experience to competently perform the responsibilities of a dietary manager with consultation from or supervision of a Registered Dietitian. The Certified Dietary Manager has passed a nationally-recognized credentialing exam and participates in continuing education as needed to maintain certified status.

(J) "Certified Nurse Assistant (CNA)." An individual who is duly certified by the Wyoming State Board of Nursing and whose certification has been verified by the management of the assisted living facility.

(K) "Chief Administrative Officer." The Director, Department of Health per W.S. 9-2-101(e), or the designated Licensure representative.

(L) "Complaint." A formal allegation of injustice or perceived harm referred to an outside party or agency.

(M) "Complaint Investigations." Those investigations performed by the Department of Health, their designee, or by the State Long Term Care.

(N) "Days." Calendar days.

(O) "Department." The Wyoming Department of Health.

(P) "Discharge." The full release of any resident from the assisted living facility.

(Q) "Food Code." The 2005 edition of the Food Code and all codes and standards therein. The Food Code 2005 is a publication of The U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration, College Park, MD 20740.

(R) "Grievance." A concern of an inequitable or inaccurate action that is handled through the facility's internal grievance procedure.

(S) "Habilitative Care." The teaching of care to perform basic ADL's including feeding, bathing, dressing, use of toilet, transfer, mobility, continence, and instrumental ADL's including shopping, finances, telephone, medications, housework and use of transportation.

(T) "HACCP." Hazard Analysis Critical Control Point.

(U) "Intermittent Nursing Care". Nursing care that is not continuous; care that starts and stops at irregular intervals.

(V) "Level 1 License." License for assisted living facilities that do not have a secure unit and are not required to meet the special staffing and education requirements for staff that are clearly defined under the rules for a level 2 facility.

(W) "Level 2 License." License for assisted living facilities that have a secure unit and are required to meet all level 2 requirements specified or implied by these rules. The assigned level will be used for regulatory purposes only.

(X) "License." The authority granted by the Licensing Division to operate an assisted living facility.

(Y) "Licensed Bed." The pieces of furniture on or in which residents lie and sleep that the authority is granted by the Licensing Division to operate an assisted living facility.

(Z) "Licensed Practical Nurse (LPN)." A Licensed Practical Nurse duly licensed by the Wyoming State Board of Nursing per the Wyoming Nurse Practice Act, W.S. § 33-21-119, et seq.

(AA) "Licensee." Any person, association, partnership, or corporation to whom an assisted living facility license is issued.

(BB) "Licensing Division." The Wyoming Department of Health, Office of Healthcare Licensing and Surveys.

(CC) "Life Safety Code (LSC)." The National Fire Protection Association 101 Life Safety Code.

(DD) "Limited Assistance". The resident performs the activity with minimal assistance from staff.

(EE) "Limited Nursing Care." The level of care provided by a certified nursing assistant, within the scope of ALF Licensure.

(FF) "Physician Extender." Physician extender means a mid-level practitioner such as an advanced registered nurse practitioner or a physician assistant.

(GG) "Manager." The person responsible for the overall operation of the assisted living facility. This individual is responsible for ensuring compliance with these rules.

(HH) "Medication Management." The requirements as established in these Program Administrative Rules, as well as the Wyoming Nurse Practice Act and the Wyoming Board of Nursing Rules and Regulations.

(II) "NFPA." The National Fire Protection Association.

(JJ) "Nursing Care Facility." An institution which is a Skilled Nursing Facility (SNF), or a Nursing Facility (NF) which is currently licensed in the State of Wyoming.

(KK) "Ombudsman." The State Long Term Ombudsman established in W.S. 9-2-1301 through 9-2-1309.

(LL) "Personal Care/Personal Care Services." The performance of activities of daily living for a resident.

(MM) "Program Administration." The rules promulgated by the Department of Health and developed by the Program Division for the day-to-day operation of assisted living facilities per W.S. 9-2-1204.

(NN) "Program Division." The Wyoming Department of Health, Aging Division.

(OO) "PRN." Means as circumstances may require; as necessary.

(PP) "Registered Dietitian (RD)." A Registered Dietitian who is currently registered with the Commission on Dietitian Registration, the credentialing agency for the American Dietetic Association.

(QQ) "Registered Nurse (RN)." A Registered Nurse duly licensed by the Wyoming State Board of Nursing per the Wyoming Nurse Practice Act W. S. § 33-21-119 et seq.

(RR) "Resident." A person eighteen (18) years of age or older, unrelated to the owner, who resides in an assisted living facility.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 5 Philosophy

(a) It is the philosophy of the Program Division to develop reasonable and enforceable rules for the placement of individuals with disabilities in community settings such as assisted living facilities in lieu of unnecessary institutionalization. This philosophy is mandated in the Supreme Court ruling on Olmstead v. L.C.

(b) These rules are designed not only to support the philosophy of community placement but to also protect the health, welfare, and safety of residents in assisted living facilities.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 6 Personnel and Staffing Requirements

(a) Management. If the assisted living facility has a governing body, it must designate a manager. If there is no governing body, the owner shall appoint a manager.

(i) The Manager shall:

(A) Be at least twenty-one (21) years of age;

(B) Assume the overall responsibility for the day-to-day operation of the facility;

(D) Be able to read, write, and speak English;

(E) Maintain financial and other records;

(F) Have a telephone with a listed number in the phone directory under the name of the assisted living facility;

(G) Be familiar with and follow the State's promulgated Assisted Living Facility Licensure and Program Administration Rules;

(H) Pass an open book test on the same. The open book test shall be administered by the Program Division. The passing score will be 85% or greater. Those individuals who successfully completed the examination administered by the Licensing Division shall have their test scores honored;

(I) The manager shall provide an acceptable plan of correction to the Licensing Division within ten (10) days of the date when a statement of deficiencies is received by the assisted living facility;

(J) The manager shall not act as, or become the legal guardian or conservator of, or have power of attorney for any resident of the facility; and

(K) The manager shall meet one or more of the following requirements:

(I) The manager shall have completed at least forty-eight (48) semester hours or seventy-two (72) quarter hours of post-secondary education in healthcare, elderly care, health case management, facility management, or other related field from an accredited college or institution; or

(II) Have completed at least two (2) years' experience working with elderly or disabled individuals. This experience may have been paid, full-time employment, or time equivalent in part-time employment or volunteer work that is directly involved with the elderly or disabled.

(b) Staffing.

(i) The staffing level shall be sufficient to meet the needs of all residents of the facility, and insure the appropriate level of care is provided.

(ii) There shall be personnel on duty to maintain order, safety, and cleanliness of the premises, to prepare and serve meals, to keep an adequate supply of clean linens, to assist the residents in personal needs and recreational activities, and to meet the other operational needs of the facility.

(iii) The assisted living facility shall not employ an individual as a nurse assistant who is not currently certified by the Wyoming State Board of Nursing. Certification must be verified by the manager of the assisted living facility.

(iv) There shall be at least one (1) RN, LPN or CNA on duty every shift. There shall be at least one (1) person on duty and awake at all times.

(v) If the assisted living facility does not employ an RN, the facility shall Contract with an RN to provide the initial assessment, periodic reviews, assistance plans, as well as the periodic updates of resident assessment, reviews, assistance plans, and medication management.

(c) Background checks. All staff of the assisted living facility shall successfully complete, at a minimum, a State of Wyoming Division of Criminal Investigation (DCI) fingerprint background check and a Department of Family Services Central Registry Screening before direct resident contact.

(d) Infection Control. Written policies must be in effect to ensure that newly hired and current employees do not spread a communicable disease that could be transmitted through usual job duties. These written policies must, at a minimum:

(i) Ensure a safe and sanitary environment for residents and personnel;

(ii) Require tuberculin testing, or screening as appropriate; and

(iii) Prohibit any person with an airborne, contagious, or infectious disease from being employed until a work release is obtained.

(A) The facility shall prohibit employees with a communicable disease or infected skin lesions from direct contact with residents and their food, if direct contact will transmit a disease.

(B) The facility shall require staff to follow universal precautions when performing direct resident care.

(e) Personnel Policies and Records.

(i) Management shall provide new employee orientation and education regarding resident rights, evacuation, and emergency procedures, as well as training and supervision designed to improve resident care.

(ii) A record for the manager and each employee shall be maintained and contain at a minimum, the following information:

(A) Name, current address and telephone number;

(B) Social Security Number;

(D) Work experience, documentation of reference checks;

(E) Date of employment;

(F) Position in the assisted living facility (job description);

(G) Documentation of tuberculin testing;

(H) Orientation checklist;

(I) I-9, (Employment Eligibility Verification);

(J) W-4, (Employee's Withholding Allowance Certificate);

(K) Licensure, Certification, or Credentials; (e.g., RN, LPN, CNA, etc.); and

(L) Documentation of all completed background and Central Registry background check with no offenses.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 7 Assisted Living Facility (ALF) Core Services

(a) The assisted living facility core services include the following:

(i) Meals, housekeeping, personal and other laundry services;

(A) Provision of mechanically altered diets and dietary supplements, if required.

(ii) A safe and clean environment;

(iii) Assistance with local transportation;

(iv) Assistance with obtaining medical, dental, and optometric care, in addition to social services;

(v) Assistance in adjusting to group living activities;

(vi) Maintenance of a personal fund account, if requested by the resident or resident's responsible party, showing any and all deposits, withdrawals, and transactions of the account;

(vii) Provision of appropriate recreational activities in/out of the assisted living facility;

(viii) Care of individuals who require any or all of the following services:

(A) Partial assistance with personal care; e.g. bathing, shampoos;

(B) Limited assistance with dressing;

(D) Stage I skin care - skin integrity intact;

(E) Infrequent assistance with mobility. The resident may use an assistive device; e.g., wheel chair, walker, cane;

(F) Cuing guidance with ADLs for the visually impaired resident, or the intermittently confused and/or agitated resident requiring occasional reminders to time, place and person;

(G) Care of the resident who can independently manage his own catheter or ostomy, e.g., resident who can change his own catheter bags, able to clean and care for his ostomy;

(H) Care of the resident incontinent of bowel or bladder if the condition can be managed independently;

(ix) Assessments completed by a Registered Nurse;

(A) Registered Nurse medication review every two (2) months or sixty-two (62) days or whenever new medication is prescribed or the resident's medication is changed;

(x) Twenty-four (24) hour monitoring of each resident.

(b) Resident Assessment and Services. The staff/contract Registered Nurse (RN) shall conduct initial and, at a minimum annually, an accurate, standardized, reproducible assessment of each resident's functional capacity, physical assessment and medication review.

(i) The completion of the ALF 102.

(A) The current version of the ALF 102 is the designated screening tool. The form may be updated and /or revised periodically by the Program Division. Providers will be notified of changes in the form. The following guidelines apply to the ALF 102:

(I) The ALF 102 is only valid if completed within forty-five (45) days prior to admission and there is no change in the resident's condition.

(II) The ALF 102 must be completed and signed by an RN.

(III) The ALF 102 may be completed telephonically; however, it must be verified in person by an RN.

(IV) A new ALF 102 shall be completed at least annually, and when there is a change in the resident's condition.

(ii) Admission orders. A resident shall be admitted only if accompanied by a history and physical completed by a physician or physician extender within ninety (90) days prior to admission. The facility shall confirm the resident's medication regimen and special treatment orders at the time of admission.

(A) Admission orders shall include an order for TB screening, influenza and pneumococcal immunization status and orders for immunization if required, unless contraindicated. The facility must develop and implement policies and procedures to ensure the following:

(I) Residents, or their legal representative are educated regarding the risks and benefits of these immunizations.

(II) The immunizations are offered unless medically contraindicated or the resident is currently immunized.

(III) If the resident is not vaccinated, the medical record must reflect the reason, such as medical contraindication or refusal.

(iii) The Registered Nurse shall make an initial assessment of the resident's needs, which describes the resident's capability to perform ADLs and notes all significant impairments in functional capability.

(A) Initial assessment. A current assessment shall be maintained in each resident's file.

(B) The assessment shall include at least the following information:

(I) Medically defined conditions and prior medical history;

(II) Physical status;

(III) Sensory and physical impairments;

(IV) Nutritional status and requirements;

(V) Special treatments and/or procedures;

(VI) Mental and psychosocial status;

(VII) Discharge potential;

(VIII) Dental condition;

(IX) Activities potential;

(X) Rehabilitation potential; and

(XI) Medication regimen.

(1.) Documentation of resident's ability to self-medicate.

(iv) Frequency of assessment. An assessment must be conducted:

(A) No earlier than one (1) week prior to admission;

(B) Immediately upon any significant change in the resident's mental or physical condition; or

(v) Use of the assessment.

(A) The results of the assessment are used to develop, review, and revise the resident's individualized assistance plan.

(vi) Resident assistance plan.

(A) An RN shall develop an assistance plan for each resident.

(B) Each facility shall construct its own forms for such plans, which at a minimum shall contain documentation of the following:

(I) Who will provide the care/services;

(II) What care/services will be provided;

(III) When will care/services be provided;

(IV) How the care/services will be provided;

(V) The expected outcome;

(VI) Resident participation in development of the assistance plan to the extent of his ability to do so. A relative or other interested party may also participate; and

(VII) Dated signature of the RN, the facility manager, and the resident or the resident's responsible party.

(vii) The assistance plan shall be reviewed and updated by the RN at least annually or when a significant change occurs, with input from direct care-givers, the resident, and others as designated by the resident.

(viii) The RN shall periodically evaluate results of the plan. The plan shall reflect assessed needs and resident decisions (including resident's level of involvement); support principles of dignity, privacy, choice, individuality, independence, and home-like environment; and shall include significant others who may participate in the delivery of services.

(c) Resident Rights. The facility shall adopt and follow a written policy of resident rights. The policy shall be posted in a conspicuous place, and there shall be documentation in the resident's record that the resident read, or management explained, the policy. This policy shall not exclude, take precedence over, or in any way abrogate the legal and constitutional rights enjoyed by all adult citizens and shall include, but is not limited to the following:

(i) Be treated with respect and dignity;

(ii) Privacy;

(iii) Free from physical or chemical restraints not required to treat the resident's medical symptoms. No chemical or physical restraints will be used except by order of a physician;

(iv) Not to be isolated or kept apart from other residents;

(v) Not to be physically, psychologically, sexually, or verbally abused, humiliated, intimidated, or punished;

(vi) Live free from involuntary confinement or financial exploitation;

(vii) Full use of the facility's common areas;

(viii) Voice grievances and recommend changes in policies and services;

(ix) Communicate privately, including, but not limited to, communicating by mail or telephone with anyone;

(x) Reasonable use of the telephone, which includes access to operator assistance for placing collect telephone calls;

(xi) Have visitors, including the right to privacy during such visits;

(xii) Make visits outside the facility. The facility manager and the resident shall share responsibility for communicating with respect to scheduling such visits;

(xiii) Make decisions and choices in the management of personal affairs, assistance plans, funds, or property;

(A) Including choice of home health agencies, pharmacies, personal care providers and any other private pay provider.

(xiv) Expect the cooperation of the provider in achieving the maximum degree of benefit from those services which are made available by the facility;

(xv) Exercise choice in attending and participating in religious activities;

(xvi) Reimbursed at an appropriate rate for work performed on the premises for the benefit of the operator, staff, or other residents, in accordance with the resident's assistance plan;

(xvii) Informed by the facility thirty (30) days in advance of changes in services or charges;

(xviii) Have advocates visit, including members of community organizations whose purposes include rendering assistance to the residents;

(xix) Wear clothing of choice unless otherwise indicated in the resident's plan, and in accordance with reasonable dress code;

(xx) Participate in social activities, in accordance with the assistance plan; and

(xxi) Examine survey results.

(d) Medications.

(i) An individual record shall be kept for each resident, recording any prescription drugs administered by the facility. This record shall include:

(A) Name of resident;

(B) Name and telephone number of primary physician;

(D) Name and description of the medication, including prescribed dosage;

(E) Dosage administered;

(F) Quantity;

(G) Times and dates administered;

(H) Method of administration;

(I) Any adverse reactions to the medication;

(J) Signature of licensed staff administering medication; and

(K) RN review date and signature.

(ii) Prescription drugs shall be dispensed from a licensed pharmacy, labeled with the name, address and telephone number of the pharmacy, name of resident, name and strength of drug, directions for use, date filled, expiration date, prescription number and name of physician. Controlled substances shall have a warning label on the bottle.

(A) An RN shall destroy all discontinued prescriptions, other than controlled substances, using accepted standards of practice.

(B) Discontinued or outdated controlled substances shall be destroyed by the RN in the presence of a licensed pharmacist and documented in the resident's record.

(iii) Self medication.

(A) Residents able to self-medicate may keep prescription medications in their room if deemed safe and appropriate by the RN.

(B) Residents may keep and use over-the-counter medications in their room without a written order by a physician unless deemed inappropriate by the RN.

(C) If more than one resident resides in the room, an assessment will be made of each person and his ability to safely have medications in the room. If safety is a factor, the medication shall be kept in a locked container.

(D) The facility will work with the resident to develop a means to mutually resolve any problems relating to self-medication.

(iv) Medication assistance.

(A) The staff shall be responsible for providing necessary assistance to residents deemed capable of self-medicating, but are unable to do so because of a functional disability, in taking oral medications. Non-licensed staff can only assist with oral medications. Medication assistance may include:

(I) Reminding resident to take medications;

(II) Removing medication containers from storage;

(III) Assisting with removal of cap;

(IV) Assisting with the removal of a medication from a container for residents with a disability which prevents independence in this act;

(V) Observing the resident take the medication; and

(VI) Documentation of observation.

(v) Medication Administration

(A) An RN shall be responsible for the supervision and management of all medication administration as required by the Wyoming Nurse Practice Act, and the Wyoming Board of Nursing Rules and Regulations.

(e) Resident Records and Reports. Each resident's records shall be current, organized and maintained in individual folders which shall be made available to the resident, the Licensing Division, or designated representative upon request.

(i) Each folder shall include the following:

(A) Information from the referring agent, if applicable;

(B) History and physical performed by a physician or physician extender;

(I) Full name of resident and former address;

(II) Date of admission;

(III) Sex, race, date of birth, social security number, and former occupation;

(IV) Name, home address, and telephone number of relative, friend, Power of Attorney, or guardian;

(V) Name, address, and telephone number of resident's personal physician, dentist, ophthalmologist or optometrist;

(VI) Medicare number or other medical insurance identifying data;

(VII) A written inventory of all personal possessions; however, this inventory need not include personal clothing;

(D) All accidents, injuries, incidents, illnesses, and allegations of abuse, neglect or exploitation shall be reported to the resident's family or responsible party and be documented in the individual resident records. All such occurrences shall also be reported to the appropriate entity for follow up and resolution. Reports of all incidents affecting the health, welfare or safety of a resident shall be provided to the Licensing Division immediately (within one business day). Reporting shall be done by telephone or fax. The facility's investigation of the incident shall be reported to the Licensing Division and the Long Term Care Ombudsman within five (5) working days. Documentation to support the facility reporting the situation and follow up must also be present in the resident records;

(E) An accounting of all personal funds deposited with and disbursed by the facility;

(I) Upon written authorization of a client, the facility must hold, safeguard, manage and account for the personal funds of the client.

(1.) The facility must deposit any personal funds in excess of $100 in an interest bearing account.

(2.) The facility must establish and maintain a system that assures a full and complete and separate accounting according to generally accepted accounting principles of each resident's personal funds entrusted to the facility.

(3.) Upon the death of a resident with a personal fund deposited with the facility, the facility must convey, within 30 days, the resident's funds a final accounting of those funds, to the individual or probate jurisdiction administering the resident's estate.

(4.) The facility must not impose a charge against the personal funds of a resident for any item or service for which payment is made under Medicaid or Medicare except for applicable deductible and coinsurance amounts.

(F) A signed copy of the resident's rights;

(G) The resident's assessment and individualized assistance plan;

(H) Copies of all applicable resident assistance contracts, signed by both parties;

(I) Written acknowledgment of the receipt and explanation of all facility policies including admission/discharge policies;

(J) Copy of all ALF 102's; and

(K) Copy of outside contractual responsibilities, if applicable.

(ii) The resident shall be assured of confidential treatment of all information in the record, and the resident's written consent (or the consent of the guardian) shall be required for the release of information to persons not otherwise authorized to receive it.

(iii) All residents' records shall be retained in a physically secure area for a minimum of six (6) years after the resident has left the facility and may be disposed of, by shredding or burning, after that time.

(iv) In the event of dissolution of the facility, the manager shall notify the Licensing Division as to the location of all residents' records.

(v) All records shall be protected from damage by fire, water and other hazards.

(vi) All entries in each resident's record shall be made in ink, signed and dated.

(f) Resident Activities. An activities program shall be available to the resident and shall be designed to enhance each resident's sense of physical, psychosocial, and spiritual well-being.

(i) A member of the facility's staff shall be designated as responsible for the resident activities program;

(ii) Space, equipment, and supplies for the activities program shall be adequate for individual and/or group activities; and

(iii) There shall be regularly scheduled activities during weekdays, evenings and weekends.

(g) Grievance Procedure.

(i) The written grievance procedure shall establish a system of receiving, reviewing, and alleviating concerns, complaints and allegations of resident rights violations, and poor service provided to include, but not limited to:

(A) Resident's method to express and document grievances;

(B) Documentation of the provider's response to verbal and written resident grievances;

(C) List of agencies, with address and telephone numbers for residents to contact if grievances are not addressed satisfactorily (e.g. State Long Term Care Ombudsman and the Department of Health, Office of Licensing and Surveys); and

(D) The facility shall provide written reports of the grievances and resolutions to the Ombudsman and the Licensing Division within ten (10) days after the grievance is filed.

(ii) The written grievance procedure shall be posted in a conspicuous place within the facility.

(h) Complaint Investigations.

(i) Resident complaints shall be referred to the Long Term Care Ombudsman or the Licensing Division.

(i) Adult Protection.

(i) The facility must assure that all residents are protected from abuse. This includes the resident's right to be free from verbal, physical, mental, or sexual abuse in accordance with the definition of abuse as stated in Section 4(a) of these rules.

(ii) The facility must adhere to written policies and procedures that prohibit the abuse of any resident. These policies and procedures must identify how the facility will screen employees before hiring, ongoing in-servicing of abuse topics with employees, and a protocol that specifies how allegations of abuse will be investigated. Each staff member must be accountable to report any suspicion or knowledge of abuse to the appropriate facility personnel immediately.

(iii) The facility is responsible to ensure all allegations of abuse are investigated expediently and that the resident(s) are protected from further, potential abuse while the investigation is in progress.

(A) Instances of abuse, neglect, or exploitation of disabled adults shall be reported to the sheriff's department, the local police department, or to the department of family services in accordance with W.S. 35-20-103.

(B) The facility must ensure that, if necessary, additional authorities are contacted if there is an allegation of abuse, neglect or exploitation. These additional authorities may include the Wyoming State Board of Nursing, Office of Healthcare Licensing and Survey, and the State Long Term Care Ombudsman.

(j) Food Service and Nutrition.

(i) Assisted Living Facilities that choose to admit residents who need therapeutic or mechanically modified diets must employ or contract with a Registered Dietitian who shall approve written menus and dietary modifications, approve special diet needs, plan individual diets, and provide guidance to dietary staff in areas of preparation, service, and monitoring. The frequency of visits is determined by the residents' needs and the competency of the dietary staff but must include at least a monthly onsite review of dietary services.

(ii) There must be an organized dietetic service that meets the daily nutritional needs of residents and ensures that food is stored, prepared, distributed, and served in a manner that is safe, wholesome and sanitary in accordance with the rules. The dietetic service must ensure that food prepared is nutritionally adequate in accordance with the Dietary Reference Intakes (DRI) for adults.

(iii) Food service supervision:

(A) Day to day responsibilities for food production and management of the dietary services shall be assigned to a person with nutrition and food service management experience equivalent to that of a Certified Dietary Manager.

(iv) A minimum of three meals in a twenty-four (24) hour period shall be provided to each resident during normal dining hours. In addition, meals and between meal snacks shall be palatable, attractive in appearance, consist of a variety of foods, and shall be served at the proper temperature.

(A) Menus shall be planned based on recognized national dietary standards recommended by a Registered Dietitian. Menus shall be prepared at least two weeks in advance and posted in the kitchen. Reasonable substitutions of similar nutritive value must be available to residents who refuse or/are unable to eat the food served. The daily menus shall be corrected to show the food actually served, and the corrected copy kept on file and available for inspection for one (1) year. A current diet manual shall be approved by the Registered Dietitian, and sufficient copies of the approved manual must be available to dietary and nursing staff in the assisted living facility.

(v) Individuals with food preparation responsibilities shall be in good health and shall practice safe food handling techniques in accordance with the current edition of Food Code published by the U.S. Public Health Service, Food and Drug Administration.

(vi) The kitchen and dining area shall be kept clean and sanitary in accordance with standards established in the current edition of FDA Food Code. The dining area shall provide suitable furniture and adequate space to comfortably seat all residents.

(vii) There shall be enough food on hand to meet at least one (1) week's menu.

(viii) Cleaning and sanitizing of dishes and silverware shall be done by automatic dishwashers.

(ix) Persons handling soiled tableware and/or silverware shall wash their hands before handling clean ware.

(x) No fly strips shall be allowed in the kitchen or dining area.

(k) Transfer and Discharge.

(i) Residents shall receive a thirty (30) day written notice prior to any facility initiated transfer or discharge, unless the resident imposes an imminent danger to self and/or others or the resident's level of care exceeds that which can be provided by an assisted living facility. Residents shall have the right to object to the request, except where undue delay might jeopardize the health, safety or well-being of the resident or others. The notice shall include contact information for the Long Term Care Ombudsman.

(ii) Residents may be asked to leave only for the following reasons:

(A) The facility has had its license revoked, not renewed, or voluntarily surrendered;

(B) The facility cannot meet the resident's needs;

(C) The resident or responsible person has a documented established pattern, in the facility, of not abiding by agreements necessary for assisted living;

(D) Non-payment of charges; or

(E) The resident engages in behavior which imposes an imminent danger to self and/or to others.

(iii) Residents who object to the request to leave the facility shall be given the opportunity of an informal conference. This informal conference must be requested within ten (10) days of the resident's notice to leave the facility. The purpose of the conference is to determine if a satisfactory resolution can be reached. Participants in the conference may include a facility representative, the resident, and at the resident's request, a family member, and/or legal representative of the resident, and the Long Term Care Ombudsman. The informal conference is not to be considered an administrative hearing.

(iv) Residents transferred to another health care facility shall be given written transfer/discharge notice which includes:

(A) The name of the resident;

(B) The reason for the transfer/discharge;

(D) The location to which the resident is transferred/discharged;

(E) The name, address, and telephone number of the Ombudsman; and

(F) A listing of all outside contracted services.

(v) The facility shall provide sufficient preparation and orientation to residents to ensure an orderly transfer/discharge from the facility.

(vi) A copy of the written resident assistance plan shall be provided to the resident prior to transfer/discharge.

(l) Quality Improvement.

(i) The facility shall have an active quality improvement program to ensure effective utilization and delivery of resident care services.

(A) A member of the facility's staff shall be designated to coordinate the quality improvement program.

(B) The quality improvement program shall encompass a review of all services and programs provided for all residents. The program shall have:

(I) A written description;

(II) Problem areas identified;

(III) Monitor identification;

(IV) Frequency of monitoring;

(V) A provision requiring the facility to complete annually a self-assessment survey of compliance with the regulations; and

(VI) A satisfaction survey shall be provided to the resident, resident's family, or resident's responsible party at least annually.

(C) Problems identified during the annual survey or the quality improvement process shall be addressed with appropriate written corrective actions.

(D) The quality improvement program shall be re-evaluated at least annually.

(m) Facility Policies and Procedures.

(i) Management shall develop policies and procedures that are available to residents and staff, including but not limited to:

(A) Resident rights;

(B) Disciplinary procedures surrounding substantiated cases of resident abuse;

(D) Medication management;

(E) Emergency care of residents (including missing resident, blizzard, water outage, etc.);

(F) Fire/disaster plan;

(G) Departure and return;

(H) Smoking;

(I) Visiting hours;

(J) Activities;

(K) Management of resident trust accounts;

(L) Personnel policies;

(M) Grievance procedure;

(N) Per Diem rate/charges/fees, to include a listing of what is included in the established charges;

(O) Incident reports;

(P) Notification of change in established per diem rate/charges/fees;

(Q) Outside contractual responsibilities; and

(R) Identification and notification of change in resident's condition.

(n) Furnishings, Buildings, Physical Plant.

(i) One half of the licensed beds shall be private rooms;

(ii) Sleeping rooms shall be homelike, well lighted, ventilated and equipped in compliance with the requirements below;

(A) All windows shall have drapes, curtains, shades or blinds to assure privacy;

(B) Beds (if provided by the facility) shall be at least standard size in width (39"), and shall be equipped with comfortable, clean mattresses and pillows. Mattresses shall be professionally renovated or replaced as needed. Extra long beds shall be used to accommodate tall residents. Rollaway-type beds, cots and folding beds shall not be used unless the resident brings these items from home for personal use;

(I) Two residents may, by consent of both parties, or by approval of the appropriate responsible party, be permitted to use one bed no smaller than double size, and occupy a single-bed sleeping room.

(D) Non-combustible wastebasket;

(E) Chair; and

(F) If common closets are utilized by two (2) or more residents, dividers shall be provided for separation of each resident's clothing. All closets shall be equipped with doors. Free-standing closets shall be deducted from the square footage in the sleeping room.

(G) The size and arrangement of the residents' beds, furnishings, possessions or equipment shall allow the resident to gain fire emergency access to windows and doors, and access to toilet room. Multiple-bed rooms shall have at least three (3) feet between beds.

(H) Residents shall be encouraged to bring personal items and furniture for their rooms, (e.g., beds, chairs, and pictures);

(I) There shall be at least one (1) bedside screen per double room available to provide resident privacy when needed;

(J) There shall be an adequate supply of hot and cold water available at each lavatory, bathtub/shower, kitchen sink, dishwasher, and laundry equipment. Hot water for bathing, and resident handwashing, and laundry should be no hotter than one hundred and twenty (120o) degrees Fahrenheit.

(K) All plumbing shall be maintained in good repair and according to the requirements of the Uniform Plumbing Code;

(I) Private water systems shall be safe, potable, and have an adequate supply. Testing shall be done monthly and records of tests shall be retained at the facility.

(II) Private water systems shall be tested and found safe and potable before Licensure is granted.

(L) Fireplaces shall be securely screened and glassed in;

(M) The facility shall be maintained so that it is free of hazards, such as loose or broken window glass, loose or cracked floors or floor coverings, or cracked or loose plaster on wall or ceilings;

(N) At least one primary grade level entrance to the building shall be freely accessible for wheelchairs;

(O) Each resident shall have his individual comb, toothbrush, towels, and wash cloths;

(P) Clean drinking glasses shall be available for the residents. Common drinking cups are prohibited;

(Q) Bathrooms shall have soap and toilet paper. The facility shall provide paper towels or a blow dryer for hands, or rack space adequate for each resident using the bathroom to hang his/her personal towel. Use of a common towel is prohibited;

(R) Provisions shall be made for privacy in all bath and toilet rooms;

(S) Automatic deodorizers or aerosol fresheners shall not be used except in bathrooms; and

(T) Residents shall not use a common bar of soap. The facility shall provide either soap dispensers or individual bars of soap for each resident.

(U) Housekeeping.

(I) Housekeeping practices and procedures shall be employed to keep the home free from offensive odors, accumulations of dirt, and dust.

(II) Floors shall be maintained and clean.

(III) Polish of floors shall provide a non-slip finish.

(IV) Throw or scatter rugs shall not be used. Non-slip mats may be used.

(V) Covered containers with tight lids shall be used for garbage storage.

(W) The facility shall be maintained free of insects and rodents. All windows shall be screened. All exit doors opening inward shall have a screen door.

(X) Linens and laundry.

(I) Laundry service for linen and residents' personal clothing shall be provided. The manager shall take measures to ensure that residents' clothing is not lost or misplaced while laundering.

(II) All linen shall be bagged or placed in a hamper before being transported to the laundry area.

(III) Bed linen shall be changed as necessary but at least weekly. Additional blankets or pillows shall be provided. Rubber or water protective sheets shall be used if indicated.

(IV) Two (2) complete changes of clean bed linen shall be on hand for each licensed bed.

(1.) Torn, worn, or unclean bed linen shall not be used.

(V) All bleaches, detergents, disinfectants, and other cleaning agents shall be separated from medicines and foods.

(VI) Soiled linen shall not be transported through, sorted, processed, or stored, in kitchens, food preparation areas, or food storage areas.

(Y) The heating system shall be inspected yearly, before the heating season, and maintained according to manufacturer's instructions.

(Z) Portable space heaters shall not be used, (e.g. electric or kerosene).

(AA) Equipment Maintenance and Testing.

(I) The devices, equipment, systems, conditions, arrangements, levels of protection, or any other features that are required for compliance with the provisions of the Life Safety Code shall be permanently maintained for the building housing the facility.

(o) Evacuation Capability, Emergency Procedures, and Fire Safety.

(i) Evacuation Capability.

(A) The evacuation capability rating for the group of residents, as defined by the Life Safety Code, in accordance with licensure rules, shall meet prompt or slow for facilities with nine (9) or more residents, and the rating shall meet prompt for facilities of eight (8) or fewer residents. The facility shall be responsible for maintaining evacuation capability ratings by timed fire exit drills.

(I) Exception shall be a facility where the construction meets the impractical evacuation capability rating.

(B) Evacuation Capability Ratings:

(I) Prompt - maximum of three (3) minutes

(II) Slow - between three (3) and thirteen (13) minutes

(III) Impractical - more than thirteen (13) minutes

(ii) Emergency Procedures.

(A) Disaster and Emergency Preparedness.

(I) The facility shall have detailed written plans and procedures to meet all potential emergencies and disasters, such as fire, severe weather, and missing residents. A copy of the plans shall be available at all times within the facility.

(1.) Emergency plans in the event of a fire shall be in accordance to the Life Safety Code Operating Features sections.

(II) The facility shall train all employees in the emergency procedures. New staff shall be trained within the first week of employment. The facility shall review the procedures with all staff at least every twelve (12) months. A training record shall be kept in each personnel file.

(iii) Fire Safety.

(A) Portable fire extinguishers shall be installed, inspected, and maintained according with NFPA 10, Standard for Portable Fire Extinguishers.

(I) State of Wyoming certified individuals shall inspect and service the extinguishers. All extinguishers shall have a tag or label securely attached that indicate the month and year the maintenance was performed and that identifies the person performing the service.

(B) Readily available and clearly readable telephone numbers for emergency contacts shall be located near all telephones.

(C) Clearly readable floor diagrams reflecting the actual floor arrangement showing the exit locations and evacuation routes shall be posted in conspicuous places. Each resident shall be instructed with its use on the first day of admission.

(D) Resident training for the fire emergency plan shall be in accordance with the Life Safety Code Operating Features sections.

(I) On the first day of admission, each resident shall be instructed in the proper action of the fire emergency plan, including the location of all the exits. A record of this instruction shall be in each resident file

(E) Fire exit drills shall be conducted in accordance to the Life Safety Code Operating Features sections. The minimum number of drills, as amended, shall be held at least twelve (12) times per year on a monthly basis with a minimum of one drill conducted each quarter on each shift. Fire exit drill records over a two-year period shall be available upon request at the facility.

(I) The facility shall be responsible for recording fire exit drills on an evaluation form that include at least the following:

(1.) Date of drill;

(2.) Time of day;

(3.) Type of drill (Practice, Announced, Surprise);

(4.) Residents who participated including staff and family members;

(5.) Time required (minutes and seconds) to evacuate all residents (including staff) from the occupied areas to a point of assembly as defined in the Life Safety Code;

(6.) List of anyone, including staff and family members, who did not evacuate in the required time allowed by the evacuation capability rating of the facility. Evacuation capability rating for each facility shall be listed on the form;

(7.) Comments on the factors that contributed to each individual's inability to evacuate successfully and any corrective actions recommended; and

(8.) Signature and date of the person completing the form.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 8 Services Which Cannot Be Provided By The Level 1 Assisted Living Facility Staff

(a) The following services cannot be provided:

(i) Continuous assistance with transfer and mobility;

(ii) Care of the resident who is unable to feed himself independently and/or; monitoring of diet is required;

(iii) Total assistance with bathing and dressing;

(iv) Invasive catheter or ostomy care, such as changing of catheter or irrigation of ostomy;

(v) Care of resident who is on continuous oxygen, if;

(A) Continuous monitoring is required; or

(B) Oxygen is ordered by the physician or physician extender to be titrated based on oxygen saturation levels;

(vi) Care of resident whose wandering jeopardizes the health and safety of the resident;

(vii) Incontinence care by facility staff;

(viii) Wound care requiring sterile dressing changes;

(ix) Stage II skin care and beyond;

(x) Care of the resident with inappropriate social behavior; e.g., frequent aggressive, abusive, or disruptive behavior; and

(xi) Care of resident demonstrating chemical abuse that puts him and/or others at risk;

(xii) Monitoring of acute medical conditions.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 9 Contractual Services Provided Outside Assisted Living Facility Authority

(a) Residents in an assisted living facility may receive services from an outside entity for care beyond that provided for or specified in the Assisted Living Program Administration Rules. These services must be arranged by the appropriate professional and be incorporated into the resident's assistance plan. The resident's choice of providers must be honored.

(i) Components of the outside service(s) contract:

(A) Who will provide service(s);

(B) What service(s) will be provided;

(D) Where the service(s) will be provided;

(E) How the service(s) will be provided; and

(ii) Life Safety Code Responsibilities for Outside Contractual Services. A contract between the resident, the ALF, and all outside service providers in the ALF must be in place prior to the time of service delivery. This contract must identify the clear delineation of services.

(A) The contract must specifically articulate the responsibilities of the resident, the ALF, and all service providers to comply with the Evacuation Capability, Emergency Procedures and Fire Safety requirements in these rules.

(B) All residents regardless of the type of service must be able to evacuate, or be evacuated, in accordance with the Life Safety Code.

(iii) Additional Contractual Services Provided Outside the Assisted Living Authority. In addition, services that must be provided outside the Assisted Living Facility Authority include, but are not limited to:

(A) LTC/HCBS Waiver services;

(B) Hospice care;

(D) Private duty care.

(iv) Long Term Care Home and Community Based Waiver. Individuals residing in assisted living facilities may be served on the long term care home and community-based waiver (LTC/HCBS) under the following conditions:

(A) When the resident requires a service that can be provided by both the long term care and the home and community based services waiver provider and the assisted living facility, but the resident cannot afford to pay the assisted living facility for the service, the case manager will ensure that the required service is provided.

(B) Form LT101 shall be used to determine medical necessity for long term care;

(D) A Plan of Care has been approved by the Program Administration Division or their designee; and

(E) Managers of assisted living facility shall maintain a list of the rooms being occupied by residents who are receiving LTC/HCBS waiver services. This list shall be provided to the Program Division upon request.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 10 Secure Dementia Units

(a) Level 2 assisted living facilities require adherence to all Level 1 requirements with the following additional criteria for a Level 2 Assisted Living Facility License.

(i) Level 2 Core Management requirements.

(A) The facility manager shall have at least three (3) years experience in working in the field of geriatrics or caring for disabled residents in a licensed facility;

(B) Certified as a residential care/assisted living facility administrator or have equivalent training.

(I) Certification requirements include a training program covering topics referenced in the regulations. The course work must take place in a college, vocational training, state or national certification program, which is approved by the Department of Health. Licensed nursing home administrators, for the purpose of these rules, meet the qualifications.

(II) Administrators must complete at least sixteen (16) hours of continuing education annually. At least eight (8) of the 16 hours of annual continuing education shall pertain to caring persons with severe cognitive impairments.

(III) A full time manager with the above qualifications must be on duty, on the premises.

(ii) Level 2 Staffing Requirements.

(A) Nursing Staff.

(I) The facility shall ensure adequate numbers of qualified nursing staff are available to meet the routine and emergency needs of residents.

(II) A licensed nurse shall be on duty, and in the facility, for a minimum of eight (8) hours during a daily 24-hour period. The eight (8) hours are not required to be consecutive.

(1.) May be an LPN if an RN is available on premises or by telephone.

(2.) To administer P.R.N. medications.

(3.) To perform ongoing resident evaluations in order to ensure appropriate, timely interventions.

(III) At least one (1) licensed nurse or CNA shall be on duty and in the secure dementia unit at all times.

(iii) Level 2 Direct Care Staff. In addition to meeting all other requirements for direct care staff stated in this Chapter, assisted living Level 2 direct care staff must receive additional documented training in:

(A) The facility or units philosophy and approaches to providing care and supervision of persons with severe cognitive impairment;

(B) The skills necessary to care for, intervene, and direct residents who are unable to independently perform activities of daily living;

(I) Wandering;

(II) Hallucinations, illusions, and delusions; and

(III) Impairment of senses;

(D) Therapeutic programming to support the highest level of residents function including:

(I) Large motor activity;

(II) Small motor activity;

(III) Appropriate level cognitive tasks; and

(IV) Social/emotional stimulation;

(E) Promoting residents dignity, independence, individuality, privacy, and choice;

(F) Identifying and alleviating safety risks to residents;

(G) Recognizing common side effects and reactions to medications; and

(H) Techniques for dealing with bowel and bladder aberrant behavior.

(I) At least one staff member with this specialized training must be available on the unit at all times to provide supervision and care to the residents, as well as to assist the residents in evacuation of the facility.

(J) Staff must have at least twelve (12) hours of continuing education annually related to care of persons with dementia.

(iv) Level 2 additional core services. In addition to the previously listed Core Services increased assistance may be required with activities of daily living depending upon assessed resident functional and cognitive ability:

(A) Assistance as needed with dressing, grooming, bathing, mobility, toileting;

(B) Assistance as needed to maintain nutrition and hydration status based individual assessed needs:

(D) Activity program developed by an activities professional, at least on a consultation basis, who has been trained in dementia specific activities. The program must be evaluated and revised as needed to meet the needs of the unit residents.

(v) Level 2 Admission Requirements. In addition to all other required assessments, Level 2 facilities must perform a placement assessment for each resident to determine if placement in a secure dementia unit is appropriate. The results of the assessment must show that the resident exhibits one (1) or more of the following on a continual basis:

(A) The resident requires cueing to find their way or they will get lost;

(B) The resident wanders and requires an appropriate and safe place to wander;

(vi) Assistance Plans for residents of secure units must address, at a minimum, the following:

(A) Memory;

(B) Judgment;

(D) Ability to solve problems;

(E) Mood and character changes;

(F) Behavioral patterns;

(G) Wandering; and

(H) Dietary needs.

(vii) Level 2 Discharge Requirements. In addition to Level 1 discharge criteria residents of Level 2 facilities must be discharged when one or more of the following situations exist:

(A) When it has been determined that intermittent nursing care has become ongoing; or

(B) When the resident requires more than limited assistance to evacuate the building.

History

Effective 2020-08-24

Wyo. Code R. 048.0003.12.08242020 § 11 Licensing

(a) Licensing shall be in accordance with the current Licensure rules and regulations, Chapter 4, for assisted living facilities as promulgated by the Department of Health.

(b) Copies of the Licensure rules can be obtained from the Licensing Division.

Healthcare Licensing and Survey

Hathaway Building, Suite 510

2300 Capitol Avenue

Cheyenne, WY 82002

Telephone: 307-777-7123

Fax: 307-777-7127

History

Effective 2020-08-24

Chapter 13 Rules for Pilot Project - Adult Foster Care Homes

Wyo. Code R. 048.0003.13.09102008 Rules for Pilot Project - Adult Foster Care Homes

DEPARTMENT OF HEALTH RULES

FOR PILOT PROJECT – ADULT FOSTER CARE HOMES

CHAPTER 13

Section 1. Authority.

This rule is being promulgated by the Department of Health pursuant to SEA 89, Chapter 219, enacted during the 2007 General Legislative session, to be codified at W.S. 42-6-105 and the Wyoming Administrative Procedures Act at W.S. 16-3-101, et seq.

Section 2. Purpose and Applicability.

These rules have been adopted to initiate and provide the process for licensure of no more than five (5) adult foster care home pilot projects.

Section 3. General Provision.

(a) The Wyoming Department of Health may issue materials to providers and/or other affected parties to interpret the provisions of this Chapter. Such materials shall be consistent with and reflect the rules and regulations contained with this Chapter. The provisions contained in the materials shall be subordinate to the provisions of this Chapter.

(b) 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.

(c) If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

Section 4. Definitions.

For the purpose of these rules, the following shall apply:

(a) "Adult" shall mean any person who is eighteen (18) years of age or older.

(b) "Adult Foster Home" shall mean a home where care is provided for up to five (5) adults who are not related to the provider by blood, marriage or adoption in need of long term care in a home like atmosphere. Resident clients in the home shall have private rooms which may be shared with spouses and shall have individual handicapped accessible bathrooms. "Adult foster homes" does not include any residential facility otherwise licensed or funded by the state of Wyoming.

(d) "Department" shall mean the Wyoming Department of Health.

(e) "License" shall mean the authority granted by the Office of Healthcare Licensing and Surveys to operate an adult foster home.

(f) "Licensee" shall mean any person or persons to whom an adult foster care home license is issued.

(g) "Licensing Division" shall mean the Wyoming Department of Health, Office of Healthcare Licensing and Surveys.

(h) "Resident client" shall mean a person eighteen (18) years of age or older, unrelated to the owner by blood, marriage or adoption, who resides and receives services in the adult foster care home.

(i) "Supervisory care" shall mean general supervision of resident clients with responsibility for awareness and assistance with resident client function and continuing needs. This type of care presupposes the ability to intervene or assist resident clients in the event of a crisis or an emergency, and assistance with self-administration of prescribed medications, per the Nurse Practice Act.

Section 5. Philosophy.

It is the philosophy of the Department to develop reasonable and enforceable rules with regard to the application for awarding a license to an adult foster care home pilot project to ensure the health, welfare and safety of resident clients in adult foster care homes.

Section 6. Application Requirements.

(a) An applicant for licensure as an adult foster care home must complete an application and provide verification of the following before it can be considered for a provisional license under this pilot project:

(b) It shall complete the appropriate application, available from the Licensing Division. In the event that a change of ownership occurs, the license will not be automatically transferred. The potential new owner must be approved under these requirements in order for the home to continue to function as an adult foster care home. If the new owner is not approved, or if the new owner is not interested in continuing to operate the home as an adult foster care home, the current licensee must arrange for an orderly, safe transfer of each resident client, must notify the Licensing Division as to the transfer disposition of each resident client, and must deliver or mail the original license back to the Licensing Division.

(c) It shall submit with the application an evacuation plan outlining the proposed adult foster care home's plan to evacuate all resident clients within three (3) minutes in case of an emergency.

(d) It shall submit with the application a floor plan of the home for review and approval.

(e) It shall pay a one-time fee of one hundred dollars ($100.00) to the Department.

(f) It shall successfully pass all required inspections of the proposed home by the Department, by a public health nurse, or by such other employee of the local department of health as is available, subject to the prior approval of the Department, as follows:

(i) It shall pass an inspection for construction requirements and Life Safety Code prior to admitting any resident clients. In addition, required policies and procedures will be submitted to the Licensing Division for approval prior to the admission of resident clients. Once these preliminary reviews are successfully completed, a provisional license will be issued, and resident clients may be admitted.

(ii) An initial inspection of care and quality of life will be unannounced, and will occur following the admission of clients, and annually thereafter.

(g) It shall be licensed pursuant to Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees.

(h) It shall attest that the adult foster care home will be the primary residence of the licensee.

Section 7. Priority of Applicants.

Because this pilot project may consist of no more than five (5) adult foster care homes, the following criteria shall be used to prioritize applications and applicants for licensure:

(a) The application and all application requirements found in Section 6 above have been met.

(b) No more than two (2) of the Adult Foster Homes in the pilot project can be in counties with a population base greater than 30,000, based on population data from the U.S. Census Bureau on the date the complete application is received.

Section 8. Licensure.

(a) A successful adult foster home applicant who is granted a provisional license shall follow all applicable existing Assisted Living Facility Rules and Regulations, excepting the following subsections:

(i) Program Administration of Assisted Living Facility Rules:

(A) Section 6. Personnel and Staffing Requirements.

(B) Section 7. Assisted Living Facility Core Services (the following sections only):

(I) (a)(vi) Maintenance of a personal fund account.

(II) (b)(i) Completion of the ALF 102.

(III) (e)(i)(E) An accounting of all personal funds.

(IV) (e)(i)(J) Copy of all ALF 102s.

(V) (j)(iii)(A) Food production management.

(VI) (j)(iv)(A) Menu planning.

(VII) (n) Furnishings, Building, Physical Plant.

(VIII) (o) Evacuation Capability, Emergency Procedures and Fire Safety.

(I) (d) Long Term Care Home and Community Based Waiver.

(D) Section 10. Secure Dementia Units.

(ii) Rules and Regulations for Licensure of Assisted Living Facilities:

(A) Section 6. Furnishings, Building, Physical Plant.

(B) Section 7. Physical Environment.

(D) Section 9. Construction, Remodeling.

(E) Section 10. Life Safety and Electrical Safety.

(F) Section 11. Licensing as an Assisted Living Facility.

(b) In addition to the applicable sections of the Assisted Living Facility Rules, an Adult Foster Care Home must meet the following requirements:

(i) Personnel and Staffing Requirements:

(A) The owner/manager shall be at least twenty-one (21) years of age and have responsibility for the day-to-day operation of the Adult Foster Home.

(B) The owner/manager shall be able to read, write, and speak English.

(C) The owner/manager shall have a land-line telephone with a listed phone number that shall be located in the Adult Foster Home.

(D) The owner/manager shall be familiar with and follow all applicable rules related to the operation of the Adult Foster Home, including the applicable rules for the Assisted Living Program Administration and Licensure.

(E) The owner/manager shall provide an acceptable plan of correction to the Licensing Division within ten (10) calendar days of the date when the statement of deficiencies is received by the assisted living facility.

(F) The owner/manager shall not act as, or become the legal guardian or conservator of, or have power of attorney for, any resident client of the facility.

(G) Any person providing supervisory care in the adult foster care home must be at least eighteen (18) years of age.

(H) The staffing levels shall be sufficient to meet the resident client needs.

(I) The Adult Foster Home shall not employ an individual as a nurse assistant, nor shall any resident of the home function as a nurse assistant, unless that person is currently certified by the Wyoming State Board of Nursing. Certification must be on file in the Adult Foster Home and available for inspection at any time.

(J) If the owner/manager is not an RN, the Adult Foster Home shall, at a minimum, contract with an RN, to ensure regular supervision of any nurse assistants, initial and periodic assessments of the resident clients, development of care plans, and medication management according to professional standards.

(K) Written policies shall be in effect to ensure employees and residents of the home (those who are not resident clients) or any potential employees do not expose resident clients to communicable diseases.

(L) Tuberculin testing/screening must be accomplished for each employee prior to any contact with resident clients and annually thereafter. In addition, each resident and resident client must be screened annually. Individuals with known positive skin tests shall provide a certificate of non-infectiousness, recommendations, if any, for treatment, and evidence they have complied with such recommendations. Any individual providing documentation of a negative skin test administered within the last twelve (12) months does not require a follow up.

(M) A record for the owner/manager and each employee shall be maintained in a secure location and contain, at a minimum, an employment application with evidence of education, work experience, and reference checks as applicable; all federal and state required documentation related to legal requirements for employment in the United States; professional licensure, certification or registration documentation; and documentation of background check results.

(ii) The home shall be in compliance with the 2000 Edition for the Life Safety Code of the National Fire Protection Association, NFPA 101, Chapters 32/33 for New or Existing Residential Board and Care Occupancies, Sections 32.2/33.2: Small Facilities.

(iii) Each home shall have at least one (1) portable, functional fire extinguisher accessible in the kitchen. The licensee may choose to have other fire extinguishers in other locations, but all extinguishers must be installed, inspected and maintained in accordance with NFPA 10, Standard for Portable Fire Extinguishers.

(iv) The home shall have an evacuation plan and the licensee shall conduct a minimum of four (4) fire drills each year, one (1) per quarter. Upon admission, resident clients shall be made aware of escape procedures.

(v) Portable space heaters shall not be used.

(vi) A ladder, folding stairs, or trap door may not be the only access to a bedroom.

(vii) Smoke detectors must be tested monthly. All smoke detectors must be cleaned and the battery changed at least annually. Documentation of compliance with these requirements must be available for review.

(viii) Resident clients may not reside in attics. They may reside in finished basements where the living quarters, heating plant, and utility room are completely and safely segregated by one (1) hour fire-resistant construction.

(ix) A water supply must be derived from a public water system, or, in its absence, from an approved source. Private water supplies must have a water sample bacteriologically tested at least annually. Documentation of compliance with this requirement must be available for review. Maximum hot water temperatures at plumbing fixtures used by residents may not exceed 120 degrees Fahrenheit (49 degrees Celsius).

(x) If a storm window, screen, or burglar guard is used, it must have a quick-opening device which can be easily opened from the inside.

(xi) The home shall be maintained free of rodents and insects. Doors and windows used for outside ventilation shall have screens.

(xii) The home shall be kept clean, neat and free of litter, and garbage.

Hazardous cleaning solutions, chemicals, and poisons must be labeled and stored in a safe place. Garbage and refuse shall be kept in durable, easily cleanable containers that do not leak and do not absorb liquids. Garbage and refuse shall be disposed of often enough to prevent the development of odor and the attraction of insects and rodents. Sewage shall be disposed of by means of a public sewage disposal system or a septic system, and must not constitute a source of contamination of food, equipment, or utensils or otherwise create an unsanitary condition or nuisance.

(xiii) The home must have a working heating system, and the licensee must maintain the temperature or the home at a comfortable, safe level (68 degrees Fahrenheit – 80 degrees Fahrenheit during waking hours and no lower than 60 degrees Fahrenheit at night).

(xiv) The home shall have interior and exterior lighting adequately maintained at a level to ensure safety and comfort for resident clients.

(xv) At least one (1) entrance to the home must be handicap accessible.

(c) Copies of the current Program Administration and Licensure rules can be obtained from the Licensing Division, whose address is:

Office of Healthcare Licensing and Surveys

400 Qwest Building

6101 Yellowstone Road

Cheyenne, WY 82002

Telephone: 307-777-7123

Fax: 307-777-7127

Email: wdh-ohls@health.wyo.gov

Website: http://wdh.state.wy.us/ohls

(d) In addition to the above rules and regulations, adult foster care homes shall be regulated in accordance with W.S. 35-2-901 through 35-2-912 and with the Wyoming Long Term Care Choices Act at W.S. 42-6-102 and 42-6-105. The Wyoming Long Term Care Choices Act shall govern in the event of a conflict between the two (2) statutory acts.

(e) A successful adult foster home applicant who is granted a provisional license shall immediately submit the name(s) of the following individuals to the Aging Division:

(i) Any individual employed by the adult foster home at the time of licensure, and any individual who becomes employed by the adult foster care home subsequent to licensure.

(ii) Any individuals, other than a resident client or a resident client's spouse, who at the time of licensure is expected to live in the adult foster home or who, after licensure, lives or comes to live in the adult foster home.

(f) The Department shall complete a criminal background check on the individuals referenced in Section 8(e)(i) and 8(e)(ii). The qualified adult foster home applicant shall reimburse the Department for the cost of the criminal background checks upon receipt of invoice from the Aging Division. Any employee or other resident in the home who is not a resident client or a resident client's spouse, and who has not completed a criminal background check, shall not have contact with resident clients until the home has received and paid for the criminal background check.

(g) The adult foster home shall have established policies and procedures with regard to who it will hire, based on information found in the criminal background check, and how it will monitor other residents in or visitors to the home to ensure the health, safety and welfare of the resident clients.

Section 9. Denying, Revoking, or Placing Conditions on a License.

(a) The Licensing Division may refuse to license a home if any employee of the home, or anyone living in the home, has been convicted of a felony which may indicate, that he may abuse a resident client or that he may steal from a resident client.

(b) The Licensing Office will provide fifteen (15) days notice prior to revoking a license unless it finds that conditions in an Adult Foster Home pose a substantial and immediate threat to the health or safety of resident clients and require immediate action and suspension of the license in order to protect the resident clients. In such a case, the licensee shall be afforded an opportunity for a hearing within ten (10) days after the suspension.

(c) The Department may, after notice and an opportunity for a hearing, revoke or suspend any license issued pursuant to these rules and the enabling legislation; it may prohibit an adult foster home from accepting new resident clients; it may place conditions on the continuation of a license; or it may require a home to take specified remedial actions within a specified time, if any of the following have occurred or are occurring:

(i) There is a threat to the health, safety or welfare of any resident client.

(ii) There is credible evidence of abuse, neglect or exploitation of any resident client, per W.S. 35-20-102 through 35-20-116.

(iii) The home is not operated in compliance with these rules and regulations or with the enabling legislation.

(d) If, in the professional judgment of the state health officer, there is a clear and present threat to the health or safety of a resident client, the state health officer may immediately close an adult foster home and transfer the resident clients to another appropriate placement. The Department shall initiate any other appropriate actions pursuant to the above paragraph within three (3) working days.

History

Effective 2008-09-10

Chapter 14 Alternative Long Term Care Pilot Project Grants

Wyo. Code R. 048.0003.14.11012007 Alternative Long Term Care Pilot Project Grants

WYOMING DEPARTMENT OF HEALTH

AGING DIVISION

RULES AND REGULATIONS FOR ALTERNATIVE

LONG TERM CARE PILOT PROJECT GRANTS

CHAPTER 14

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to SEA89, enacted during the 2007 General Legislative Session, which will be codified at W.S. 42-6- 101 et seq., and the Wyoming Administrative Procedures Act at W.S.16-3-101, et seq.

Section 2. Purpose. These rules are adopted to provide a method of selecting recipients for three (3) pilot project grants to study the feasibility of innovation in alternative long term care facilities by instituting the alternative long term care home pilot projects as authorized by W. S. 42- 6-104.

Section 3. Special Provisions.

(a) Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

(b) 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.

(c) Unless otherwise specified, 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, including any applicable amendments, corrections, or revisions, but excluding any subsequent amendments or changes.

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.

(a) "Advisory Council" shall mean the Wyoming Advisory Council on Aging.

(b) "Department" shall mean the Wyoming Department of Health.

(c) "Eligible recipient" shall include cities, counties, and any entity planning for long term care needs or providing long term care, including private nonprofit and private for profit entities.

(d) "Project" shall mean those projects outlined in W.S. 42-6-104(a)(ii), (iii) and (iv).

Section 5. Authority to Award and Administer Grant Funds.

(a) The Department shall have the following responsibilities with regard to administering the pilot project grant awards:

(i) It shall develop a Request for Proposal (RFP), in consultation with the Advisory Council, for funding for up to three (3) pilot program grants. The RFP developed by the Department and the Advisory Council shall comply with all Department of Administration and Information's RFP requirements. The RFP shall prioritize grant recipient requirements;

(ii) It shall provide technical assistance to eligible recipients making an application through the RFP for the grant funds for the pilot program;

(iii) It shall collect and analyze the RFP applicant information and shall, in consultation with the Council, select grant recipients pursuant to the priorities outlined in the RFP;

(iv) It shall enter into a contract with the grant recipient that further outlines the project requirements, detailing how measurable outcomes will be achieved, and ensuring that the grant funds are used to effectuate the goals of the pilot project;

(v) It shall consider the extent to which the proposal moves the staff of the facility to a more patient centered culture;

(vi) It shall consider one (1) project to reconfigure an existing nursing home to achieve a resident-centered cultural change;

(vii) It shall fund one (1) study relating to the creation of an alternative eldercare home, as defined in W.S. 42-6-102(a)(iii), provided that an acceptable project proposal is received in response to the request for proposals;

(viii) It shall fund one (1) study relating to the creation of an alternative eldercare home, as defined in W.S. 42-6-104(a)(iv);

(ix) It shall inform the Joint Labor, Health and Social Services Interim Committee if legislation is needed to authorize any additional rules and regulations to effectuate the goals of the pilot projects.

(b) The Advisory Council has the following responsibilities with regard to administering the pilot project grant awards:

(i) It shall review and approve the Request for Proposal (RFP) format as developed by the Department. As noted above, the RFP developed by the Department and the Advisory Council shall comply with all Department of Administration and Information's RFP requirements;

(ii) It shall, in consultation with the Department, assist in selecting grant recipients pursuant to the priorities outlined in the RFP.

Section 6. Criteria for and Priorities Given to Pilot Project Grant Awards. The following criteria and priorities shall be considered in awarding funds under this pilot project:

(a) Demonstrated community need and community support. Priority shall be given to those applicants demonstrating significant community resources and community financial support. If such support is not currently available, a plan must be submitted to develop such support;

(b) Existing licensure or a demonstrated ability to obtain licensure from the Office of Healthcare Licensing and Surveys for any existing or planned facility involved in the pilot project;

(d) Demonstrated financial and organizational management capabilities by management/owner to ensure grant funds are used in a manner that is appropriate to the project;

(e) Ability to meet the required match of twenty-five percent (25%) of the grant amount;

(f) Demonstrated ability to create a culture change or innovative approach to long term care.

Section 7. Funds Available. The total amount of funds available for the pilot projects shall not exceed one hundred fifty thousand dollars ($150,000.00).

Section 8. Conflict of Interest.

(a) Applicability. This section applies to any person involved in:

(i) The review of completed applications;

(ii) Making recommendations to the Department and/or Advisory Council regarding an entity that may receive a pilot project grant and the amount of said grant.

(b) Responsibilities of persons with potential conflict of interest. A person who believes that he or she may have a conflict of interest shall disclose such conflict of interest as soon as he or she becomes aware of the conflict of interest. If the person is a staff member of the Department and there appears to be a conflict of interest, the person shall disclose the conflict of interest in writing to the Department. If, at that time, the Department agrees that there is a conflict of interest, the person shall excuse himself or herself from any of the activities related to determination of funding allocation from the Department to the entity.

History

Effective 2007-11-01

Chapter 15 Electronic Monitoring of Long-term Care

Wyo. Code R. 048.0003.15.05132021 § 1 Authority

The Department of Health (Department) promulgates this chapter pursuant to Wyoming Statutes 9-2-1204, 35-1-240, 35-2-908, 35-2-1308(a), and 35-4-101.

History

Effective 2021-05-13

Wyo. Code R. 048.0003.15.05132021 § 2 Purpose & Applicability

(a) This chapter implements the Long-term Care Electronic Monitoring Act, W.S. 35-2-1301 to -1308; and

(b) This chapter applies to electronic monitoring in assisted living facilities and nursing care facilities.

History

Effective 2021-05-13

Wyo. Code R. 048.0003.15.05132021 § 3 Definitions & Construction

(a) The following definitions apply to this chapter:

(i) "Assisted living facility" means as defined in W.S. 35-2-901(a)(xxii).

(ii) "Nursing care facility" means as defined in W.S. 35-2-901(a)(xvi).

(iii) "Electronic Monitoring Device" means as defined in W.S. 35-2-1308(a)(iv)

(b) Provisions that use the term "resident" are intended to apply to the "resident's representative" when necessary or appropriate to account for an individual with a power of attorney for health care or other legal authority to make health care decisions on behalf of a resident who lacks capacity to consent.

History

Effective 2021-05-13

Wyo. Code R. 048.0003.15.05132021 § 4 Electronic Monitoring Grievances and Complaints

(a) Each resident may submit a grievance to the facility or the Department related to the facility's actions regarding the resident's use of electronic monitoring equipment. This includes but is not limited to any refusal to permit monitoring or a denial of a request to change rooms or roommates if a roommate does not consent to use of electronic monitoring.

(b) Each resident must be informed in writing that they have a right to submit a grievance to the facility or the Department without discrimination or reprisal from the facility.

(c) The facility must provide each resident information on the process to submit a grievance, the requirements for the facility to respond, and the right of the resident to contact the Long-Term Care Ombudsman at any time, including if a grievance is not resolved to the satisfaction of the resident.

(d) The facility must attempt to resolve the resident's grievance and provide a written response to each grievance within 14 business days.

(e) The facility shall identify a facility staff person who is responsible for receiving resident grievances and ensure compliance with these rules.

(f) The facility shall forward all unresolved grievances having to do with electronic monitoring to the Long-Term Care Ombudsman.

(g) The facility shall provide the resident with contact information, including telephone number and address, for the following:

(i) The individual identified in 4(e) above;

(ii) The Long-Term Care Ombudsman;

(iii) Protection & Advocacy System, Inc.;

(iv) The local office for Department of Family Services, Adult Protective Services;

(v) Wyoming's Medicaid Fraud Control Unit; and

(vi) The State Survey Agency.

(h) The facility shall provide the resident a copy of their rights to summit grievance and information on the process to submit grievances related to the use of electronic monitoring devices at the following times:

(i) Upon the resident's admission;

(ii) Upon the residents request for an electronic monitoring device;

(iii) Once every year following a resident's request for and continued use of the electronic monitoring device; and

(iv) Upon any amendment or other change to the facility's electronic monitoring device grievance policy.

(i) At any time, including if a facility fails to respond to or resolve a resident's grievance, the resident may forward the grievance to the Long-Term Care Ombudsman. The Long-Term Care Ombudsman shall handle the grievance as a "complaint" under the Long Term Care Ombudsman Act, W.S. 9-2-1301 to -1309.

(j) The facility shall provide the Long-Term Care Ombudsman access to all facility records regarding a resident's grievance or complaint, upon the Long-Term Care Ombudsman's request and the consent of the resident.

History

Effective 2021-05-13

Wyo. Code R. 048.0003.15.05132021 § 5 Facility Use of a Recording from a Resident's Electronic Monitoring Device

(a) Pursuant to W.S. 35-2-1303(d), in the event the resident uses a copy of a recording made by a resident's electronic monitoring device in an administrative hearing, a facility may request a copy of that recording. This request must explain the reason for the request and be limited to a timeframe of the recording specific to the scope of any complaint made by the resident against the facility or facility employee. A resident has the right to refuse permission to provide access to the recording. A facility may not access any recording without written permission of a resident.

(b) Facilities requesting recordings from a resident must notify the Long-Term Care Ombudsman of the request and the reason for their request within one business day of the request. Facility must notify the Long-Term Care Ombudsman of receipt of any recording within one business day of receipt.

(c) Pursuant to W.S. 35-2-1303(d), a facility may use a recording made by a resident's electronic monitoring device with the consent of the resident according to the following:

(i) If the facility is an assisted living facility to investigate a suspicion of:

(A) Abuse, neglect, or exploitation as required under Rules, Department of Health, Aging Division, chapter 12, § 7(i) (2020);

(B) A violation of resident rights established under Rules, Department of Health, Aging Division, chapter 12, § 7(c) (2020); or

(C) The resident not receiving care and services in accordance with the resident's needs as contemplated under Rules, Department of Health, Aging Division, chapter 12 (2020).

(ii) If the facility is a nursing care facility, to investigate a suspicion of:

(A) Abuse, neglect, or the misappropriation of resident property as required under 42 C.F.R. § 483.12;

(B) A violation of resident rights established under 42 C.F.R. § 483.10; or

(C) The resident not receiving care and services in accordance with the resident's needs as contemplated under 42 C.F.R. Part 483, Subpart B.

History

Effective 2021-05-13

Wyo. Code R. 048.0003.15.05132021 § 6 Facility Licensure

A facility's compliance with this chapter is a condition of the facility's licensure pursuant to W.S. 35-2-908.

History

Effective 2021-05-13

134 Chemical Analysis of Blood Alcohol

Chapter 1 General Provisions

Wyo. Code R. 048.0010.1.12112013 General Provisions

The document referenced in the rules database link is not available in an electronic format. If you are in need of this rule, please contact the Secretary of State's Office at: Rules Registrar Wyoming Secretary of State's Office Ph. 307.777.7378 Email: Rules@wyo.gov

History

Effective 2013-12-11

Chapter 2 Approval of Analytical Methods

Wyo. Code R. 048.0010.2.12112013 Approval of Analytical Methods

History

Effective 2013-12-11

Chapter 3 Procedures for Analysis

Wyo. Code R. 048.0010.3.12112013 Procedures for Analysis

History

Effective 2013-12-11

Chapter 4 Permit Requirements

Wyo. Code R. 048.0010.4.12112013 Permit Requirements

History

Effective 2013-12-11

Chapter 5 Program Oversight Requirements

Wyo. Code R. 048.0010.5.12112013 Program Oversight Requirements

History

Effective 2013-12-11

137 Clinical Laboratories, Licensure of

Chapter 1 General Provisions

Wyo. Code R. 048.0013.1.05052004 General Provisions

RULES AND REGULATIONS FOR LICENSURE OF CLINICAL LABORATORIES

CHAPTER I

GENERAL PROVISIONS

Section 1. Authority. These rules of the Department of Health, Preventive Health and Safety Division are promulgated pursuant to Sections 33-34-101 through 33-34-109, W.S. 1977.

Section 2. Purpose. To provide standards conducive to good laboratory practice that will assure all citizens of the state they have access to, and receive, a minimum quality of laboratory services regardless of the nature of the provider of those services.

Section 3. Severability. If any provision of these rules or the application thereof to any person, program, service, or circumstance is held invalid, the invalidity shall not affect other provisions or applications of these rules. To the extent that these rules can be given effect without the invalid provision; the provision of these rules are severable.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules 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.

(a) "Advisory committee" means the committee established pursuant to Section 33-34-106, W.S. 1977, to assist the state agency with the implementation of this act.

(b) "Approved method(s)" means a method of analysis that is approved for use in diagnostic testing by the state agency. Approval will be based on the general acceptance of the method by laboratory scientists, its accuracy and precision relative to its application, and satisfactory performance on standards, controls, and unknown material, if such a determination is deemed necessary by the state agency.

(c) "Approved reference laboratory" means any laboratory that meets or exceeds the standards established for CLIA-approved laboratories.

(d) "Blood bank" means a facility for the collection, processing, or storage of human blood or blood derivatives, but shall not include such a facility located in a memorial, district, or private hospital.

(e) "CLIA" means Clinical Laboratory Improvement Act of 1967, P.L. 90-174, Section 5 (a).

(f) "Clinical laboratory" means any facility for the microbiological, serologic, chemical, hematological, biophysical, cytological, or pathological examination of materials derived from the human body for the purpose of obtaining information for the diagnosis, prevention, or treatment of disease or the assessment of medical condition.

(g) "Inspection" means the on-site inspection of a facility by a qualified, trained employee of the state agency or by qualified individuals employed by the federal government, the College of American Pathologists (CAP), or the Joint Commission for the Accreditation of Hospitals (JCAHO).

(h) "Laboratory Director" means the person who is responsible for the administration of the technical and scientific operation of a clinical laboratory or blood bank, including supervision of procedures and reporting findings of tests, as specified in Chapter II, Section 2.

(i) "Laboratory reference system" means a system of periodic testing of methods, procedures, and materials of clinical laboratories and blood banks, including without limitation the distribution of manuals of approved methods, inspection of facilities, cooperative research, and periodic submission of test specimens for examination.

(j) "Medicare standards" means the regulations found in C.F.R. Title 20, Chapter III, Subpart P, Part 405, that apply to laboratories receiving reimbursement from the Health Care Financing Administration.

(k) "Physician office laboratory" means a clinical laboratory that is part of a single physician or group practice that performs laboratory testing only for the patients of the physician(s) in the practice.

(l) "Provisional directorship" means that certified, reference laboratory director provides scientific, technical, and administrative advice to a laboratory, visits that laboratory at least once a month, and is available for consultation by telephone as needed.

(m) "Qualified, technical personnel" means that the staff hired to perform laboratory testing are trained in laboratory methodology and practice to satisfactorily carry out their duties, as specified in Chapter II, Section 2.

(n) "Reference Laboratory" means any clinical laboratory that accepts specimens referred from physicians or other health officials. This includes hospital laboratories and independent clinical laboratories.

(o) "State-approved proficiency testing program" means laboratory reference system that are the external evaluation programs sponsored by the College of American Pathologists, the American Association of Bioanalysts (also known as the American Society of Internal Medicine Program), and the Centers for Disease Control in Atlanta, Georgia.

(p) "State-run proficiency testing program" means a laboratory reference system that is the external evaluation program sponsored and administered by the state agency.

(q) "State agency" means the Wyoming Department of Health, Preventive Health and Safety Division.

(r) "The (this) act" means W.S. 33-34-101 to 33-34-109, Licensing of Clinical Laboratories and Blood Banks.

Section 5. Applicability.

(a) All clinical laboratories in Wyoming, including those operated by the state, are subject to the requirements of this act. Laboratories operated by the U.S. Government are exempt from the requirements of this act.

(b) The Department may issue manuals, bulletins, or both, to interpret the provisions of this chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this chapter.

The provisions contained in manuals or bulletins shall be subordinate to the provisions of this chapter.

(c) 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.

History

Effective 2004-05-05

Chapter 2 Licensure

Wyo. Code R. 048.0013.2.05052004 Licensure

RULES AND REGULATIONS FOR

LICENSUREOF CLINICAL LABORATORIES

CHAPTER II

LICENSURE

Section 1. License Required.

All clinical laboratories in Wyoming Shall have a valid license issued by the state agency. In order to receive license, a laboratory shall have a director certified by the state agency, and meet the appropriate inspection and proficiency testing requirements as specified in Chapters III, IV, and V following.

Section 2. Qualifications for Laboratory Personnel.

(a) Laboratory Director

(i) A physician licensed by the Board of Medical Examiners; or is a Ph.D. with a major in chemical, physical, or biological science and is certified by the American Board of Medical Microbiology, the American Board of Clinical Chemistry, the American Board of Bioanalysts, or another national accrediting board in a laboratory specialty acceptable to HHS, and has at least one (1) year of general laboratory training and experience.

(ii) Document continuing education of a minimum ten (10) contact hours per year or twenty (20) contact hours per two (2) years appropriate to specific need.

(b) Laboratory Supervisor

(i) Holds a master's degree from an accredited institution with an undergraduate degree in a laboratory science and have at least two (2) years pertinent laboratory experience; or is a Clinical Laboratory Scientist and have two (2) years of pertinent laboratory experience; or has earned a bachelors's degree in one (1) of the chemical, physical, or biological sciences and has at least two (2) years of clinical laboratory experience; or has successfully completed three (3) years (ninety (90) semester hours or equivalents) in an accredited college or university with the following distribution of courses:

(A) Sixteen (16) semester hours in chemistry

(B) Sixteen (16) semester hours in biology

(ii) Document continuing education of a minimum ten (10) contact hours per year or twenty (20) contact hours per two (2)years appropriate to specific need.

(i) Holds a bachelor's degree in medical technology from an accredited college or university; or has earned a bachelor's degree in the chemical, physical, or biological sciences and has two (2) years of clinical laboratory experience and/or training; or has successfully completed three (3) years (ninety (90) semester hours or equivalent) from an accredited college or university with the following distribution:

(A) Sixteen (16) semester hours in chemistry

(B) Sixteen (16) semester hours in biology

(C) Three (3) semester hours in mathematics and has two (2) years of clinical laboratory experience; or has passed the (HEW) examination.

(ii) Document continuing education of a minimum ten (10) contact hours per year or twenty (20) contact hours per two (2) years appropriate to specific need.

(d) Clinical Laboratory Technician

(i) Has successfully completed sixty (60) semester hours including chemistry, biology, and medical laboratory techniques at an accredited institution; or has successfully attained a science related associated degree and has one (1) year pertinent laboratory experience and/or training; or is a high school graduate or equivalent and has successfully completed an official military medical laboratory procedure course of at least fifty (50) weeks duration and has held the military occupation speciality of Medical Laboratory Specialist.

(ii) Document continuing education of a minimum five (5) contact hours per year or ten (10) contact hours per two (2) years appropriate to specific need.

(e) Clinical Laboratory Aid

(i) High school graduate or equivalent and has completed one (1) year in a medical technician program or other medical assistant program; or is a high school graduate or equivalent and has two (2) years of pertinent laboratory experience as a trainee with documentation of training.

(ii) Document continuing of a minimum five (5) contact hours per year or ten (10) contact hours per two (2) years in a clinical laboratory discipline.

(f) Clinical Phlebotomist

(i) High school graduate or equivalent and has documentation of training pertinent for specimen collection in the current laboratory position.

Section 3. Issuance of Certificate of Qualification.

(a) The state agency shall send a qualification form for a certificate, in care of the laboratory director, to all clinical laboratories known to be operating in the state as of January 1, 1985. After January 1, 1985, an individual shall request, in writing, a qualification form for a certificate from the state agency.

(b) The state agency shall issue a certificate to individuals meeting the qualifications of Laboratory Director as specified in Chapter II, Section 2.

(d) The certificate will be valid for one (1) year from the date on which it was issued.

(e) The state agency will automatically renew the Certificate of Qualification on a yearly basis.

Section 4. Limits for Laboratory Directors.

(a) A laboratory director certified to direct a reference laboratory may direct no more than two (2) laboratories and concurrently provide provisional directorship for no more than six (6) laboratories.

(b) A laboratory director certified to direct a physician office laboratory may direct one (1) such laboratory.

Section 5. Application for License.

(a) The state agency shall send an application for license to all laboratories operating in the state as of January 1, 1985.

(b) The owner of the laboratory or his legally authorized representative shall complete the application for license.

(c) After January 1, 1985, the owner(s) or director-owner shall request, in writing, an application for license from the state agency.

(d) The license application shall be accompanied by the appropriate license fee.

(i) The fee shall be one hundred dollars ($100.00) for each category of tests.

(ii) Test categories are: microbiology, serology, chemistry, hematology, biophysics, cytology, and pathology.

(iii) The license fee for any laboratory shall not exceed five hundred dollars ($500.00)

(e) For reference laboratories, a certified reference laboratory director that provides provisional directorship may be named as director for licensure purposes. A laboratory requiring this arrangement shall document the visits by the director and such documentation shall accompany the license application. The state agency shall note the provisional status of the director in these instances.

Section 6. Issuance of License.

(a) The license application shall require:

(i) The name, address, and phone number of the laboratory;

(ii) The name and address of the owner;

(iii) The name and Certificate of Qualification; number of the director;

(iv) A list of the laboratory tests performed;

(v) A list of personnel that perform the laboratory tests;

(vi) Documentation of participation in the appropriate proficiency testing program.

(vii) For reference laboratories, CLIA license number, Medicare provider number, documentation of accreditation from JCAHO or CAP, and a copy of the most recent inspection report.

(b) The license shall be issued:

(i) To the owner if he is the director of the laboratory or;

(ii) Jointly to the owner and director of the laboratory or;

(iii) Jointly to co-owners and directors of the laboratory.

(c) The license shall specify the owner, the laboratory director, laboratory classification, location of the laboratory, and the laboratory procedures or categories of procedures authorized.

(d) The license shall be valid for the calendar year in which it was issued.

(e) A license shall automatically be voided if there is a change in the laboratory director.

(f) A license shall automatically be voided thirty (30) days following a change in ownership or location.

(g) Application for a new license may be made prior to any change in the laboratory director, ownership, or location of the laboratory or within the thirty (30) day expiration period noted in (f) above.

(h) A laboratory shall notify the state agency, in writing, if the laboratory intends to offer a new test or tests for which it has not been licensed, during the license year. The state agency shall have thirty (30) days beginning with receipt of the notice to amend the existing license, reissue a license, or make no change in the existing license. During the thirty (30) day period, the state agency may, depending on the nature of the test(s) being considered, determine by inspection, check testing or both, that the laboratory can satisfactorily perform the new test(s).

(i) The state agency shall renew a license on a yearly basis provided:

(i) The appropriate fee is submitted with a completed renewal form;

(ii) The laboratory director has a valid Certificate of Qualification;

(iii) The laboratory has met the appropriate inspection and profic iency testing requirements.

Section 7. Acceptance, Collection, Reporting, and Examination of Specimens.

(a) All licensed laboratories shall accept only those specimens collected by a physician, laboratory director, dentist, trained personnel under the direction of a physician, laboratory director, dentist, or local, state, or federal health authorities.

(b) Examinations of specimens shall be made only at the request of a physician, dentist, or local, state, or federal health authorities authorized to use laboratory findings.

(c) Results of a test or tests shall only be reported to the submitter of the specimen or as directed by the submitter. The report shall be written, signed, and dated and shall include the name and address of the laboratory in which the test(s) were actually performed.

(d) All specimens shall be tested on the premises of the laboratory that accepted the specimen unless the specimen was forwarded to an approved reference laboratory.

History

Effective 2004-05-05

Chapter 3 Level 1 Laboratories

Wyo. Code R. 048.0013.3.05052004 Level 1 Laboratories

RULES AND REGULATIONS

FOR LICENSURE OF CLINICAL LABORATORIES

CHAPTER III

LEVEL I LABORATORIES

Section 1. Description.

Level I laboratories are clinical laboratories that perform any or all of the following tests:

(a) Qualitative examination of urine by dipstick or tablet methods for chemical constituents.

(b) Chemical examination of blood by dipstick or tablet method for glucose.

(d) Pregnancy testing through the use of commercially available kit methods.

(e) Primary culturing of infected sites for transmittal to an approved reference laboratory.

Preincubation is allowed under this provision.

(f) Qualitative chemical examination of stool specimens for occult blood.

(g) Microscopic examination for pinworms, yeast, and Trichomonas Vaginalis.

(h) Spun hematocrit determination.

History

Effective 2004-05-05

Chapter 4 Level 2 Laboratories

Wyo. Code R. 048.0013.4.05052004 Level 2 Laboratories

RULES AND REGULATIONS FOR

LICENSURE OF CLINICAL LABORATORIES

CHAPTER IV

LEVEL II LABORATORIES

Section 1. Description.

Level II laboratories perform any or all of those tests listed for Level I laboratories and any or all of the following tests:

(a) Hemoglobin by approved methods.

(b) Red and white blood cells counts.

(d) Prothrombin time and/or partial thromboplastin time tests.

(e) Blood glucose by approved methods.

(f) Screening tests for mononucleosis and/or rheumatoid factor.

(g) Throat cultures for the Beta-Hemolytic Streptococci, including the use of differential tests such as bacitracin discs.

(h) Colony counts for urinary tract infections not to include identification or susceptibility testing.

(i) Gram stains of pustular material, exudates, aspirated lesions, and pharyngeal, cervical or genito-urinary swabs.

(j) Presumptive identification of Neisseria Gonorrhoea from the cervix or genito-urinary tract by approved methods and provided all such identifications are confirmed by an approved reference laboratory.

History

Effective 2004-05-05

Chapter 5 Level 3 Laboratories

Wyo. Code R. 048.0013.5.05052004 Level 3 Laboratories

RULES AND REGULATIONS FOR

LICENSURE OF CLINICAL LABORATORIES

CHAPTER V

LEVEL III LABORATORIES

Section 1. Description.

Level III laboratories perform any tests that are not listed for Level I and II laboratories. They may perform any or all of those tests listed for Level I and II laboratories.

Section 2. Standards of Licensure for Reference Laboratories.

(a) Reference laboratories that are licensed under CLIA, certified for Medicare, accredited by JCAHO or CAP, shall be deemed to have met the licensure requirements of this act, except as noted below.

The state agency reserves the right to inspect these laboratories, if it deems necessary, and shall give a (thirty) 30 day notice prior to such inspection.

(b) Reference laboratories that are not licensed, certified, or accredited as in (a) above shall be inspected at least once every two (2) years by the state agency. Such inspection shall meet or exceed the Medicare standards for independent laboratories. The state agency shall give thirty (30) day notice prior to inspection.

(c) All reference laboratories shall satisfactorily participate in a state approved proficiency testing program and shall forward a copy of the proficiency testing result report(s) to the state agency. Satisfactory performance shall be based on the criteria of acceptable performance established by the provider of the materials. If such information is unavailable, the following criteria shall be used:

(i) For all test categories except immunohematology, the laboratory shall achieve a grade of seventy-five percent (75%) or better;

(ii) For immunohematology, a score of ninety percent (90%) or better shall be achieved;

(iii) Grades shall be determined by agreement with the reference results given by the provider of the materials, with allowance for deviation from the mean, where such consideration is applicable.

(d) All reference laboratories shall have a minimum of one (1) qualified supervisor, as specified in Chapter II, Section 2, and have a sufficient number of qualified personnel for the volume and diversity of tests performed.

(e) Qualified supervisor(s) shall be under the direction of the director and shall supervise technical personnel, reporting, and performing tests requiring special scientific services. In the absence of the director or where provisional directorship is provided, the supervisors shall be responsible for the proper performance of all laboratory procedures and reporting. A laboratory director may be a supervisor.

Section 3. Standards for Licensure of Physician Office Laboratories.

(a) All physician office laboratories shall be inspected at least once every year. Such inspection shall meet or exceed the Medicare standards for record keeping and quality control that can be applied to physician office laboratories.

(b) All physician office laboratories shall satisfactorily participate in a state approved proficiency testing program and shall forward a copy of the proficiency testing result report(s) to the state agency.

Satisfactory participation shall be based on the same criteria noted in Section 2 (c) of this Chapter.

History

Effective 2004-05-05

Chapter 6 Enforcement

Wyo. Code R. 048.0013.6.05052004 Enforcement

RULES AND REGULATIONS FOR

LICENSURE OF CLINICAL LABORATORIES

CHAPTER VI

ENFORCEMENT

Section 1. General Provisions.

(a) Proceedings to revoke, annul, suspend, or limit a license shall be initiated by the state agency when:

(i) The facilities or equipment are deemed to be inadequate to provide the laboratory services for which the laboratory is licensed;

(ii) The laboratory personnel do not meet qualifications as specified in Chapter II, Section 2;

(iii) The laboratory has not been able to demonstrate that it can satisfactorily perform or meet applicable quality assurance standards for the laboratory tests for which it is licensed;

(iv) In the process of applying for a Certificate of Qualification or a laboratory license, or renewal of either, there is evidence of misrepresentation or that false information has been given to the state agency;

(v) There is evidence that laboratory personnel have falsified reports, violated confidentiality in reporting, or are negligent in receiving, processing, and reporting results on specimens submitted for testing.

(b) When the state agency has sufficient evidence to indicate that the laboratory should not continue to operate under the conditions of its license, the state agency shall issue notice that a hearing shall be made before it. All hearings shall be conducted as a contested case under the Wyoming Administrative Procedures Act, W.S. 16-3-101 to 16-3-115.

(c) Hearings shall be held twenty-one (21) days after the notice of hearing is made, in writing, to the laboratory director and/or owner.

(d) The state agency shall render its decision within ten (10) days after the hearing. At that time, the state agency shall enter its order pursuant to the Wyoming Administrative Procedures Act. The state agency may:

(i) Dismiss the proceedings;

(ii) Revoke or annul the license;

(iii) Suspend the license for some specific period of time or until some condition is met;

(iv) Limit the license;

(v) Recommend that legal action be taken pursuant to W.S. 33-34-109.

Section 2. Specific Proceedings.

(a) Deficiencies noted on inspection reports.

(i) Reference laboratories inspected for CLIA licensure, Medicare certification, JCAHO or CAP accreditation shall formulate a plan of corrective action and complete such plan in accordance with the requirements of that agency or organization.

(ii) When the state agency inspects a laboratory;

(A) All deficiencies shall be brought to the attention of the laboratory director or the supervisor at the end of the inspection;

(B) Within ten (10) days after the inspection, the state agency shall forward a copy of the inspection report to the laboratory director;

(C) Within ten (10) days of receipt of the inspection report, the laboratory shall return a plan of corrective action to the state agency and such plan; shall be completed within sixty (60) days of the date when the corrective action plan was sent to the state agency;

(D) At the end of the sixty (60) day corrective action period, the state agency may re-inspect the laboratory.

(iii) At any time during the corrective action process, the laboratory may request, in writing, consultation or assistance from the state agency in completing its corrective action plan;

(iv) When the laboratory demonstrates that it is unwilling or unable to take the necessary corrective action, the state agency shall initiate proceedings as noted in Section 1 of this Chapter.

(b) Unsatisfactory Performance on Proficiency Testing.

(i) When the laboratory performs unsatisfactorily in one (1) or more test areas on one shipment, no action will be taken.

(ii) When the laboratory performs unsatisfactorily in one (1) or more test areas for two (2) consecutive shipments, the state agency shall notify the laboratory director of the errors and offer its consultative services to assist in taking corrective action. For hospital laboratories only, such notice shall be made to the hospital administrator.

(iii) When the laboratory performs unsatisfactorily in one (1) or more test areas for three (3) consecutive shipments, the state agency shall notify the laboratory director by certified mail of the errors and indicate that proceedings noted in Section 1 of this Chapter shall be initiated unless the laboratory director responds to the notice within five (5) days of the mailing date of the notice. For hospital laboratories only, such notice shall be made to the hospital administrator who shall be responsible for reporting.

(iv) When the laboratory director or the hospital administrator respond to the notice in (3) above, the state agency may request that the laboratory suspend the provision of the test(s) in question for no more than thirty (30) days, so that a disposition concerning the laboratory's capability to perform the test(s) can be made.

(v) When the laboratory demonstrates that it is unwilling or unable to take the necessary corrective action, the state agency shall initiate proceedings as noted in Section 1 of this Chapter.

History

Effective 2004-05-05

138 Collection of Charges

Chapter 1 Collection of Charges

Wyo. Code R. 048.0014.1.02042002 Collection of Charges

Rules and Regulations

Collection of Charges - Health Care Institutions

Chapter 1

Section 1. Authority. These rules are promulgated pursuant to W.S. 25-11-108.

Section 2. Purpose. These rules have been adopted to implement W.S. 25-11-101 through 25-11- 108 to:

(a) Establish uniform procedures for collection of charges from residents in Department of Health Institutions: Veterans' Home of Wyoming, Wyoming Pioneer Home, Wyoming Retirement Center, Wyoming State Hospital, and Wyoming State Training School;

(b) Establish charges based upon an ability to pay;

(d) Establish limitations on liability for established charges;

(e) Establish penalties for giving false or misleading information in determining an ability to pay.

Section 3. Definitions. The definitions provided for in W.S. 25-11-101 as they currently appear or as amended, are incorporated herein by reference. Other applicable definitions are as follows:

(a) "Actual cost" means the cost of providing treatment or services for resident in a state institution including minimum costs, as set by the department having the direct authority and control of the institution, or maintaining of a resident;

(b) "Agency" means the Department of Health which is administratively responsible for the respective institutions;

(d) "Debt" means any form of legal indebtedness, liability or obligation to pay money by express agreement against the resident's assets such as mortgages, liens, loans, purchase contracts or security interests;

(e) "Deduction" means deductions as per the Department of Family Services Combined Manual unless Department of Health policy dictates otherwise;

(f) "Established charge" means that part of the actual cost for which the resident, and/or resident's estate and legally responsible persons are liable;

(g) "Exemptions" means exemptions as per the Department of Family Services Combined Manual unless Department of Health policy dictates otherwise;

(h) "Income" means all cash, profits, wages or gains available to a person from any source as defined by the Department of Family Services Combined Manual, unless the Department of Health's policy dictates otherwise;

(i) "Indebtedness" means a sum of money due and owing for services rendered at a state health care institution;

(j) "Medicaid" means a program authorized by Title XIX of the Social Security Act, and the Wyoming Medical Assistance and Services Act in W.S. 42-4-101 through 42-4-112;

(k) "Resident" means a patient or resident voluntarily admitted or involuntarily committed to a state health care institution;

(l) "Resources" means assets as per Department of Family Services Combined Manual, unless the Department of Health's policy dictates otherwise;

(m) "Services and treatment" means any help, use or benefit to a resident as a result of the work performed by the staff at a state health care institution, including but not limited to diagnosis, evaluation, medication, therapy or prescribed care, observation, supervision, discharge planning, rehabilitation, reformation, and custodial or domiciliary care. Services and treatment shall not include education provided to any person which is required by state or federal law;

(n) "Schedule of Charges" means sliding scale based upon the ability to pay;

(o) "State Institution" means any state health care institution listed in Title 25 of the Wyoming Statutes that are under the direct authority and control of the Department of Health;

(p) "Third party payor" means an entity which is under contract with the resident or legally responsible person to pay costs for medical, nursing home or other specified services and treatment;

(q) "Verification" means acquiring information or documents that prove a statement to be true.

Section 4. Agency Responsibilities for Collection.

(a) The Agency shall be responsible for:

(i) Promulgating on or before October 1 of each year a schedule of charges based on actual costs for services and treatment at each state health care institution;

(ii) Establishing a schedule of charges for each state health care institution or related group of state health care institutions;

(iii) Establishing criteria for determining an ability to pay established charges, including assessing income and resources and making allowances for that resident and its dependents;

(iv) Deciding which cases will be referred to a collection agency pursuant to W.S. 25-11- 106(c) or to the attorney general's office for further proceedings against the resident's estate pursuant to W.S. 25-11-105(b) and W.S. 9-1-415 (b);

(v) Establishing written policies and procedures for implementing these rules.

Section 5. State Health Care Institution Responsibilities for Collection.

(a) The state health care institutions shall be responsible for:

(i) Establishing a schedule of charges and actual costs for services and treatment given to resident;

(ii) Providing necessary information to third party payors for submission of claims;

(iii) Notifying legally responsible persons of established charges, liability for payment and agency action in the event payment is not made;

(iv) Establishing written policies and procedures necessary for the state health care institution to implement these rules.

Section 6. Notice Requirements.

(a) When a resident is voluntarily admitted or involuntarily committed to a state health care institution, the institution shall advise the legally responsible person in writing prior to admission, at the time of admission or within fifteen (15) days after admission of the following:

(i) The obligation to pay pursuant to W.S. 25-11-101(a) (iii), 25-11-102(c) and 25-11-103;

(ii) The schedule of charges for services and treatment established by the agency pursuant to W.S. 25-11-102(a) or the established daily rate;

(iii) Liability for payment and any applicable limitations as provided in W.S. 25-11-105;

(iv) The right to request agency review of the established charge as provided in W.S. 25-11- 103(b) or appeal the agency decision pursuant to the Wyoming Administrative Procedure Act in W.S. 16-3- 107; and the right of the agency to amend the established charges based upon change of financial information;

(v) Penalties for falsifying or misrepresenting any financial information as provided in W.S. 6-5-303.

(b) Upon the court vesting the legal custody of a child in the agency and ordering the legally responsible person to pay charges pursuant to W.S. 14-6-236, the institution shall comply with the notice requirements;

(c) Whenever the initial established charge is revised after a resident has been admitted, the institution shall notify the legally responsible person within a minimum of thirty (30) days prior to the effective date of the revision. The notice shall also include the basis for the revision and the effective date.

Section 7. Determining Established Charges.

(a) The legally responsible party shall complete the following procedures in determining the established charge:

(i) Complete a financial questionnaire, identifying all income and assets, and any assets disposed of by the legally responsible person in the past three (3) years or in accordance with Wyoming Medicaid Procedure. The Questionnaire shall be:

(A) Signed by the legally responsible person or his/her legal guardian or conservator under oath and subject to penalty of false swearing as set forth in W.S. 6-5-303;

(B) Submitted within forty-five (45) days of the resident's admission. If the financial questionnaire is not submitted within forty-five (45) days, the agency shall set the established charge as the actual cost until financial information becomes available.

(ii) Provide any documents required by the institution for verifying any information stated on the financial questionnaire on an annual basis;

(iii) Update the financial questionnaire on an annual basis;

(iv) Notify the institution of any change in circumstances which affect a legally responsible person's income and assets. The notice shall be submitted to the institution within sixty (60) days of the changed financial status. If a legally responsible person fails to notify the institution within sixty (60) days, the agency may set the established charge as the actual cost;

(v) The legally responsible person may be exempt from the requirements if the legally responsible person pays the actual costs for services and treatment set by the agency throughout the resident's admission to a state institution;

(vi) If payment becomes overdue or the legally responsible person's financial status changes, the legally responsible person shall comply with the financial disclosure requirement;

(b) The institution shall complete the following procedures in determining the established charge:

(i) Review the information stated in the financial questionnaire;

(ii) Verify any stated information by requesting copies of documents as necessary which shall be incorporated into the resident's record;

(iii) Allow any applicable deductions for payments actually made by the legally responsible person including but not limited to:

(A) Federal and state withholding taxes;

(B) Social security taxes and/or other required retirement deductions;

(D) Court ordered alimony and child support payments.

(iv) Allow minimum living allowances for:

(A) The resident's personal support per the schedule established by the state institution;

(B) The resident's spouse, parent and other legal dependent's supported in the home per the schedule established by the state institution.

(v) Allow any applicable exemptions based upon the resident's needs and the institution's services. Exemptions may not exceed five times the Medicaid resource limit.

(vi) Determine the legally responsible person's ability to pay charges based on available income, assets, deductions and exemptions;

(vii) Obtain an assignment of benefits from the legally responsible person who has the insurance coverage;

(viii) Established charges shall be actual costs in the following situations:

(A) If a legally responsible person submits claims directly to the third party payor in lieu of assigning benefits to the institution; or

(B) If the party payor is obligated by law or contract to pay full actual costs for services provided to a resident admitted to an institution;

(ix) Revise the established charge upon the annual promulgation of actual costs or if a change occurs in the resident's financial status;

(x) Review the established charge and ability to pay on an annual basis;

(xi) Refer any payor's protest of the established charge to the agency in accordance with W.S. 25-11-103(b);

(xii) Submit established charges to the administrator or his designee for approval.

Section 8. Confidentiality of records.

(a) A legally responsible person's financial questionnaire and other personally identifiable information are confidential and will not be disclosed except as necessary to determine an ability to pay the established charge, to verify any disclosed financial information, or for use by the state agency in a contested case or other legal proceeding which involves the resident or his legally responsible person;

(b) A legally responsible person shall have signed an authorized consent form prior to a state institution disclosing financial or other personally identifiable information, except as provided in Section 8 (a) of these rules and regulations.

Section 9. Recording and Collecting Charges.

(a) An account shall be established for each resident which records the established charge, payments received, and the unpaid balance of established charges;

(b) Monthly billings shall be sent to the legally responsible person the month following either receipt of the completed financial questionnaire or forty-five (45) days after the resident's admission to a state institution. The monthly billings shall include, at a minimum, the daily established charge and the total monthly balance due. (For specific billing procedures), please refer to relevant policy for applicable state institutions;

(c) If full payment is not received within thirty (30) days after mailing the monthly billing, the state institution shall send a notice to the legally responsible person that the payment is overdue. The notice may also provide that the account may be referred to the agency for collection if payment is not received within ninety (90) days after the end of the month in which the charges accrue;

(d) If full payment is not received within ninety (90) days after the end of the month in which the charges accrue, the account is in arrears, and the state institution may refer the account to the agency for collection. If a third party payor payment is pending, the state institution may refer only the difference between the third party payor payment and the unpaid established charge;

(e) If partial payment is received, the state institution may carry forward the indebtedness according to the state accounting system. Any indebtedness shall be referred to the agency for collection pursuant to W. S. 25-11-106 if full payment is not received within the ninety (90) days after the end of the month in which the charges accrue. The agency retains the right to seek full reimbursement of any unpaid established charges from the resident or other legally responsible persons, or from the resident's estate upon his death by filing claim;

(f) Any collection efforts by the agency shall comply with W. S. 9-1-415. If any unpaid established charges are collected, the agency shall complete the following procedures:

(i) Credit the resident's account for the amount collected;

(ii) Prorate the amount collected if the established charges have accrued at more than one state institution.

(g) Finance or handling charges may apply.

Section 10. Discharge for Nonpayment for Services Rendered.

A resident of a facility may be involuntarily discharged for nonpayment of established charges for services rendered by the facility. The facility shall provide a resident, his guardian or legally responsible person, whichever individual is appropriate, with at least thirty (30) days written notice of the facility's intent to begin steps necessary to involuntarily discharge the resident for failure to pay established charges for services rendered by the facility.

Section 11. Penalties for False Information.

(a) If a legally responsible person knowingly makes a false acknowledgment, declaration or statement in disclosing any information regarding the resident's income and assets on the financial questionnaire, the agency may file a petition with the state attorney general to initiate court proceedings pursuant to W. S. 6-5-303;

(b) Upon verifying a false acknowledgment, declaration or statement on the resident's financial questionnaire, the agency may take any of the following actions:

(i) Reevaluate the legally responsible person's financial status and ability to pay;

(ii) Make any necessary adjustments in the established charges, including setting the established charges as the actual cost;

(iii) Seek reimbursement from the resident, his/her estate and other legally responsible persons for any unpaid established charges to the state institution had the false statement not occurred.

(iv) Discharge the resident.

Section 12. Schedule of Charges.

(a) Criteria for determining ability to pay established charges shall include the following:

(i) Income;

(ii) Exemptions;

(iii) Resources;

(iv) Deductions;

(v) For an adult resident who has a family to support or for a juvenile resident who is supported by a family refer to Department of Family Services Combined Manual; Medicaid / Medicare certified agencies shall have these agencies established charges per state medicaid / medicare manuals / regulations for their program participants.

Section 13. Discharge of Uncollectible Debts.

(a) Institutional determination of uncollectible debts will be submitted to the Agency Director;

(b) Pursuant to W. S. 9-1-415, all uncollectible debts must be certified by the State Auditor's Office on the attached SA-25 Forms.

History

Effective 2002-02-04

146 Developmental Disabilities - Children Respite Program

Chapter 1 General Introduction and Information

Wyo. Code R. 048.0022.1.05121994 General Introduction and Information

CHAPTER 1

GENERAL INTRODUCTION AND INFORMATION

Section 1. Purpose. The purpose of these rules is:

(a) To establish minimum standards for the provision and administration of a statewide program to provide community based respite care services to families with a member under the age of twenty-one (21) years who has developmental disabilities and is not eligible for the home and community based waiver services under medicaid.

Section 2. Authority. These standards are authorized by W.S. 9-2-102(a)(iii) and W.S. 35-1- 628 and have been adopted by the Wyoming Department of Health -Division of Developmental Disabili- ties. These statutes give the Department of Health the authority to prescribe standards for the adminis- tration of the Respite Program.

Section 3. Definitions.

(a) Department: The Department of Health of the State of Wyoming.

(b) Developmental disability: A severe, chronic disability which is attributable to a mental, emotional or physical impairment or combination of impairments, manifested before the person attains twenty-two years of age, is likely to continue indefinitely and results in substantial functional limitations in three (3) or more of the following areas:

(i) Self-care;

(ii) Receptive and expressive language;

(iii) Learning;

(iv) Mobility;

(v) Self-direction;

(vi) Capacity for independent living; and

(vii) Economic self-sufficiency.

(d) Individualized care: Means basic child care plus additional specialized care necessary to meet the unique needs of a specific child.

(e) Medicaid Home and Community Based Waiver Services: Services to qualified Medicaid eligible children, who but for the provision of such services, would require the level of care provided in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

(f) Medicaid Home and Community Based Waiver Eligibility: A child who has completed the waiver eligibility process, i.e. LTMR 104 and who has a completed Individual Plan of Care, which has been approved by the Division.

(g) Parent: A parent, guardian or person acting as a parent of a child and with whom the child resides. The term does not include a state agency having custody of a child or foster parents acting in behalf of the State.

(h) Provider: An individual trained to provide care to meet the individual needs of the eligible child.

(i) Respite care: Means the care of a child who has a developmental disability by a provider for specified periods of time to allow other members of the family temporary relief from continuous care.

History

Effective 1994-05-12

Chapter 2 General Responsibilities

Wyo. Code R. 048.0022.2.05121994 General Responsibilities

CHAPTER 2

GENERAL RESPONSIBILITIES

Section 1. Community Based Respite Care Services.

(a) The Division of Developmental Disabilities is responsible for the administration of funds provided under W.S. 35-1-628.

(b) Division responsibilities include:

(i) Establishing criteria for eligibility for respite care services which shall include consid- eration of:

(A) The family's need for services, including factors such as the demonstrated willingness and ability of family members to provide care and the special requirements of the family member with a developmental disability;

(B) Parent(s) gross income;

(ii) Developing a sliding fee scale establishing a reasonable co-payment for respite care services provided;

(iii) Authorizing hours of service for all eligible children not exceeding total Legislative appropriation;

(iv) Maintaining records; and

(v) Providing information about availability of service.

(i) Providing proof of eligibility;

(ii) Locating and training individuals willing to be providers;

(iii) Making co-payment directly to provider; and

(iv) Maintaining a log of respite services purchased.

(d) Provider responsibilities include:

(i) Submitting to an abuse and criminal history background check as specified in W.S. 7- 19-106 & 201, as amended;

(ii) Receiving training to meet the individualized needs of the child for whom they provide services;

(iii) Restricting care to less than three eligible children during the same time period;

(iv) Submitting documentation of provider's qualifications;

(v) Complying with the provider agreement which may be obtained at the Division office.

(vi) Submitting periodic invoices to the parent and the Division for services rendered; and

(vii) Maintaining documentation of service provided.

History

Effective 1994-05-12

Chapter 3 Respite Program Service System

Wyo. Code R. 048.0022.3.05121994 Respite Program Service System

CHAPTER 3

RESPITE PROGRAM SERVICE SYSTEM

Section 1. Eligibility Determination.

(a) The child for whom the parent is requesting services shall meet the definition of a child with a developmental delay.

(b) The child shall not be eligible to receive home and community based waiver services under medicaid;

(d) The child shall reside with his/her parent(s) in a private residential setting;

(e) The child shall require services of a trained respite care provider.

Section 2. Provider Criteria. Provider shall:

(a) Be eighteen (18) years of age or older;

(b) Be selected by the parent; and

(i) Parent will provide training specific to the needs of their child.

History

Effective 1994-05-12

Chapter 4 Procedures

Wyo. Code R. 048.0022.4.05121994 Procedures

CHAPTER 4

PROCEDURES

Section 1. Application Process.

(a) Parents shall file an application with the Division. The application shall contain at least the following information:

(i) Applicant name, address and phone number;

(ii) Name of child for whom service is being requested;

(iii) Nature of the child's disability;

(iv) Eligibility status regarding the home and community based service waiver under Medicaid;

(v) Other respite services the child is receiving;

(vi) Household composition;

(vii) Parent(s) gross income.

(b) The Division shall determine eligibility in a reasonable time period.

(d) Eligibility shall be reviewed at least annually.

(e) The Division shall protect the confidentiality of all personal information gathered for the purposes of establishing eligibility.

Section 2. Service Authorization.

(a) Following application approval, the parent shall recruit and train a provider.

(b) Documentation of the provider's qualification and related information shall be submitted to the Division by the provider.

Section 3. Provider Invoice.

(a) The Division shall provide a written invoice to the provider and parent for signature. The invoice shall contain at least the following information:

(i) Provider name, address, and phone number;

(ii) Rate of payment;

(iii) Rate of parent co-payment; and

(iv) Duration.

Section 4. Payment Process.

(a) Provider shall submit an invoice to the Division and parent detailing services provided. The invoice shall contain at least the following information:

(i) Child(ren)'s name(s);

(ii) Dates and times of service;

(iii) Total hours;

(iv) Amount of co-payment billed to parent;

(v) Amount due from the Division; and

(vi) Provider shall certify accuracy of information. (b) The Division shall process invoices and remit a payment within thirty (30) days from the end of the previous month.

(d) The provider shall maintain a copy of all invoices for a minimum of three (3) years.

History

Effective 1994-05-12

Chapter 5 Programs Evaluations Monitoring

Wyo. Code R. 048.0022.5.05121994 Programs Evaluations Monitoring

CHAPTER 5

PROGRAM EVALUATION AND MONITORING

Section 1. Payment Records.

(a) The Division shall follow generally accepted accounting principles.

(b) The Division may conduct random sample audits of service provision and billing.

History

Effective 1994-05-12

Chapter 6 Contested Decisions

Wyo. Code R. 048.0022.6.05121994 Contested Decisions

CHAPTER 6

CONTESTED DECISIONS

Section 1. Informal Resolution. The administrator of the Division or designee shall attempt to resolve any disagreement over eligibility determination or service authorization through mediation with the parents and/or provider.

Section 2. Formal Resolution. Any disagreements which can not be resolved through informal mediation shall follow the procedures outlined in the Department's contested case procedures which may be obtained at the Department's office.

History

Effective 1994-05-12

144 Developmental Disabilities - Infants and Toddlers

Chapter 8 Services for Infants and Toddlers with Developmental Delays

Wyo. Code R. 048.0020.8.02082019 § 1 Authority

(a) These rules are promulgated by the Department of Health, Behavioral Health Division, pursuant to Wyoming Statutes 9-2-102, 21-2-706, and 35-1-620.

(b) These rules govern the operation of all early intervention programs and services provided to infants and toddlers with developmental delays ages birth through age two (2), pursuant to Wyoming law, by a Regional Part C Program Provider and by other public agencies within the State of Wyoming.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 2 Purpose and Applicability

(a) The Department adopts this Chapter to govern:

(i) The eligibility of infants and toddlers for the Part C Early Intervention Program, and

(ii) The implementation and maintenance of a region-wide, comprehensive, coordinated, multidisciplinary, interagency system to provide Part C early intervention services for families and their infant or toddler who has been identified as having developmental delays.

(b) This program shall be governed consistent with 34 C.F.R. Part 303.

(c) The Department may issue manuals, bulletins, or both, to interpret the provision of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

(d) Incorporation by reference.

(i) For any code, standard, rule, or regulation incorporated by reference in these rules;

(A) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(B) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (ii) of this section; and

(C) The incorporated code, standard, rule, or regulation is maintained at the Behavioral Health Division and is available for public inspection. Copies are available from the Division at the cost of the person requesting the copy.

(ii) Each code, standard, rule, or regulation incorporated by reference is further identified as follows:

(A) 34 C.F.R. Part 303, which is referenced throughout these rules and serves as the United States Department of Education's rules governing early intervention programs for infants and toddlers with disabilities and. Copies are available at the Division's website: http://www.health.wyo.gov/‌behavioralhealth/dd/earlyedu/.

(B) Rules, Office of Administrative Hearings, General Agency, Board or Commission Rules, Chapter 2 (2017), which are referred to in Section 9 as the "OAH Contested Case Rules" and are publically available at: http://rules.wyo.gov.

(e) The Division may recover funds from an Early Intervention Service Provider for services to any infant or toddler erroneously classified and reported to the Division as an infant or toddler with a developmental delay.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 3 Definitions

(a) Except as otherwise specified, the terminology used in this Chapter is the standard terminology and has the meaning used in the IDEA and 34 C.F.R. Part 303. Any ambiguity in these rules should be resolved in favor of providing opportunities for children under three years of age who are at risk of having substantial developmental delay if they do not receive early intervention services.

(b) For the purpose of these rules, the following definitions shall apply:

(i) "Developmental Delay" means children who are experiencing at least a 25% developmental delay or a negative of at least 1.5 standard deviation utilizing appropriate diagnostic instruments and procedures in one or more of the following areas: (1) cognitive development; (2) physical development, including vision and hearing; (3) communication development; (4) social or emotional development; (5) adaptive development.

(ii) "Division" means the Behavioral Health Division of the Wyoming Department of Health.

(iii) "Early Intervention Service Provider" or "Provider" means an individual provider who is either employed or contracted by a Regional Part C Program Provider to provide early intervention services as defined in the Individual Family Service Plan (IFSP). The early intervention service provider must either:

(A) Be a licensed professional in the State of Wyoming; or

(B) Meet the personnel standards established in 34 C.F.R. § 303.119, and have education or experience in early childhood development.

(iv) The "Individuals with Disabilities Education Act" or "IDEA" means the Individuals with Disabilities Education Act, 20 U.S.C. §§ 1400 through 1482.

(v) "Informed Clinical Opinion" means determinations made by licensed professionals using qualitative and quantitative information regarding the difficult to measure status of a child's development and the potential need for early intervention.

(vi) "Regional Part C Program Provider" means the entity or agency located in a specific geographical area of the state that provides early intervention services to infants and toddlers with developmental delays through a contract with the Division. The Regional Part C Program Provider must provide early intervention services within their jurisdiction consistent with Part C of the Individuals with Disabilities Education Act (IDEA), 34 C.F.R. Part 303, these rules, and Division policy.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 4 Identification, Evaluation, and Eligibility Determinations

(a) Each infant or toddler referred to an Early Intervention Service Provider must receive an evaluation of eligibility pursuant to this section within forty-five (45) days of the Provider's receipt of the initial referral.

(b) An infant or toddler may be deemed eligible for services under this Chapter if he/she is less than three (3) years old, a resident of the state of Wyoming and:

(i) Has a documented developmental delay; or

(ii) Has a diagnosed physical or mental condition that has a high probability resulting in a developmental delay.

(c) An infant or toddler may receive services for up to six (6) months based solely on informed clinical opinion provided that:

(i) The infant or toddler must be deemed eligible for services under subsection (a) within six (6) months after the beginning of services under this provision; and

(ii) The infant or toddler must qualify for services under subsection (a) to continue receiving Early Intervention Services.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 5 Assessment for Service Provision

(a) Each infant or toddler deemed eligible for services pursuant to Section 4, must also receive an initial assessment within forty-five (45) days of the Provider's receipt of the initial referral. The initial assessment must consist of:

(i) A family assessment;

(A) The family assessment must be:

(I) Family-directed;

(II) Designed to determine the resources, priorities, and concerns of the family, and the identification of the supports, and services necessary to enhance the family's capacity to meet the developmental needs of the child;

(III) Voluntary on the part of the family;

(IV) Conducted by qualified personnel who are trained to utilize appropriate methods and procedures;

(V) Based on information provided by the family though a personal interview; and

(VI) Incorporate the family's description of its resources, priorities, and concerns related to enhancing the child's development.

(ii) A review of the pertinent records related to the child's current health status and medical history; and

(iii) A review of the evaluation conducted pursuant to section 4.

(b) The Early Intervention Service Provider shall use the results of the initial assessment to develop an Individual Family Service Plan in accordance with this Chapter and 34 C.F.R. Part 303 to ensure that comprehensive services are provided which address the needs of the infant or toddler and his/her family.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 6 Individual Family Service Plan (IFSP)

(a) Each infant or toddler's IFSP must:

(i) Identify the natural supports of the family and incorporate those supports into specific strategies contained in the IFSP;

(ii) Include child and family outcomes that are measureable, and functional,

(iii) Address family concerns and the developmental delays of the child;

(iv) Include the specific services that will be offered to the family and child, when services will begin, and frequency of services; and

(v) Be signed by the parent or primary caregiver and all IFSP team members.

(b) The Early Intervention Service Provider shall review the IFSP at least every six (6) months and document the infant or toddler's progress on the child and family's outcomes. The Provider must develop a new IFSP annually.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 7 Early Intervention Service Provider Standards

(a) All persons providing services on behalf of a Regional Part C Program Provider must meet applicable licensure requirements under Title 33 of the Wyoming Statutes and applicable agency, board, or commission rules.

(b) Service coordinators must be knowledgeable of and support best practices for providing early intervention services.

(c) Early intervention services may be provided by paraprofessionals or assistants who are appropriately trained and supervised according to State laws and regulations.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 8 Natural Environment

(a) Regional Part C Program Providers must ensure early intervention services are provided in natural environments.

(i) Natural environments include settings where typically developing infants and toddlers participate, including their home, child care settings, and other community or public settings;

(ii) The infant or toddler's IFSP must include a statement of the natural environment in which early intervention services will be provided.

(iii) Services may only be provided outside of the natural environment, such as a clinician's office, if:

(A) The parent(s) and the Individual Family Service Plan team determine that early intervention outcomes cannot be achieved satisfactorily in a natural environment; and

(B) For each early intervention service that cannot be delivered in a natural environment, the IFSP contains written justification, and a plan and timeline of moving services back to a natural environment.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 9 Complaint Procedures

(a) Complaints may be submitted by a parent, Regional Part C Program Providers, early intervention provider, or other entity that provides early intervention or health care to the infant or toddler or family. All complaints must be in writing and mailed to the attention of the Part C Coordinator, Wyoming Department of Health, 6101 Yellowstone Rd., Suite 220, Cheyenne, WY 82009. The Division shall, within 60 days of receiving the written complaint:

(i) Send written acknowledgement to complainant of receipt of complaint;

(ii) Carry out an independent investigation including, if necessary, an on-site visit;

(iii) Give the complainant the opportunity to submit additional information, either orally or in writing, about the allegation of the complaint;

(iv) Provide the provider with an opportunity to respond to the complaint, and provide a proposal to resolve the complaint;

(v) Review all relevant information and make an independent determination as to whether the provider is violating a requirement of these rules, 34 C.F.R. Part 303, or the IDEA; and

(vi) Issue a written decision to the complainant that addresses each allegation in the complaint, and contains:

(A) Findings of fact and conclusions;

(B) The Division's final decision, and

(b) During a complaint investigation the Division shall provide an opportunity for the complainant to voluntarily engage in mediation with the Regional Part C Program Provider they have a complaint about.

(c) Complaint Resolution. In resolving a complaint in which a failure to provide appropriate services has been found, the Division shall require the Early Intervention Service Provider to:

(i) Address any failure to provide appropriate services,

(ii) Take corrective action appropriate to address the needs of the child; and

(iii) Implement appropriate future provisions for services to all children who are identified as having developmental delays.

(d) Due process hearing procedures. Following the complaint resolution process, a parent or Early Intervention Services Provider may request an administrative hearing to contest any issue regarding the identification, evaluation, or placement of an infant or toddler, or the provision of early intervention services to the infant or toddler or family. Notice, opportunity for hearing, and hearing procedures shall be in accordance with the procedural safeguards established in 34 C.F.R. Part 303, Subpart E.

(e) Hearings under this section shall be governed by the OAH Contested Case Rules, which have been incorporated by reference under these rules.

(f) Within ten (10) business days of receiving a request for an Administrative Hearing, the Division will notify the parent and the Regional Part C Program Provider via certified mail that the request has been received along with information regarding the process and timelines for Administrative Hearings.

(g) Child's status during proceedings. During the pendency of any administrative or judicial proceeding regarding a due process hearing, unless the parents of the child agree otherwise, the child that is the subject of the dispute must remain in his or her current services.

History

Effective 2019-02-08

Wyo. Code R. 048.0020.8.02082019 § 10 Payment for Services

(a) In determining contract amounts pertaining to state general funds, regional Part C Program Providers shall calculate the number of children age birth through two (2) years of age who have a completed and signed IFSP on December 1st or the first business day thereafter. These numbers shall be used to calculate payments to service providers for the subsequent fiscal year.

(b) In determining contract amounts pertaining to federal funding, the Division shall multiply the total number of children age birth through two (2) receiving Part C Early Intervention Services on December 1st by the specified federal per child amount.

(c) Part C funds may only be used for early intervention services that an eligible infant or toddler needs but is not currently entitled to under any other federal, State, local, or private source. All Part C funds disseminated by formula are specified as payer of last resort. The regional Part C Program Provider is required to identify all available resources in their community and to use such resources prior to the use of Part C funds to develop or pay for direct services.

(i) The Regional Part C Program Provider may bill public and private insurance to pay for early intervention services if the parent provides informed consent. A parent's refusal to provide consent to access insurance shall not result in the denial of early intervention services to a child and their family. The consent to bill insurance must clearly state the parents:

(A) Agree to the Early Intervention Service Program's filing of an insurance claim to obtain reimbursement for specifically identified services;

(B) Acknowledge the information and records identified in the request for consent will be released to specifically identified persons or entities in connection with submitting the claim for reimbursement;

(C) Understand the parent is not required to consent to the filing of insurance claims and may refuse to do so at any time in the future; and

(D) Recognize that any refusal to permit the early intervention program to access their private insurance does not relieve the early intervention program of its obligation to provide all required services at no cost.

(ii) Families must be informed by the regional Part C Program Provider of possible consequences that may occur in accessing their private insurance, including but not limited to:

(A) A decrease in available lifetime benefit coverage or decrease in any other public benefit;

(B) Increase in premiums;

(D) Decreased or inability to obtain alternate acceptable coverage.

(d) If a family's public or private insurance is accessed, the Regional Part C Program Provider may use Part C funding to pay for deductible and co-pays. Proceeds from public or private insurance are not treated as program income.

(e) The regional Part C Program Provider must provide the following without charge to the parent/caregiver:

(i) Implementing the child find requirements in 34 C.F.R. § 303.321;

(ii) Evaluation and assessment, as included in 34 C.F.R. § 303.321, and including the functions related to evaluation and assessment in § 303.12;

(iii) Service coordination, as included in 34 C.F.R. §§ 303.34 and 303.344(g); and

(iv) Administrative and coordinative activities related to the development, review, and evaluation of IFSPs in 34 C.F.R. §§ 303.340 through 303.346.

History

Effective 2019-02-08

147 Emergency Medical Services - General

Chapter 0 Appendices A-E

Wyo. Code R. 048.0023.0.12082008 Appendices A-E

APPENDIX A

EXECUTIVE ORDER No. 76-4

Pursuant to the authority vested in the office of the Governor of the State of Wyoming under W. S. Sections 9-32.4 and 9-160.7, I Ed Herschler, Governor of the State of Wyoming, hereby order: Section 1: The Wyoming Advisory Committee on Emergency Medical Services is created under the sponsorship of the Wyoming Department of Health and Social Services, Division of Health and Medical Services for the purpose of assisting the efforts of various Federal, State and local agencies, private industry, and interested citizens toward the development and implementation of an integrated, statewide program for emergency medical services. The said Committee shall stimulate the interest, planning, and development of activities which result in the highest possible standard of medical care to victims of trauma and critical illness in Wyoming.

Section 2: The said Committee shall perform the following

(a) Act in an advisory capacity to the Division of Health and Medical Services and through the said Division to the Governor on all matters related to emergency medical care programs.

(b) Make recommendations concerning the development and implementation of statewide emergency medical care programs.

(d) Make recommendations concerning guidelines and standards for the delivering of emergency medical care which recognizes the concepts of the National Highway Safety Act of 1966 and the Emergency Medical Services Act of 1973.

(e) Foster and encourage action in the interest of improved care and treatment to victims of trauma and critical illness in Wyoming.

(f) Coordinate the State’s participation in federally supported programs related to emergency medical care and make recommendations as to the use of funds received under such programs.

Section 3: The members of the said Committee shall be appointed by the Governor and serve at his pleasure. Persons appointed to serve on the Committee shall have demonstrated an interest or involvement in emergency medical care activities. A Chairman and Vice- Chairman shall be elected from the membership of the Committee in accordance with by-laws approved by the Governor. The composition of the Committee shall be one member representing each of the following:

(1) Wyoming Chapter of the American Academy of Orthopaedic Surgeons.

(2) The Wyoming Trauma Committee, American College of Surgeons.

(3) Wyoming Ambulance and Emergency Medical Services Association.

(4) Wyoming Highway Patrol.

(5) Wyoming Disaster and Civil Defense Agency.

(6) Wyoming Hospital Association.

(7) Wyoming Governor’s Office of Highway Safety.

(8) Wyoming Nurses Association.

(9) Wyoming Office of Emergency Medical Services.

(10) Wyoming State Health Planning and Development Agency.

(11) Wyoming Registered Emergency Medical Technician.

(12) Private Physician

(13) Private Physician

(14) Consumer from Wyoming Health Safety System Agency

(15) Consumer from Wyoming Health Safety System Agency

(16) Wyoming Hospital Administrator

(17) Wyoming Ambulance Operator

Section 4: The Wyoming Department of Health and Social Services, Division of Health and Medical Services, and its responsible office, is hereby designated as the official administrative and operational agency for coordination, planning, implementation, and evaluation of the Wyoming Emergency Medical Services System.

GIVEN under my hand and the Executive Seal of the State of Wyoming this 7th day of December 1976.

APPENDIX B

EXECUTIVE ORDER No. 1998-7

Pursuant to the authority vested in the Office of Governor of the State of Wyoming under W. S.

Sections 9-23.4 and 9-160.7, I, Jim Geringer, Governor of the State of Wyoming, hereby order: Section 1: The Wyoming Advisory committee on Emergency Medical Services is reaffirmed under the sponsorship of the Wyoming Department of Health Division of Public Health, Office of Emergency Medical Services for the purpose of assisting the efforts of various federal, state, and local agencies, private industry, and interested citizens toward the continued development and implementation of an integrated, statewide program for emergency medical services and trauma system. The Committee shall promote the planning and development of activities which will result in the delivery of the highest possible standard of medical care to victims of trauma and critical illness in Wyoming.

Section 2: The Committee shall perform the following duties:

(a) Act in an advisory capacity to the Department of Health’s Office of Emergency Medical Services on all matters related to emergency medical services programs and trauma system development.

(b) Make recommendations concerning the development and implementation of statewide emergency medical services programs.

(c) Determine statewide emergency medical services’ needs and provide a broad basis for responsibility and policy decisions.

(d) Make recommendations concerning guidelines and standards for the delivery of emergency medical care, which recognizes the concepts of the National Highway Safety Act of 1966 and the Emergency Medical Services Act of 1973, et seq.

(e) Make recommendations concerning the development and implementation of the statewide trauma system.

(f) Coordinate the State’s participation in federally supported programs related to emergency medical care and trauma systems and make recommendations as to the use of funds received under such programs.

Section 3: The members of the Committee shall be appointed by the Governor and serve at his pleasure. Individuals appointed to serve on the Committee shall have demonstrated an interest or involvement in emergency medical care or trauma system activities. A chairman and vice- chairman shall be elected from the membership of the Committee in accordance with by-laws approved by the Department of Health. The composition of the Committee shall be one member representing each of the following:

(1) A physician form the Wyoming Chapter of the American Academy of Family Physicians.

(2) A physician from the Wyoming Chapter of the American College of Emergency Physicians.

(3) A physician from the Wyoming Trauma Committee of the American College of Surgeons.

(4) A member of the Wyoming Nurses Association.

(5) A representative from the Wyoming Hospital Association.

(6) A representative from the Wyoming Medical Society.

(7) A Wyoming certified Emergency Medical Technician.

(8) A Wyoming licensed ambulance operator.

Terms are indefinite. A member who ceases to represent the organization he/she was appointed to represent shall be replaced at the recommendation of the Department of Health.

Section 4: The Wyoming Department of Health, Division of Public Health, Office of Emergency Medical Services is hereby designated as the official administrative and operational agency for coordination, planning, implementation, and evaluation of the Wyoming Emergency Medical Services System and Trauma System.

GIVEN under my hand and the executive seal of the Governor’s office this 16th day of November, 1998.

APPENDIX C

EQUIPMENT REQUIREMENTS FOR AMBULANCES

The Department of Health’s Office of Emergency Medical Services has established the following equipment list as the recommended minimum necessary for ground ambulances involved in the transportation or treatment of ill or injured patients in the prehospital setting.

Basic Life Support

Airway Management and Ventilation:

• Oxygen tank - fixed (minimum capacity of 3,000 liters with reduction gauge and flow meter) and portable with regulator.

• Oxygen masks in infant, child and adult sizes.

• Nasal cannulas in child and adult sizes.

• Oral airways; infant, child and adult sizes.

• Nasopharyngeal airways with lubricant; infant, child and adult sizes.

• Self-inflating resuscitation bags; with oxygen reservoir. Infant, child and adult sizes.

• Masks for use with resuscitation bags; neonate, infant, child and adult sizes.

• Oxygen connecting tubing.

• Portable suction unit with various tonsillar and flexible suction catheters.

• Bite sticks.

Patient Assessment:

• Blood pressure cuff, infant, child and adult sizes.

• Stethoscope; infant and adult.

• Flashlight/penlight (with extra batteries and bulbs).

• Thermometer with hypothermia capacity

Obstetrics:

• Sterile pre-packaged OB delivery kit.

• Thermal absorbent blanket and head cover.

Immobilization:

• Traction splint - child and adult.

• Firm upper and lower extremity splints to include joint above and below injury, rigid with padding.

• Backboard with appropriate securing straps; pediatric and adult sizes.

• Spinal immobilization device; such as KED.

• Rigid cervical collars; pediatric and adult sizes.

• Triangular bandages - minimum of six (6).

• Scoop type stretcher

Personal Protection:

• Infectious disease prevention materials - gloves, goggles or face shields, masks, gowns, boots or shoe covers, appropriate disinfectants.

• Sharp object disposable containers which can be permanently be sealed when full.

• Antiseptic hand wipes.

• Hearing protection.

• HEPA mask.

• Appropriate mask with one-way valve & appropriate filter.

• Minimum of a Level C protective suit.

• Traffic safety vest.

Bandaging:

• Burn package - includes sterile sheets or towels for children.

• Sterile trauma dressings of various sizes - 5 x 9; 8 x 10.

• Sterile gauze bandages of various sizes.

• Adhesive tape in various sizes.

• Elastic bandages in various sizes.

Communications:

• Two-way communication equipment between dispatcher, ambulance and medical facity.

Other:

• Sterile saline irrigation fluid.

• Bandage/trauma shears.

• Disposable basins or emesis bags.

• Disposable bedpan and urinal.

• Stretcher, main; shall be four-wheeled elevating cot for primary patient with appropriate patient restraining device.

• Activated charcoal as directed by physician medical director.

• Patient restraints as directed by physician medical director.

• Sugar cubes or hypertonic sugar solution.

• Cold Packs • Blankets.

• Disaster/triage tags.

• Warning flares and /or signal devices.

• Fire extinguisher.

Optional:

• Automatic external defibrillator (AED) - strongly recommended for systems that lack immediate response from an advanced life support service.

• Length-based tape or chart for pediatric equipment sizing such as Broselow type tape.

• Pulse oximetry.

• Protective helmets.

• Protective coat with reflective materials.

• Scissors capable of cutting heavy metal.

• Pediatric transport chair.

• Ring cutter.

• Tweezers (splinter).

• Portable trauma kits for treating patients away from the ambulance.

• Eye wash.

• Self-assisted medications as outlined in the basic EMT curriculum - ambulance service’s physician medical director must authorize ambulance service to stock.

• Pedi-wheel.

• Small stuffed toy.

It is highly recommended that pediatric equipment be maintained in a separate jump kit from the adult equipment.

Advanced Life Support

(In addition to Basic Life Support)

Airway Management and Ventilation:

• Laryngoscope handle with extra batteries and bulbs; pediatric and adult.

• Laryngoscope blades - sizes 0, 1 and 2 straight - sizes 3 and 4 straight or curved.

• Endotracheal tubes (minimum of 2 each size) - sizes 2.5 to 5.0 mm uncuffed - 5.5 to 8.0 mm cuffed.

• Combitube or similar Division approved multi-lumen lower airway adjunct.

• Stylettes for endotracheal tubes; pediatric and adult.

• Magill forceps - pediatric and adult.

• Lubricating jelly (water soluble).

• Nasogastric tubes - pediatric sizes 5F and 8F - adult sizes 14F, 16F, and 18F.

• End-tidal CO2 detectors or esophageal detector devices.

Monitor/Defibrillator:

• Portable, battery-operated, cardiac monitoring defibrillator with recorder, quick- look paddles or hands-free patches, pediatric and adult electrodes and paddles, with capability to provide electrical discharge below 25 watt-seconds.

Vascular access:

• Intravenous catheters, 14g - 22 g.

• Intraosseous needles or devices.

• Tourniquets - constricting bands.

• Syringes of various sizes • Needles; sizes 14g - 24g.

• Blood sample tubes; adult and pediatric.

• Intravenous administration sets - micro/macro/adjustable flow rate sets • Intravenous securing devices.

Medications:

The Office of Emergency Medical Services shall maintain separate lists of approved medication for the EMT-Intermediate and Paramedic ambulance services.

It is recommended that pediatric medications/equipment be maintained in a separate jump kit from the adult medications/equipment.

APPENDIX D

APPENDIX E

ARTICLE 2. CARDIOPULMONARY RESUSCITATION DIRECTIVES

Effective dates. - Laws 1993, ch. 108, § 2, makes the act effective immediately upon completion of all acts necessary for a bill to become law as provided by art. 4, § 8, Wyo Const. Approved February 25, 1993.

§ 35-22-201. Definitions

(a) As used in this article, unless the context otherwise requires:

(i) “Cardiopulmonary resuscitation” means measures to restore cardiac function or to support breathing in the event of respiratory or cardiac arrest or malfunction. “Cardiopulmonary resuscitation” includes, but is not limited to, chest compression, delivering electric shock to the chest, or manual or mechanical methods to assist breathing;

(ii) “Cardiopulmonary resuscitation directive” means as advance medical directive pertaining to the administration of cardiopulmonary resuscitation;

(iii) “Emergency medical service personnel” means any emergency medical technician at any level who is certified by the Department of Health. “Emergency medical service personnel” includes a first responder certified by the Department of Health. (Laws 1993, ch. 108, § 1.)

Editor’s notes. - There is no subsection (b) in this section as it appears in the 1993 printed act.

§ 35-22-202. Cardiopulmonary resuscitation directives; who may execute.

Any adult who has the decisional capacity to provide informed consent to or refusal of medical treatment or any other person who is, pursuant to the laws of this state or any other state, authorized to make medical treatment decisions on behalf of a person who has such decisional capacity, may execute a cardiopulmonary resuscitation directive. (Laws 1993, Ch. 108, §1.)

§ 35-22-203. Cardiopulmonary resuscitation directive forms; duties of Department of Health.

(a) On or before January 1, 1994, the state Department of Health shall promulgate rules and protocols for the implementation of cardiopulmonary resuscitation directives by emergency medical personnel. The protocols adopted shall include uniform methods of identifying persons who have executed a cardiopulmonary resuscitation directive. Protocols adopted by the Department of Health shall include methods for rapid identification of persons who have executed a cardiopulmonary resuscitation directive, controlled distribution of methods of identifying persons who have executed a cardiopulmonary resuscitation directive, and the information described in subsection (b) of this section. Nothing in this subsection shall be construed to restrict any other manner in which a person may make a cardiopulmonary resuscitation directive.

(b) Cardiopulmonary resuscitation directive protocols to be adopted by the state Department of Health shall, at a minimum, require the following information concerning the person who is the subject of the cardiopulmonary resuscitation directive;

(i) The person’s name, date of birth and sex:

(ii) The person’s eye and hair color;

(iii) The person’s race or ethnic background;

(iv) If applicable, the name of the hospice program in which the person is enrolled;

(v) The name, address and telephone number of the person’s attending physician;

(vi) The person’s signature or mark or, if applicable, the signature of a person authorized by this article to execute a cardiopulmonary resuscitation directive;

(vii) The date on which the cardiopulmonary resuscitation directive was signed;

(viii) the person’s directive concerning the administration of cardiopulmonary resuscitation , countersigned by the person’s attending physician. (Laws 1993, Ch. 108, § 1.) § 35-22-204. Duty to comply with cardiopulmonary resuscitation directive immunity; effect on criminal charges against another person.

(a) Emergency medical service personnel, health care providers and health care facilities shall comply with a person’s cardiopulmonary resuscitation directive that is apparent and immediately available. Any emergency medical service personnel, health care provider, healthcare facility or any other person who, in good faith, complies with a cardiopulmonary resuscitation directive which is perceived to be valid shall not be subject to civil or criminal liability or regulatory sanction for such compliance.

(b) Compliance by emergency medical service personnel, healthcare providers or healthcare facilities with a cardiopulmonary resuscitation directive shall not affect the criminal prosecution of any person otherwise charged with the commission of a criminal act.

(c) In the absence of a cardiopulmonary resuscitation directive, a person’s consent to cardiopulmonary resuscitation shall be presumed. (Laws 1993, Ch. 108, § 1.)

§ 35-22-205. Effect of declaration after inpatient admission.

A cardiopulmonary resuscitation directive for any person who is admitted to a health care facility shall be implemented as a physician’s order concerning resuscitation as directed by the person in the cardiopulmonary resuscitation directive, pending further physicians’ orders. (Laws 1993, ch. 108, § 1.)

§ 35-22-206. Effect of cardiopulmonary resuscitation directive; absence; on life; or health insurance.

Neither a cardiopulmonary resuscitation directive nor the failure of a person to execute one shall affect, impair or modify any contract of life or health insurance or annuity or be the basis for any delay in issuing or refusing to issue an annuity or policy of life or health insurance or any increase of a premium therefor. (Laws 1993, ch. 108, § 1.)

§ 35-22-207. Revocation of cardiopulmonary resuscitation directive.

A cardiopulmonary resuscitation directive may be revoked at any time by the person who is the subject of the directive or by any other person who is, pursuant to the laws of this state or any other state authorized to make medical treatment decisions on behalf of the person who is the subject of the directive. (Laws 1993, ch. 108, § 1.) § 35-22-208. Effect of article on euthanasia; mercy killing; construction of statute.

Nothing in this article shall be construed as condoning, authorizing or approving euthanasia or mercy killing. In addition, the legislature does not intend that this article be construed as permitting any affirmative or deliberate act to end a person’s lief, except to permit natural death as provided by this article. (Laws 1993, ch. 108, § 1.)

History

Effective 2008-12-08

Chapter 1 General Provision

Wyo. Code R. 048.0023.1.12082008 General Provision

History

Effective 2008-12-08

Chapter 2 Ambulance Service Business License

Wyo. Code R. 048.0023.2.12082008 Ambulance Service Business License

RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES

CHAPTER 2

AMBULANCE SERVICE BUSINESS LICENSE

Section 1. License Required. No person shall maintain, conduct, operate, or advertise that they operate an ambulance service in this state without a license.

Ambulance services desiring to have their personnel participate in the State Volunteer EMT Pension Fund program must maintain a current business license.

Section 2. Exceptions. An ambulance service business license shall not be required for:

(a) The United States or an agency or political subdivision of the State of Wyoming;

(b) An industrial ambulance, except for annual reporting requirements;

(d) A person operating a volunteer ambulance service in an ambulance area in which no other ambulance services meeting the requirements of the Act are located;

(e) A person using a vehicle rendering service as an ambulance in the case of a major catastrophe or emergency when licensed ambulances based in the locality of the catastrophe or emergency are incapable of rendering the services required;

(f) A person using a privately owned vehicle or aircraft not designated as an ambulance and not ordinarily used in transporting patients, while operating under the provisions of W.S. 33-28-103 in the performance of a life-saving act; or

(g) A person operating an ambulance service based outside of Wyoming, except that any ambulance service receiving a patient within this state shall be required to obtain an ambulance business license. The Division shall grant a license to an ambulance service based in another state whose licensing requirements insure that the purpose of W.S. 33-38-101, et seq and these rules are met.

Section 3. Application.

(a) Unless the service operated is a type listed in Section 2 above, no person shall commence operation of an ambulance service in this state prior to receiving an ambulance service business license.

(b) A person planning to establish an ambulance service shall apply for an ambulance service business license at least thirty (30) says prior to the date when she anticipates commencing operations. The applicant shall complete an application form provided by the Division and shall submit the completed application form and a twenty dollar ($20.00) application fee to the Division by certified mail, return receipt requested.

(i) The applicant's name, physical address, and mailing address;

(ii) The type of business organization (for example, sole proprietorship, partnership or corporation) and a statement of whether the business organization is for profit or nonprofit;

(iii) If the business organization is a partnership, the names, business addresses and mailing addresses of each partner, including silent partners and limited partners;

(iv) If the business organization is a corporation or a limited liability company, the names, business addresses and mailing addresses of all corporate officers and the name, business address and mailing address of each shareholder who owns ten percent (10%) or more of the corporation's stock. If a parent corporation owns ten percent (10%) or more of the corporation's stock, the application shall list the names, business addresses and mailing addresses of all corporate officers of the parent corporation and of each shareholder in the parent corporation who owns ten percent (10%) or more of the parent corporation's stock;

(v) The trade name or business name of the applicant;

(vi) For each attendant whom the applicant anticipates using, the name, training history, and current certification status of the individual;

(vii) The name of the individual responsible for ensuring that each attendant working for the ambulance service meets all continuing medical education. If this individual is designated as an ambulance administrator, that title should be included on the application form;

(viii) A completed application for a permit for each ambulance to be used in the ambulance service business. Each such application shall comply with Chapter 3 of these rules;

(ix) The location from which the ambulance service shall operate, and the boundaries of its normal area of operation;

(x) A copy of a certificate of insurance, issued by an insurance carrier licensed to do business in Wyoming, which certificate shows that each ambulance owned or operated by the ambulance service company is covered by insurance providing for the payment of benefits and damages in at least the following amounts:

(A) Liability coverage in the amount of one million dollars ($1,000,000.00) for each individual claim and two million dollars ($2,000,000.00) for personal injury or death claims arising out of any one (1) motor vehicle accident, or the limits allowed to participants of the state's Local Government Liability Pool;

(B) Liability coverage in the amount of one hundred thousand dollars ($100,000.00) for property damage claims arising out of any one (1) transaction or occurrence, or the limits allowed to participants of the state's Local Government Liability Pool; and

(C) Liability coverage in the amount of two million dollars ($2,000,000.00) for personal injury, death or other claims arising out of any one (1) transaction or occurrence, or the limits allowed to participants of the state's Local Government Liability Pool.

(xi) A statement of affirmation that the ambulance service shall be operated in full compliance with all applicable federal and state requirements, including such rules as the Division may from time to time promulgate or amend;

(xi) The name of the physician medical director and, if an individual is so designated, of the ambulance administrator, with signatures indicating that those individuals have agreed to serve in their respective capacities; and

(xii) Such other information as the Division may require in order to accomplish full implementation of applicable federal and state requirements and of the Division's rules.

(d) Inspection of records. The Division, at its sole discretion, may at any time inspect the records of any person holding an ambulance service business license to verify information contained in the ambulance business license application.

Section 4. Decision and Appeal.

(a) Within thirty (30) days after receipt of an application for an ambulance service business license, the Division shall issue the license or deny the application for a license. The Division's decision shall be based upon whether the application for an ambulance service business license is in compliance with all applicable federal and state requirements and with the Division's rules.

(b) If the Division issues an ambulance service business license to the applicant, it shall mail the license to the applicant.

(c) If the Division denies the applicant's application for an ambulance service business license, it shall send a written notice of denial to the applicant. The notice of denial shall explain the reasons for the denial.

(d) An applicant for an ambulance service business license whose application is denied, may appeal the denial by sending its request for an administrative hearing on the denial to the Division, by certified mail, return receipt requested, so that it is received by the Division within thirty (30) days of the date when the Division mailed the notice of denial to the applicant. All aspects of the administrative hearing on the denial shall be governed by the provisions of Chapter 9 of these rules.

Section 5. Expiration. A license shall expire on December 31st of each year.

Section 6. Renewal of License. The Division may renew a license if the license holder has complied with the requirements of these regulations. Applicants for a license renewal must complete a license renewal form and pay a twenty dollar ($20.00) license fee. The license holder must convey the license renewal form and fee to the Division at the following address:

Wyoming Department of Health Office of Emergency Medical Services Hathaway Building Cheyenne, Wyoming 82002 The Division must receive the license renewal form and the license renewal fee before December 1st of each year for renewal to be processed by the expiration date.

Section 7. Non-transferability of License. A license is not transferable. Any change in ownership, including sale, transfer or assignment, shall terminate the license.

Section 8. Change in Ownership or Termination. The license holder shall notify the Division at least thirty (30) days before terminating the business or transferring the ownership of the business to another entity or location.

Section 9. Change in Information. A license holder shall notify the Division by certified mail within ten (10) days after any information contained in the application changes or becomes inaccurate.

Section 10. Insurance coverage. A license holder shall immediately notify the Division and cease operations if the coverage required by Section 3 (c)(x) is no longer in force and effect.

Section 11. Operation Requirements.

(a) An ambulance service business license holder shall:

(i) Obtain an ambulance permit, as required by Chapter 3 of these rules, for each ambulance used in the ambulance service business;

(ii) Insure that all attendants are certified as required by these rules. An ambulance service business license holder shall not, at any time, allow a person not appropriately certified as an attendant (including individuals who at one time were appropriately certified but whose certification is no longer current) to function as an attendant on any ambulance operated by the ambulance service business license holder;

(iii) Display a copy of the ambulance service business license in a prominent location on the premises of the ambulance service business at all times; and

(iv) Be operational and en route within ten (10) minutes or as soon thereafter within a reasonable and prudent amount of time of each request for service, unless other arrangements regarding dispatch time have been made and agreed to by the individual requesting service.

(b) An ambulance service business license holder, other than a non-emergency ambulance service or an air ambulance, shall provide ambulance service twenty-four (24) hours per day, seven (7) days per week.

Section 12. Disciplinary Action.

(a) The Division may, at its sole discretion, deny, refuse to renew, restrict, suspend, or revoke an ambulance service business license at any time when the Division has received a credible allegation that an applicant for or a holder of an ambulance service business license has:

(i) Renewed, obtained, or attempted to renew or obtain a license by fraud, bribery, or misrepresentation;

(ii) Advertised the ambulance service in a false or misleading manner;

(iii) Obtained a fee by fraud or submitted a fraudulent billing, including billing for a service not rendered or billing for a service not medically necessary;

(iv) Failed to establish and abide by a set of procedures and precautions, as published by the Centers for Disease Control, to assist health care personnel in protecting themselves from infectious disease;

(v) Violated any federal or state law or regulations, or violated any of these rules; or

(vi) Received a termination notice from the physician medical director of the ambulance service. [See the requirements for summary suspension in Chapter 9 of these rules.]

(b) Before notice of suspension is sent pursuant to Chapter 9, Section 3, the Division may at its sole discretion, send a written warning to the license holder.

(c) A holder of an ambulance service business license may appeal any adverse action which the Division takes under this section by:

(i) Filing a request for an administrative hearing within thirty (30) days of the time the Division has mailed the notice of action to the license holder. Such request shall be sent by certified mail, return receipt requested, to the Division; and

(ii) Complying with all requirements of Chapter 9 of these rules.

History

Effective 2008-12-08

Chapter 3 Ambulance Permit Requirements

Wyo. Code R. 048.0023.3.12082008 Ambulance Permit Requirements

RULES AND REGULATIONS EMERGENCY MEDICAL SERVICES

CHAPTER 3

AMBULANCE PERMIT REQUIREMENTS

Section 1. Permit Required. All ambulance services covered by these Rules shall be required to obtain a permit for each ambulance used in his ambulance service.

Section 2. Application. An ambulance service shall apply for a permit by completing an application provided by the Division. The application shall contain at a minimum:

(a) A description of each ambulance including type, make, model, year of manufacture, and motor or chassis number;

(b) An inventory verification of the recommended supplies and equipment carried aboard the ambulance;

(d) The name and address of the person(s) owning and operating the ambulance.

Section 3. Ambulance Specification Criteria. All ground ambulances purchased or leased, per Manufacturers Statement of Origin, shall not exceed the Federal certified Gross vehicle Weight Rating for the chassis when fully configured and assuming payload of one hundred fifty (150) pounds per passenger space.

Section 4. Types of Aircraft Meeting the Criteria. Aircraft, when used for ambulance service, shall comply with the current Federal Aviation Regulations and 14 CFR 135, or these rules and regulations, whichever are more restrictive.

Section 5. Equipment Criteria. Recommended minimum equipment for ground ambulances shall be established by the Division. Recommended equipment lists shall be available from the Division. [See attached Appendix C]

Section 6. Equipment Criteria for Air Ambulances.

(a) Required equipment for an air ambulance service may be kept separate from the aircraft in modular prepackaged form to facilitate rapid loading and easy access aboard the aircraft when responding to a call.

(b) All equipment and materials used in an air ambulance shall be secured to prevent any hazard during flight.

(d) The equipment required to be on board an air ambulance when the aircraft is used to provide ambulance service shall be as indicated in the Federal Aviation Regulations 14 CFR 135, and the above Section 5.

Section 7. Safety Equipment Criteria.

(a) A ground ambulance shall be equipped with approved safety belts for the driver and for the front seat passenger(s), if any, and for all seating places in the rear compartment.

(b) An air ambulance shall have a Federal Aviation Administration (FAA) certificate of airworthiness maintained current by compliance with all required FAA inspections, as defined by the Federal Aviation Regulation.

(i) A minimum 1A10BC rated fire extinguisher;

(ii) A portable battery operated light; and

(iii) Maps covering areas in which the ambulance provides services.

Section 8. Communications Equipment Criteria.

(a) Each ambulance shall be equipped with a two-way radio or telephone or other wireless communication device capable of direct communication with Wyoming hospitals for the purpose of patient evaluation and medical procedure authorization.

(b) Any ambulance-to-hospital communication shall be conducted on a Federal Communications Commission (FCC), State Communications Office or Division-approved frequency.

(d) Each ground ambulance shall be identified with an MS # for communication purposes with hospitals and other agencies. Ambulances MS# are assigned by the Wyoming Hospital Association on behalf of the OEMS.

Section 9. Maintenance Criteria.

(a) The ambulance shall contain compartments so that medical supplies may be kept in a clean and sanitary condition.

(b) Equipment shall be securely stored so that the patient is not injured during a sudden stop or movement.

(c) The ambulance interior and exterior shall be kept clean. The interior shall be cleaned, as necessary, after each use. When a patient with a communicable disease, other than the common cold, has been transported in an ambulance, the ambulance interior and all equipment coming in contact with the patient shall be thoroughly disinfected. The infection control guidelines of the Centers for Disease Control shall be adhered to.

(d) All linens, airway and oxygen masks, nasal cannulas or any other supplies or equipment coming into direct patient contact shall either be of a single use, disposable type or cleaned, laundered or disinfected prior to reuse, as appropriate.

(e) All equipment shall be kept clean and in proper working order.

(f) The ambulance shall be maintained in accordance with manufacturer's specifications and be in good safe operating condition at all times.

(g) Emergency vehicle warning lights and audible warning devices shall be maintained to function in the manner in which they were designed to function.

(h) The ground ambulance shall meet the safety inspection criteria, as established by the Division. [See attached Appendix D]

Section 10. Inspection and Decision. After receiving an application, the Division may inspect the ambulance or have its designee inspect the ambulance. The Division shall grant the permit if the ambulance meets the requirements of this Chapter. If the Division denies the permit, it shall specify the reasons for denial, the corrective action required by the Division, and a date by which the corrective action must be taken. The Division may at any time inspect an ambulance requiring a permit under this Chapter.

Section 11. Term of Permit; Non-transferable. Permits shall remain effective as long as the ambulance meets the requirements of this Chapter. The permit is not transferable.

Section 12. Permit Display. Permit decals shall be prominently affixed to the rear door or rear window of the ambulance.

Section 13. Ambulance Inspection. The Division may, at its sole discretion, inspect each ambulance subject to the requirements of this Chapter. The Division may inspect an ambulance or its maintenance records at any time or place to determine if the ambulance is being operated safely and in compliance with these regulations. [See attached Appendix D]

3-3

History

Effective 2008-12-08

Chapter 4 Response and Reporting Requirements

Wyo. Code R. 048.0023.4.10132016 Response and Reporting Requirements

RULES AND REGULATIONS

FOR EMERGENCY MEDICAL SERVICES

CHAPTER 4

RESPONSE AND REPORTING REQUIREMENTS

Section 1. Authority. In addition to the authority delegated under W.S. 33-36-101, these rules are promulgated under the authority of W.S. 35-1-801 to enable the Division in developing and reporting on the comprehensive EMS and Trauma system by establishing uniform criteria for EMS agency reporting and response. For the purposes of this chapter, "EMS agency" means any ambulance, authorized fire protective service or other entity dispatched with the intent to provide medical care in response to an emergency request for medical care.

Section 2. Ambulance Personnel Criteria. An ambulance shall comply with the following:

(a) Ground ambulances, when transporting a patient, shall be staffed with a driver and at least one (1) licensed EMT as provided in Chapter 5;

(b) All air ambulance service flights shall require at least one (1) licensed EMT and a flight crew in conformity with current Federal Aviation Regulations and 14 CFR Parts 91, 120, and 135; and

(c) Any physician, registered nurse, physician assistant, or nurse practitioner currently licensed in this state may provide care in an ambulance in accordance with their scope of practice when approved by the ambulance service.

Section 3. Running Criteria.

(a) The driver of a ground ambulance shall comply with all Wyoming traffic laws and regulations, including W.S. 31-5-928 and 31-5-952;

(b) In the absence of decisive factors to the contrary, ambulances shall transport "emergent" or "urgent" patients to the closest accessible medical facility equipped, staffed and prepared to receive emergency cases and administer emergency medical care appropriate to the needs of the patient; and

(c) Siren and approved warning light restrictions. Ground ambulance drivers shall not activate warning lights or use the siren except when responding to an emergency call, providing for safety at the scene of a response or other hazard, or transporting emergency patients who are classified as "emergent" or "urgent" as defined in Section 5 of this Chapter.

Section 4. Patient Care Reporting.

(a) To promote the uniform provision and accountability of the comprehensive emergency medical services and trauma system, all EMS agencies and their personnel shall utilize the Division's electronic patient care reporting system to document the provision of emergency medical services or related trauma care.

(b) EMS personnel providing care to a patient shall provide patient care reports to any EMS agency or healthcare facility receiving the transfer of care of a patient to ensure the continuity of patient care and patient safety.

(c) At a minimum, EMS personnel shall ensure that appropriate personnel receiving the transfer of care of a patient are aware of the patient's presence, that systems and equipment necessary for the monitoring and safety of the patient are in place, and that a verbal report of the care provided by the ambulance service has been provided to the appropriate person.

(d) EMS personnel providing care to and transport of a patient shall leave a copy of the patient care report with the receiving medical facility or EMS agency at the time of the transfer of care of the patient whenever practicable. EMS personnel that provide care to a patient shall submit complete and accurate patient care reports for every request for service in the electronic system maintained by the Division no later than two (2) hours after the ambulance or agency is returned to service and available for response with the following exceptions:

(i) If a patient is transported to a receiving facility outside of the agency's primary response area, and the distance and return time factors prohibit the upload of the patient care report into the system, then the patient care report shall be submitted to the Division's electronic system no later than twelve (12) hours after the return to service;

(ii) If an equipment or system failure occurs that prohibits the upload of the patient care report into the system, then the patient care report shall be submitted to the Division's electronic system no later than twenty-four (24) hours after the system is restored. In these circumstances, the EMS agency or reporting party shall notify the Division. Password expiration or system access actions that are the responsibility of the EMS agency or person shall not be considered equipment or system failures;

(iii) The submission of an amendment or addendum to a previously submitted patient care report, which is submitted to ensure that the previous report is complete and accurate.

(e) Cardiac rhythm strips, 12 lead electrocardiograph (ECG) tracings, and any other reports generated by patient monitoring equipment, shall be considered to be part of the patient care report. Copies of these reports shall be provided to the receiving facility and uploaded into the Division's electronic system.

(f) The Division may inspect the patient care reports of any EMS agency covered by these rules.

(g) No person shall release a patient care report without the patient's consent, except as provided in subpart (h) of this section.

(h) A person may release a patient care report:

(i) to a health care facility;

(ii) to the Department of Health, including its individual divisions and programs;

(iii) to a law enforcement officer;

(iv) to the Wyoming Attorney General's office;

(v) pursuant to a lawful court order; or

(vi) as otherwise required or permitted by law.

Section 5. Patient Classifications. For the purpose of these Rules and Regulations the following patient classification definitions shall be used:

(a) "Emergent" means the patient requires immediate transport and treatment to prevent death or permanent disability.

(b) "Urgent" means there is a serious illness or injury to the patient which could expose the patient to risk of death or permanent disability unless treatment is initiated at a medical facility within a reasonable length of time.

(c) "Non-emergent" means a patient who has an injury or illness that is presently stable, which poses no present threat to life or risk of permanent disability, and does not require the use of emergency vehicle warning devices.

(d) For patients who are classified as emergent or urgent, the use of emergency vehicle warning devices is appropriate.

Section 6. Other Mandatory Reporting Requirements.

(a) All EMS agencies that come under the provisions of these rules shall submit to the Division a copy of any requests for information filed with them. Any such requests shall be sent to the Division by certified mail, return receipt requested, within thirty (30) days of receipt of such request.

(b) All EMS agencies shall report any service of process, as defined in Chapter 1, Section 4(qq) of these rules to the Division within one (1) working day of receipt of service.

(c) Any EMS agency or person licensed or authorized under these rules that has cause to believe or information indicating that any person or EMS agency is, or may be in violation of these rules, shall report that information to the Division. Failure to report such information shall be considered aiding and abetting in the violation of these rules.

(d) EMS agencies authorized to perform needle or surgical cricothyrotomy or rapid sequence intubation (RSI) shall notify the Division via e-mail within two hours of the performance of these procedures. The Division shall review all cases.

(e) Ambulance services shall notify the Division within two (2) hours of any incident or accident requiring reporting to the Federal Aviation Administration (FAA) or the National Transportation Safety Board, or that inhibits or prohibits the ability of the ambulance to transport a patient.

History

Effective 2016-10-13

Chapter 6 Advanced Training Programs

Wyo. Code R. 048.0023.6.12082008 Advanced Training Programs

RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES

CHAPTER 6

ADVANCED TRAINING PROGRAMS

Section 1. Required. All ambulance services and fire protection services desiring to utilize advanced level prehospital personnel must establish training and continuing education programs. Training programs for emergency medical personnel shall address not only adults but shall include emergency medical services for children (EMS-C).

Section 2. Review by Agencies. All advanced training programs shall be reviewed and approved by the Division, the Task Force on Prehospital Care, and the Board.

Section 3. Program Committee. Any person desiring to establish a training program for EMT Intermediate or Paramedic personnel shall form a Program Committee:

(a) Program Committees for EMT Intermediate personnel shall consist of:

(i) Ambulance service and/or fire protection service representatives in the geographic area who shall employ or utilize the personnel.

(ii) A physician licensed to practice medicine in this state as a Medical Doctor or Doctor of Osteopathy who agrees to act as program director;

(iii) A representative from the sponsoring hospital; and

(iv) An identified course coordinator. The coordinator must be certified at or above the EMT Intermediate level, and have completed a Division approved Instructor/Coordinator program.

(b) Program Committees for Paramedic personnel shall include:

(i) Ambulance service and or fire protection service representatives in the geographic area who shall employ or utilize the personnel;

(ii) A physician licensed to practice medicine in this state as, a Medical Doctor or Doctor of Osteopathy, who agrees to act as program director;

(iii) Personnel from the sponsoring hospital who represent nursing, administration, the emergency department, and the intensive care unit; and

(iv) An identified course coordinator. The Coordinator shall be certified at the Paramedic level or licensed as a nurse, Medical Doctor or Doctor of Osteopathy, and have completed a Division approved Instructor/Coordinator program.

Section 4. Application. The Program Committee shall submit an application for an advanced training program to the Division. The application must include:

(a) A summary, with appropriate documentation, explaining the medical need for the program;

(b) A description of the proposed training program consisting of:

(i) Content;

(ii) Time Schedule;

(iii) Instructors by name and subject;

(iv) Materials and physical facilities;

(v) Number of students;

(vi) Clinical and field internship requirements, and

(vii) Record keeping methods;

(d) Provisions for commitment of sponsor hospital as required by Chapter 7 of these

rules. (See Chapter 7, Section 3. )

Section 5. Decision. The Division shall notify the Program Committee of its decision concerning the applicant's application for an advanced training program within ten (10) days of its decision. If the Division denies an applicant's application, the applicant may reapply.

Section 6. Supervision. Following approval, the program shall be supervised by the program director, who shall be a Wyoming licensed physician (Medical Doctor) or (Doctor of Osteopathy). The program director shall ensure that each instructor is thoroughly knowledgeable in his subject and understands his responsibility and shall maintain the standards of quality instruction as provided in the curriculum.

Section 7. Admission Requirements.

(a) Students shall be admitted to an EMT Intermediate training program who:

(i) Are currently certified by the Division as an EMT Basic;

(A) Show evidence of having completed twelve (12) months of active affiliation with a Wyoming licensed ambulance service attendant. The Division, at its sole discretion, may waive this after review by the Division on a case-by-case basis; or

(B) Show evidence of having completed twelve (12) months of active affiliation with the Division recognized fire protection service providing basic patient care. The Division, at its sole discretion, may waive this after review by the Division on a case-by-case basis;

(ii) Are recommended by at least one (1) licensed physician;

(iii) Are approved by the agency's physician medical director and the ambulance administrator and/or the fire protection service's chief.

(iv) Are free of any physical or mental disabilities which would, in the judgment of the student's physician medical director, render them incapable of performing as an EMT Intermediate.

(v) Complete the practical performance review with the physician medical director using the state proficiency checklist; and

(vi) Successfully complete the precourse written exam no more than thirty (30) days prior to the program's starting date.

(b) Students shall be admitted to a Division approved Paramedic training program only if they:

(i) Are currently certified by the Division as an EMT Basic or EMT Intermediate.

(ii) Have at least one (1) year of regular patient care while serving as an EMT Basic attendant or EMT Intermediate.

(iii) Are recommended by one (1) licensed physician;

(iv) Are accepted by the Program Committee; and

(v) Are free from any physical or mental disabilities which would, in the judgment of the student's physician medical director, render them incapable of performing as a Paramedic.

Section 8. Instructors. Instructors for an EMT Intermediate program shall be:

(a) Physicians;

(i) Physicians shall be current in the American College of Surgeon's Advanced Trauma Life Support (ATLS) program or the American College of Emergency Physicians (ACEP) equivalent program, and

(ii) Be current in Advanced Life Support (ACLS) as developed by the American Heart Association, in accordance with current national standards, shall serve as the instructor for the advanced life support/emergency cardiac care sections of the training program.

(b) Registered nurses licensed in this state;

(d) Individuals acceptable to the Division.

Section 9. Curriculum. Curriculum requirements shall be established by the Division. Programs must include completion of a Division approved field preceptorship program.

Section 10. Educational Records. The program coordinator shall maintain accurate records of each student's involvement in the training curriculum. These records must be submitted to the OEMS at the time of course completion. Such records shall include, but not necessarily be limited to, attendance at lectures, demonstrations, subject matters covered, completion of the prescribed clinical requirements, time spent at each clinical area, special experience containing a clinical training component, and verification of practical skill competency.

Section 11. Task Force on Prehospital Care.

(a) Composition of the Task Force. The Division shall appoint a Task Force on Prehospital Care selected from currently practicing Wyoming licensed physicians. The Task Force shall consist of seven (7) members selected from the following specialties:

(i) Anesthesiology;

(ii) Cardiology;

(iii) Emergency room medicine;

(iv) Family/general practice;

(v) General Surgery and/or other surgical specialty;

(vi) Internal medicine; or

(vii) Pediatrics.

(b) Operation of the Task Force. The Task Force may meet quarterly, or as needed, for the purpose of advising the Division and Board by:

(i) Reviewing applications and making recommendations on EMT Intermediate or Paramedic training program requests;

(ii) Reviewing the appointment of hospitals as sponsor hospitals for the EMT Intermediate or Paramedic program;

(iii) Reviewing EMT Intermediate and Paramedic training curriculum;

(iv) Recommending the EMT Intermediate and Paramedic certification policy;

(v) Making Recommendations concerning other technical medical areas as requested by the Division or the Board; and

(vi) Reviewing requests from physician medical directors and make recommendations to the Board on requests for new/additional First Responder, EMT Basic, EMT Intermediate, or Paramedic medication and/or skill authorizations.

History

Effective 2008-12-08

Chapter 7 Advanced Life Support (ALS) Systems

Wyo. Code R. 048.0023.7.12082008 Advanced Life Support (ALS) Systems

RULES AND REGULATIONS FOR EMERGENCY MEDICAL SERVICES

CHAPTER 7

ADVANCED LIFE SUPPORT (ALS) SYSTEMS

Section 1. Operation Approval. Before engaging or employing EMT Intermediate or Paramedic personnel, all ALS services shall establish a system in accordance with this Chapter and obtain operational approval from the Division. An ALS system shall consist of one (1) or more (ALS) services, a physician medical director, and a sponsor hospital.

(a) "EMT Intermediate system" means an ALS service that has been authorized by the Board and the Division to utilize EMT Intermediate personnel in accordance with the guidelines established by the Board and the Division.

(b) "Paramedic System" means an ALS service that has been authorized by the Board and the Division to utilize Paramedic personnel in accordance with the guidelines established by the Board and the Division.

Section 2. Application.

(a) The physician medical director shall submit an application to the Division. The application for an ALS system shall contain:

(i) A description of the medical need for the proposed system, including any supporting documentation; and

(ii) A proposed operations manual.

(b) The application shall be reviewed by the Division and the Task Force on Prehospital Care. The Task Force shall provide a recommendation to the Board for final review.

Section 3. Sponsor Hospital.

(a) An ALS service shall obtain the commitment of a sponsor hospital.

(b) The system shall be approved by the hospital administrator and chief of the medical staff of the sponsor hospital.

(i) For an EMT Intermediate system, shall have a registered nurse on duty for the emergency room twenty-four (24) hours a day and capable of constant voice communication coverage with a physician.

(ii) For a Paramedic system, shall have a registered nurse, on duty in the emergency room twenty-four (24) hours a day and capable of constant voice communication coverage with a physician.

(A) The registered nurse shall:

(I) (Be) current in Advanced Cardiac Life Support (ACLS) with the standards of the American Heart Association;

(II) Have audited the Advanced Trauma Life Support (ATLS) course of the American College of Surgeons or an equivalent nursing trauma course;

(III) Function in accordance with the Wyoming Nursing Act; W.S. 33-21-119, et seq.; and

(IV) Be immediately available at all times to communicate with EMT Intermediate, or Paramedic personnel in the field.

(B) The Physician shall:

(I) Be current in Advanced Trauma Life Support (ATLS) with the standards of the American College of Surgeons or its equivalent from the American College of Emergency Physicians;

(II) Be current in Advanced Cardiac Life Support (ACLS) with the standards of the American Heart Association;

(III) Be available to communicate with the EMT Intermediate or Paramedic personnel in the field;

(IV) Explain the medical role of EMT Intermediate and Paramedic personnel to appropriate hospital staff;

(V) Cooperate with the Division in the collection of statistical data;

(VI) Maintain direct communications capability between the sponsor hospital and the ALS service(s);

(VII) Provide clinical experience with supervision for trainees during the training program and for continuing medical education;

(VIII) Provide for audit in review of EMT Intermediate cases

and Paramedic advanced life support cases as outlined in Chapter 8. All concerned EMT Intermediate or Paramedic personnel shall attend the meetings; and

(IX) Practice in a hospital which has an intensive care unit or a monitored bed unit (MBU).

Section 4. Physician Medical Director. Both EMT Intermediate and Paramedic systems shall be supervised by a physician medical director. The physician medical director shall be a physician licensed to practice medicine in this state. The physician medical director's duties shall include at a minimum:

(a) Filing with the Division copies of current protocols and authorizations, that have been reviewed and approved by the Division and the Task Force, for EMT Intermediate or Paramedic systems;

(b) Monitoring PCRs where EMT Intermediate activities were carried out. The trip reports shall be monitored quarterly;

(c) Monitoring Paramedic PCR forms where advanced life support activities were carried out. The trip reports shall be monitored quarterly; and

(d) Reviewing reports of EMT Intermediate and Paramedic advanced skills usage with all concerned personnel, then submitting reports to the Division no later than December 31st of each year or as requested by the Division.

Section 5. Communication Systems. All ALS service systems shall maintain a communication system capable of:

(a) Voice communication between the ALS service and the sponsor hospital and physicians;

(b) Voice and/or EKG recording units for services utilizing manual, automatic or semiautomatic defibrillation certified personnel.

(c) Telemetry is not mandatory except for the EMT Intermediate ambulance services approved for the optional cardiac level skills and medications. Advanced life support data shall be reviewed for the purpose of medical audit by the Physician Medical Director, the Division and the Physician's Task Force, as deemed necessary.

Section 6. Decision. Upon receipt of all required information, the Division shall notify the Program Committee within ten (10) working days following its decision. The Division shall approve the system if it meets the requirements of this Chapter. If the proposed system does not meet the requirements of this Chapter, the Division shall not approve the system. If the Division does not approve the application for the system it shall provide recommendations for future compliance and applicant may reapply.

History

Effective 2008-12-08

Chapter 9 Hearings

Wyo. Code R. 048.0023.9.12082008 Hearings

RULES AND REGULATIONS EMERGENCY MEDICAL SERVICES

CHAPTER 9

HEARINGS

Section 1. Purpose. This Chapter has been adopted to provide uniform procedures for the conduct of contested cases involving the denial, revocation, restriction or suspension of a license or certificate.

Section 2. Definitions. The definitions set forth in the Wyoming Administrative Procedures Act W.S. 16-3-101, et seq., are incorporated by reference and, for the purposes of a contested case hearing the following definitions apply.

(a) "Contested Case" means a proceeding involving the denial, revocation, restriction or suspension of a license or certification during which legal rights, duties or privileges of a Contestant are required by law to be determined by the Department after an opportunity for hearing. The hearing shall be conducted in accordance with the Wyoming Administrative Procedures Act, W.S. 16-3-101, et seq.;

(b) "Contestant" means the person who requests the hearing;

(d) "Discovery" means pre-hearing procedures used to obtain information from the adverse party;

(e) "Hearing" means a contested case hearing before a hearing officer;

(f) "Hearing Officer" means the individual or individuals designated by the Department to serve as the presiding officer(s) at a hearing held under this Chapter of these rules;

(g) "Respondent" means the Department;

(h) "Wyoming Administrative Procedures Act" or "WAPA" means W.S. 16-3-101, et seq.; and

(i) "Wyoming Rules of Civil Procedure" or "WRCP" means the rules governing procedure in all courts of record in the State of Wyoming, in all actions, suits or proceedings of a civil nature, Rule 1 of the Wyoming Rules of Civil Procedure.

Section 3. Emergency Suspension.

(a) Pursuant to W.S. 16-3-113, the Department shall order summary suspension of a certificate or license if the Department finds, and incorporates such finding in the order, that public health, safety or welfare imperatively requires emergency action of suspension of the certificate or license.

(b) The Department shall accept written notice from the physician medical director that the physician has terminated his position as physician medical director for an EMT, attendant or ambulance service as constituting sufficient evidence supporting a finding that public health, safety or welfare imperatively requires emergency action of suspension, if the physician also provides reason to believe that:

(i) The EMT, attendant or ambulance service has failed or refused to demonstrate the practical performance competency required of an EMT, attendant, or ambulance service;

(ii) The EMT, attendant or ambulance service intentionally misstated or failed to provide any fact that would have resulted in the denial of a certificate or license; or

(iii) Some fact, reason or condition exists that would have resulted in the denial of a certificate or license, whether or not such fact, reason or condition existed at the time of the approval.

(c) The notice of summary suspension shall be issued immediately upon receipt by the Department of the notice described in paragraph (b) of this section. This notice shall be sent by certified mail and/or delivered personally to the ambulance service, attendant or EMT's last known address. Any summary suspension shall become effective immediately upon receipt by the EMT, attendant or ambulance service of notice from the Department.

(d) Proceedings consistent with this Chapter shall be promptly instituted to determine whether the summary suspension shall be affirmed as a revocation or suspension, modified as a restriction, vacated or terminated.

Section 4. Appeal Following Denial, Suspension, Revocation, or Restriction.

(a) A person or an entity whose license or certificate was denied, suspended, revoked, or restricted on the grounds of engaging in conduct constituting a ground for disciplinary action set forth in Chapter 2, Section 12, or Chapter 5, Section 9 or as otherwise provided by law, may request an appeal of the decision within thirty (30) days following the Division's decision.

(b) The request for appeal of the decision shall be in writing and shall contain:

(i) The name of the person or entity (Contestant), address and telephone number;

(ii) A statement in ordinary and concise language setting forth the grounds for the appeal including all statues or rules upon which the Contestant relies;

(iii) The action for which the appeal is sought; and

(iv) The remedy requested by the Contestant.

(c) Within thirty (30) days after receiving the request, the Department shall make its decision and notify the Contestant. The Department may:

(i) Decide in favor of the Contestant;

(ii) Notify the Contestant that a contested case hearing shall be held; or,

(iii) Notify the Contestant a contested case hearing is denied. Following such notification, the Department shall issue findings and an order. The order shall be the Department's final decision and may be appealed to the district court pursuant to the WAPA.

Section 5. Initiation of Contested Case Hearing.

(a) The Department shall notify the Contestant at least twenty (20) days before holding a contested case hearing. The Department and Contestant may waive this requirement by written agreement.

(b) The Notice of the complaint shall be served as required by Chapter 1, Section 4(qq) of these rules.

(i) The potential Contestant's name;

(ii) The time and place of the hearing;

(iii) The docket number assigned to the case;

(iv) The legal authority and jurisdiction under which the hearing is to be held;

(v) The particular sections of the statues and rules involved; and

(vi) A statement in ordinary and concise language setting forth the grounds for the Department's intended action.

Section 6. Answer. If she wishes to contest the Department's intended action, the potential Contestant must file a response within twenty (20) days after receiving the notice. Failure to file a response within twenty (20) days shall be deemed a waiver of any right to respond.

Section 7. Informal Disposition.

(a) Unless contrary to law or rule, a disciplinary proceeding may be settled by informal means at any time.

(b) Settlement conference. Any party may request that the matter be set for a settlement conference. Upon such request, the Hearing Officer shall schedule a conference and direct that a representative of each party attend, such representative to have authority to settle the matter. The Hearing Officer shall neither attend the conference nor be advised of the proposals of either party. The Hearing Officer may designate another individual, not previously involved in the matter, to attend the conference and assist the parties in attempting to reach a settlement.

Section 8. Hearing Officer.

(a) The Department shall appoint a Hearing Officer to preside over each contested case hearings on a case-by-case basis, or for schedules period of time, as she sees fit.

(b) The Hearing Officer shall be an individual or individuals determined by the Department to be qualified to serve in such a capacity, who has not taken part in the investigation, preparation, or earlier disposition of the case to be heard.

(i) The Hearing Officer shall withdraw himself from consideration of a case at any time he deems himself disqualified. Withdrawal shall be made in writing to the Department.

(ii) Any party may request in writing that the Department remove and replace the Hearing Officer in a contested case. This request must be accompanied by a statement and affidavits, setting forth the alleged grounds for disqualification. The Department may deny a party's request for removal and shall issue a written statement explaining grounds for his denial which shall be made part of the record. If the request is granted, the Department shall appoint a new Hearing Officer as soon as is practicable.

(iii) The Contestant may object to the appointment of the Hearing Officer in the record at the hearing. The objection shall set forth the alleged grounds for disqualification.

(c) The Hearing Officer shall have all powers necessary to conduct a fair and impartial hearing, including but not limited to the following authority:

(i) To administer oaths and affirmations;

(ii) To subpoena witnesses and require the production of any books, papers or other documents relevant or material to the inquiry;

(iii) To rule upon offers of proof and relevant evidence;

(iv) To provide for discovery and determine its scope;

(v) To regulate the course of the hearing;

(vi) To schedule conferences for the settlement and to hold conferences for simplifications of the issues;

(vii) To dispose of procedural requests or similar matters; and

(viii) To take any other action authorized by the Department's rules.

(d) Failure or refusal to appear or obey orders of the Hearing Officer may result in the sanctions provided in W.S. 16-3-107(c) and (f).

Section 9. Discovery. Discovery in a Department disciplinary proceeding shall be governed by W.S. 16-3-107 and Wyoming Rules of Civil Procedure (WRCP).

Section 10. Pre-hearing Conference.

(a) At a time on or before the day of the hearing, the Hearing Officer, on his own or either party's motion, may meet with the parties for a conference to consider simplification of the issues, stipulations and admissions of fact, clarifications or limitation of evidence, and any other matters that may expedite the proceeding and assure a just conclusion of the case. The meeting may be held by the telephone conference.

(b) Any stipulations, limitations or agreements made at a pre-hearing conference shall be recited in the record and shall control the course of the proceedings, unless modified during the hearing to prevent manifest injustice.

Section 11. Evidence and Testimony.

(a) Burden of Proof. The Department shall have the burden of proof for all disciplinary proceedings.

(b) Admissibility of Evidence. Admissibility is governed by W.S. 16-3-108 and WRCP.

(i) The parties shall be entitled to present oral or documentary evidence, submit rebuttal evidence and conduct cross-examinations, as maybe required for a full disclosure of the facts. All documentary or physical evidence submitted for consideration shall be marked as exhibits. The Department's exhibits shall be marked by letters of the alphabet beginning with "A." Contestant's exhibits shall be marked by numbers beginning with "1."

(ii) The Hearing Officer shall allow oral or documentary evidence which is not relevant, immaterial or unduly repetitions evidence.

(i) The grounds for objections to any evidentiary rulings by the Hearing Officer shall be briefly stated. Rulings on all objections shall appear in the records. Only those objections made before the Hearing Officer, or specifically stipulated to by both parties, may be relied on in a subsequent proceeding.

(ii) Formal exception to an adverse ruling is not required.

(d) Privileged and Confidential Information.

(i) Any privilege at law shall be recognized by the Hearing Officer in considering evidence.

(ii) No employee of the Department shall be compelled to testify, or to divulge information which is confidential or privileged at law and which is contained within the records of the Department or acquired within the scope of his employment except as provided in W.S. 16-3-107.

(e) The Hearing Officer may take official notice of any material fact not appearing in evidence in the record that is of the nature of traditional matters of judicial notice or within the special technical knowledge or files of the Department. Parties shall be given an opportunity to contest matters officially noticed prior to a final decision by the Department in accordance with W.S. 16-3-108.

(f) Each witness who is present to give testimony must identify himself or herself by stating his or her name and address, indicate on whose behalf he or she shall testify, and be administered the following oath by the Hearing Officer: "Do you swear or affirm to tell the whole truth, and nothing but the truth?"

Section 12. Representation.

(a) All parties have a right to represent themselves, to be represented by an attorney authorized to practice pursuant to the rules of the Supreme Court of Wyoming, or be represented by any other person chosen by the Contestant to appear on his behalf. If the Contestant is represented by an attorney, the Contestant shall pay his attorney's fees and costs. During such hearings:

(i) A party, his attorney, or his representative may examine or cross- examine witnesses;

(ii) The Hearing Officer may examine witnesses; but

(iii) Other than as delineated in (i) or (ii) above, no other person may examine or cross-examine witnesses.

(b) The Respondent may request the Attorney General to assist in contested case hearings to the extent required by W.S. 16-3-112(c).

Section 13. Location of Hearing.

(a) Hearings involving certification of a Contestant and licensing of an ambulance service shall be held in Cheyenne, Wyoming unless the Department consents, in writing to a different location.

Section 14. Consolidation of Hearings. Upon motion of on of the parties, the Hearing Officer may consolidate two or more hearings if the hearings involve the same parties with similar related issues.

Section 15. Procedural Rights of Contestant. The Contestant, or his representative may, in keeping within the Wyoming Rules of Civil Procedure:

(a) Engage in discovery; and

(b) Bring witnesses, establish all pertinent facts and circumstances, present an argument, and question or refute any testimony or evidence, including the opportunity to confront and cross-examine adverse witnesses, in compliance with the WRCP.

Section 16. Failure to Appear. If a Contestant fails to appear at the place, date, and time specified in a notice, the Hearing Officer may:

(a) Continue the hearing until a later date and provide proper notice as prescribed in these rules;

(b) Proceed to conduct the hearing without the Contestant and dispose of the contested case; or

Section 17. Order of Procedure.

(a) As nearly as practicable, the following order shall be followed:

(i) Opening statements may be made, Respondent first, then Contestant.

(ii) The Respondent shall have the burden of proof and shall offer evidence first, and then the Contestant may offer evidence.

(iii) No testimony shall be received by the Hearing Officer unless given under oath/affirmation administered by the Hearing Officer.

(iv) Closing statements may be made, Respondent first, then Contestant, then the Respondent in rebuttal.

(v) The Hearing Officer may limit the time for opening and closing statements.

(vi) After all parties have had an opportunity to be heard, the Hearing Officer shall excuse all witnesses and close the evidence.

(vii) Evidence may be reopened only upon written motion by a party to the proceeding and a showing of good cause.

(b) Upon their own motion, all parties or other interested parties may submit legal briefs after the close of the hearing. The Hearing Officer shall allow reasonable time, not less than ten (10) days from the date of the hearing, for preparation of briefs. The time may be extended upon agreement between the parties with the approval of the Hearing Officer.

Section18. Decisions.

(a) The Hearing Officer shall make proposed findings of fact and conclusions of law within twenty (20) working days of the close of the hearings (the time permitted for parties or other interested persons to submit briefs shall be included within twenty {20} working days) and forward them to the Department for final determination. This time may be extended but not by more than ten (10) working days, unless the parties stipulate in writing or on the record at the hearing, to a later date.

(i) Within ten (10) working days of the close of the hearing, or at such later time as the Hearing Officer may allow, each party shall be allowed to file with the Hearing Officer any proposed findings of fact and conclusions of law, together with a supporting brief. Such proposals and briefs shall be served on all other parties.

(ii) Within ten (10) working days after the issuance of the Hearing Officer's proposed findings of fact and conclusions of law, any of the parties may submit exceptions. Such exceptions shall be filed with the Department and served on all other parties.

(b) Within ten (10) working days after the period for submitting exceptions pursuant to (a)(ii), the Department shall make and enter into the record the final decision. The final decision shall be served on all parties to the proceedings. The final decision shall include:

(i) A statement of the findings of fact and conclusions of law; and

(ii) The appropriate rule, order, relief or denial thereof. The Decision shall be based upon the contested case record or any portion stipulated to by the parties. The decision shall include facts officially noticed and relief upon as provided by W.S. 16-3-108(d). It shall be made on the basis of a preponderance of evidence contained in the record.

(c) Final decision of the Department shall be in accordance with W.S. 16-3-114 and Rule 12 of the Wyoming Rules of Appellate Procedure, except as otherwise agreed by the parties.

Section 19. Appeals Appeals from a final decision of the Department shall be in accordance with W.S. 16-3-114 and Rule 12 of the Wyoming Rules of Appellate Procedure, except as otherwise agreed by the parties.

Section 20. Transcripts and Record.

(a) When a contested case is set for hearing, the Department shall assign a docket number and date of filing on a docket. The Department shall maintain a separate file for each docketed case in which all pleadings, transcriptions, correspondence, appears, and exhibits for that case shall be maintained. All such items shall have noted thereon the assigned docket number and the date of filing.

(b) The Department shall record all contested case proceedings:

(i) Electronically;

(ii) Through the use of a qualified court reporter; or

(iii) Any other appropriate means determined by the Department. Transcription of oral proceedings or written transcripts of a witness' testimony may be obtained by Contestant from the Department upon payment of the cost of copying the transcripts.

(i) All formal and informal notices, pleadings, motions and intermediate rulings;

(ii) Evidence received or considered, including matters officially noticed;

(iii) Questions and offers of proof, objections and rulings;

(iv) Proposed findings of fact and conclusions of law, submitted by any party;

(v) The proposed findings of fact and conclusions of law of the Hearing Officer; and

(vi) Any exceptions to the Hearing Officer's proposed findings of fact and conclusions of law.

(d) The Department's final decision or a stipulation resolving the matter shall be part of the record unless otherwise agreed by the parties.

Section 21. Ex Parte Matters. Unless required for the disposition of ex parte matters authorized by law, the Hearing Officer shall not consult with an individual or party on any matter at issue as allowed in W.S. 16-3-111.

History

Effective 2008-12-08

Chapter 12 Emergency Medical Services Needs

Wyo. Code R. 048.0023.12.07172014 Emergency Medical Services Needs

EMERGENCY MEDICAL SERVICES NEED ASSESSMENT MASTER PLAN IMPLEMENTATION GRANTS

CHAPTER 12

Section 1. Authority.

These rules are promulgated by the Department of Health, Office of Emergency Medical Services pursuant to W.S. § 33-36-115, and the Wyoming Administrative Procedures Act at W.S. § 16-3-1101, et. seq.

Section 2. Pumose and Applicabilitv.

These rules establish eligibility, implement an application procedure, create a process for facilitating the award of grant funds from the Emergency Medical Services Sustainability Trust Income Account for Emergency Medical Services Needs Assessment and Master Plan Implementation Grants.

Section 3. Severability.

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

The following definitions shall apply in the interpretation and enforcement of this chapter only. All other terms apply as defined in Chapter I of these rules.

(a) "Authorized Representatives" means those individuals designated by appointment or election to act on behalf of an applicant, grantee, and/or a political subdivision within a proposed service area including, but not limited to, a county, joint powers board, or emergency medical services special district.

(b) "Department" means the Wyoming Department of Health.

(d) "Political Subdivision" means any area defined or recognized as a political subdivision under state law.

(e) "Service Area" means any area typically and reasonably served by an emergency medical service regardless of existing geopolitical boundaries and which corresponds to a rural urban commuting area as defined by the U.S. Department of Agriculture (USDA).

Section 5. Needs Assessment Grant Application Requirements.

(a) Any person, entity, or group that is interested in improving emergency medical services in a proposed service area may submit an application to the Division for an Emergency Medical Services Needs Assessment Grant.

(b) Needs assessment Grant applications must include:

(i) A narrative request for an assessment of emergency medical services in the proposed service area and an analysis of the current emergency medical services system. The narrative must include information on the following:

(A) The proposed service area and population served within the proposed service area;

(B) The need for the assessment including any concerns with the current level of volunteerism and certification, call volume, and response times, and any additional concerns that form the basis for the request;

(D) The level of commitment of all entities involved to implement changes proposed as a result of an Emergency Medical Services Needs Assessment.

(ii) A signed letter of commitment for local matching funds m an amount not less than Five Thousand Dollars ($5,000.00).

(iii) Signatures of authorized representatives of all involved political subdivisions within the proposed service area.

Section 6. Needs Assessment Grant Application Calendar and Award Procedure.

(a) Applications for Emergency Medical Services Needs Assessment Grants may be submitted to the Division from April 1"through June 30'h of each year.

(b) The Division may consult with applicants during the review process to determine whether a further detailed assessment of emergency medical services in the proposed service area is appropriate.

(c) No later than sixty (60) days after the close of the application period, the Division shall make a final determination to either:

(i) Award an Emergency Medical Services Needs Assessment Grant to the applicant(s); and

(ii) Engage a contractor to further assess the current capabilities, strengths, weaknesses, coverage gaps, and workforce shortfalls of the entire emergency medical services system within the proposed service area; or

(iii) Deny the request for an Emergency Medical Services Needs Assessment Grant.

(d) Within sixty (60) days of notification of award, grantee must submit local matching funds to the Division in an amount not less than Five Thousand Dollars ($5,000.00).

(i) The Division shall apply all matching funds to the Emergency Medical Services Needs Assessment contract.

(ii) The Emergency Medical Services Needs Assessment shall not commence until matching funds are received from the grantee.

(iii) Failure to submit local matching funds to the Division within sixty (60) days shall void the Emergency Medical Services Needs Assessment Grant Award.

Section 7. Emergency Medical Services Needs Assessment.

The Department shall contract with a third-party to conduct the Emergency Medical Services Needs Assessment for awarded applicants. The contractor shall be chosen through the Request for Proposal (RFP) process.

(a) Contractor shall consult with the grantee and affected entities within the proposed service area including representatives of public, private, and volunteer ambulance services, county and local government agencies, hospitals providing emergency medical services, and other appropriate stakeholders.

(b) Contractor shall assess the current capabilities, strengths, weaknesses, coverage gaps, and workforce shortfalls of the entire emergency medical services system within the proposed service area.

(i) The assessment shall include the collection of data using common quality and performance improvement benchmarks, indicators, and scoring formats.

(A) Benchmarks, indicators, and scoring formats to be utilized by the contractor for the needs assessment shall be determined by the Division prior to engaging the contractor to conduct the assessment.

(ii) The assessment may build upon but not duplicate the findings in the Rural Policy Research Institute's "Status and Future of Health Care Delivery in Rural Wyoming, June 2007" report to the Wyoming Healthcare Commission.

(iii) The assessment shall address the following components and relevant sub-components within the current emergency medical services delivery system:

(A) System design and delivery model to include:

(I) Local authority structure, ordinances and integration with and support from other local healthcare and emergency response entities;

(II) Human resources including EMS leadership and administration and management practices;

(III) The level of volunteerism and the potential for sustainment;

(B) Response time reliability to include:

(I) The total demand for service upon the system by type, including historical demand and projected trends;

(II) A fractile measurement of the systems response times;

(III) The system's ability or inability to respond to every request for service and the causative factors;

(I) Current system finances;

(II) Billing practices;

(III) Funding sources within the service area, including the third-party payor mix within the service area and the relative need for subsidy;

(D) The delivery and quality of clinical care and the use of quality improvement processes to include:

(I) The current level of care authorized and provided based on the scopes of practice established within the Wyoming EMS system;

(II) Medical direction including the level of involvement and expertise of the local Medical Director;

(III) Education and training status;

(E) Public education and outreach efforts to include the support and perception of the local community.

(F) Public access to the emergency response system.

(G) Communication systems to include the EMS agency's ability to communicate with hospitals, local and state emergency management, air medical ambulances, emergency response agencies and the support and involvement of the local dispatch entity or public safety answering point (PSAP).

(H) Integration and involvement with other components and activities of the comprehensive, statewide, emergency medical system, such as the trauma plan and program, or the cardiac or stroke patient programs.

(I) The level of emergency preparedness of the system and its ability to respond to a disaster or public health emergency.

(J) The Division, at its discretion, may choose alternate components to be addressed in the assessment on a case-by-case basis.

(c) Contractor shall prepare a written report of the findings and recommendations of the Emergency Medical Needs Assessment, including a master plan for a coordinated, efficient emergency medical service delivery system within the service area.

Section 8. Master Plan Implementation Grant Applications and Awards.

Subsequent to the completion of an Emergency Medical Services Needs Assessment under Section 7 of this Chapter, service areas may apply for funding to assist in the implementation of the master plan developed as a result of the needs assessment, subject to the following:

(a) Applications for a Master Plan Implementation Grant may be submitted by a county, joint powers board, or an emergency medical services special district.

(b) Applications must be submitted to the Division no later than ninety (90) days after the completion of the Emergency Medical Services Needs Assessment.

(i) A narrative specifying how Master Plan Implementation Grant funds will be used to address findings and recommendations identified in the Emergency Medical Services Needs Assessment, including, but not limited to:

(A) the intended use of the funds; and

(B) how those funds will allow the applicant to improve emergency medical service delivery for the service area; and

(ii) A working budget which demonstrates how the grant will be used to address revenue gaps on a temporary basis, not to exceed two (2) years, while transitioning to a defined time when revenue is expected to be sufficient to sustain services in the master plan service area.

(d) Award of Master Plan Implementation Grants shall be based upon demonstrable need. Those service areas demonstrating the greatest need for assistance, at the discretion of the Division, shall be given the highest priority in receiving Master Plan Implementation Grants.

(e) Grants shall be documented in writing through an executed grant award agreement, signed by the Department and an authorized representative of the grantee, and shall specify the terms and conditions of the award, payments terms, and grantee deliverables.

History

Effective 2014-07-17

Chapter 13 Designation of Heart Attack and Stroke Centers

Wyo. Code R. 048.0023.13.04122016 Designation of Heart Attack and Stroke Centers

CHAPTER 13

DESIGNATION OF HEART ATTACK AND STROKE CENTERS

Section 1. Authority.

(a) This Chapter is promulgated by the Department of Health pursuant to W.S. §§ 35-2-1001 and the Wyoming Administrative Procedure Act at W.S. §§ 16-3-101 through 16-3-115.

(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.

Section 2. Definitions. The following definitions shall apply in the interpretation and enforcement of this chapter. Except as otherwise specified, the terminology used in this chapter is intended to have the standard meaning used in healthcare.

(a) "Accreditation" means the recognition or certification made by an independent agency establishing that a hospital has met the criteria specified by that agency for recognition as outlined in this chapter.

(b) "Accrediting agency" means the American Heart Association, the Society for Cardiovascular Patient Care or the Joint Commission.

(c) "Heart Attack Receiving Center" means a hospital that has applied for and received designation as a Heart Attack Receiving Center under the provisions of this chapter. Heart Attack Receiving Centers shall be considered a higher level of care than Heart Attack Referring Centers.

(d) "Heart Attack Referring Center" means a hospital that has applied for and received designation as a Heart Attack Referring Center under the provisions of this chapter.

(e) "Higher level of care" means a hospital capable of providing diagnostic, interventional or tertiary care beyond the capacity of the hospital from which a patient originates.

(f) "Comprehensive Stroke Center" means a hospital that has applied for and received designation as a Comprehensive Stroke Center under the provisions of this chapter. Comprehensive Stroke Centers shall be considered a higher level of care than Primary Stroke Centers.

(g) "Department" means the Wyoming Department of Health.

(h) "Designated hospital" means a hospital designated under the provisions of this chapter.

(i) "OEMS" means the Wyoming Office of Emergency Medical Services.

(j) "Primary Stroke Center" means a hospital that has applied for and received designation as a Primary Stroke Center under the provisions of this chapter. Primary Stroke Centers shall be considered a higher level of care than Acute Stroke Ready Centers.

(k) "The Joint Commission" means the not-for-profit organization known until January 1, 2007 as the "Joint Commission on Accreditation of Healthcare Organizations" (JCAHO).

(l) "Acute Stroke Ready Center" means a hospital that has applied for and received designation as an Acute Stroke Ready Center under the provisions of this chapter.

Section 3. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

Section 4. Categories of Recognition and Accrediting Agencies.

(a) Hospitals may apply for and receive designation under this chapter as one or more of the following:

(i) Heart Attack Receiving Center

(ii) Heart Attack Referring Center

(iii) Comprehensive Stroke Center

(iv) Primary Stroke Center

(v) Acute Stroke Ready Center

(b) Designation of hospitals under the provisions of this chapter shall be contingent on the accreditation of the facility by an accrediting agency as specified by this chapter.

Section 5. Application, Recognition and Renewal Process. Any hospital desiring recognition under the provisions of this chapter shall complete the following application process:

(a) Prior to the initiation of an accreditation process with an independent agency, hospitals will submit a Letter of Intent to the OEMS declaring the following:

(i) The category of accreditation and recognition being sought;

(ii) The anticipated accrediting agency;

(iii) The expected timeframe of completion;

(iv) Contact information for the designated person with oversight of the hospital's accreditation process.

(b) Upon receiving recognition by an accrediting agency the hospital will provide to the OEMS:

(i) A Letter of Completion of the Accreditation Process from the facility to the Department;

(ii) A completed Facility Designation Application;

(iii) Copies of documentation establishing the successful completion of the accreditation process and recognition by the accrediting agency, to include but not limited to, certificates, letters or other means provided by the accrediting agency;

(iv) Copies of agreements required under Section 7 of this chapter;

(v) Other documentation as may be required by the OEMS.

(c) Within thirty (30) days of receipt of the materials specified under paragraph (b) of this section, the OEMS will provide a letter of recognition stating that the hospital is duly recognized under the requirements of this chapter or a request for further documentation in support of the application.

(d) Hospitals already accredited or certified according to the provisions of this chapter prior to the effective date of these rules may submit documentation as specified in paragraph (b) of this section and request recognition under this chapter.

(e) No less than ninety (90) days prior to the expiration of an accreditation as outlined in Section 6 of this chapter, a hospital designated under the provisions of this chapter will submit the following to the OEMS:

(i) A Letter of Intent to Renew Accreditation; or

(ii) A Notice of Voluntary Withdrawal pursuant to Section 6(a) of this chapter.

Section 6. Withdrawal of designation. Hospitals designated under the provisions of this chapter may have the designation withdrawn under the following provisions:

(a) Voluntary Withdrawal. If a hospital designated under the provisions of this chapter chooses to withdraw designation under this chapter, the hospital shall provide a letter stating its intent to withdraw from these provisions, and the reason(s) for withdrawal.

(b) Involuntary Withdrawal. The OEMS shall provide a written Notice of Involuntary Withdrawal when it determines that any of the following conditions exist:

(i) The receipt of notice by the OEMS from the accrediting agency that the hospital is no longer compliant with the agency's criteria.

(ii) The suspension, revocation or denial of accreditation or renewal of accreditation by the accrediting agency.

(iii) Failure to comply with the provisions of this chapter.

(c) Declaration of action. Hospitals designated under the provisions of this chapter shall provide written notice of suspension, revocation, denial of accreditation or any other disciplinary, corrective, or administrative action taken by the accrediting agency to the OEMS within ten (10) days of receipt of such action.

Section 7. Coordination among designated hospitals. Hospitals designated under the provisions of this chapter will provide for the coordination of the referral and transfer of acute heart attack and stroke patients by ensuring the following:

(a) The establishment of written agreement(s) with a facility or facilities determined to be the next higher level of care whether such facility exists within the state or outside of the state.

(b) The establishment of written agreement(s) with Wyoming licensed ambulance services, both ground and air ambulance, to provide for the timely transfer of patients to the next higher level of care.

History

Effective 2016-04-12

Chapter 14 Community EMS Practitioners, Agencies and Education Programs

Wyo. Code R. 048.0023.14.08112023 § 1 Authority

The Department adopts these rules under W.S. § 33- 36-103 and W.S. § 35-1-804 to enhance the comprehensive Emergency Medical Services (EMS) and trauma system by establishing criteria for the establishment and operation of Community EMS Programs.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 2 Definitions

As used in this chapter, "Division" means the Department of Health, Office of Emergency Medical Services (OEMS). The terminology used in this chapter is intended to have the standard meaning used in healthcare, except as otherwise specified.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 3 Endorsement

(a) A currently licensed EMT, AEMT, IEMT or Paramedic, may apply for endorsement as a Community EMS Technician or Community EMS Clinician.

(b) Applications for endorsement must contain a verifiable copy of a transcript showing the successful completion of the appropriate Division-approved Community EMS Education Program as described in Section 4 of this chapter.

(c) The Division may deny endorsement to any person who submits incomplete or inaccurate information on an application. Fraudulent information shall be cause for denial, revocation or suspension of the person's EMT, AEMT, IEMT, or Paramedic license.

(d) A person may not hold himself out to be or provide the services of a Community EMS Technician or Community EMS Clinician without endorsement as such by the Division.

(e) An endorsement as a Community EMS Technician or Community EMS Clinician shall expire concurrently with the expiration of the person's EMT, AEMT, IEMT, or Paramedic license.

(f) An endorsement as a Community EMS Technician or Community EMS Clinician may be renewed concurrent with the renewal of the person's EMT, AEMT, IEMT or Paramedic license upon submission of documentation of ten (10) hours of continuing medical education in any subject covered in the Community EMS Technician or Community EMS Clinician curriculum described in section 4 of this chapter. These hours are in addition to the continuing education requirements for renewal of the EMT, AEMT, IEMT, or Paramedic license.

(g) The Division may endorse an EMT, AEMT, IEMT, or Paramedics who has completed a Community EMS course of study and received the standardized Certified Community Paramedic (CP-C) credential from the International Board of Specialty Certifications as a Community EMS Clinician as long as the EMTs, AEMTs, IEMTs, or Paramedic's CP-C credential is maintained.

(h) The Division may deny, suspend or revoke an endorsement of a Community EMS Technician or Community EMS Clinician for failure to maintain compliance with this section or for any reason established under chapter 16 of these rules.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 4 Approved Educational Programs

(a) The Division may approve a Community EMS Education Program that:

(i) Submits an application for approval to the Division;

(ii) Is conducted by:

(A) A college or university;

(B) An educational institution or health services organization that has an articulation agreement with a college or university; or

(C) An educational program accredited by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP), in which case approval shall only be for Community EMS Technician courses; or

(iii) Tests student proficiency and periodically measures student learning;

(iv) Maintains records of student attendance at didactic sessions, practical laboratory requirements, and performance of clinical requirements;

(v) Provides, by policy, for the removal of a student from the course for unsatisfactory performance; and

(vi) Demonstrates that the program has adequate training space, equipment and other resources required to conduct the particular level of instruction.

(b) Community EMS Technician education programs must provide:

(i) A minimum of forty (40) hours of didactic training in the following subjects:

(A) The Community EMS Technician role in the health care system;

(B) The social determinants of health model;

(D) Developing cultural competency;

(E) Personal Safety and Wellness of the Community EMS

Technician; and

(ii) A minimum of forty (40) hours of practical lab skills training and clinical experience in a primary or public health setting.

(i) A minimum of one hundred seven (107) hours of didactic training and practical and lab skills covering the following subjects:

(A) The Community EMS Clinician's role in the health care system;

(B) The social determinants of health model;

(D) Developing cultural competency;

(E) Personal safety and wellness of the Community EMS

Clinician;

(F) Systems of care;

(G) Chronic disease management;

(H) Recognition and treatment of mental health; and

(I) Pandemic response

(ii) A minimum of one hundred sixty (160) hours of clinical experience, appropriate to the individual's established scope of practice, in a primary or public health care setting which provides instruction in:

(A) The compiling of the medical history of sub-acute, semi-chronic patients;

(B) The performance of physical examinations and documentation;

(D) The recognition of the clinical differences between populations;

(E) Obtaining specimens and samples for laboratory testing;

(F) Interpreting test and report results;

(G) The use and maintenance of home health equipment and devices; and

(H) Proper accessing, care, and maintenance of implanted ports, central lines, catheters, and ostomies.

(d) An application for approval under this section must contain:

(i) A description of the structure of the program within the college, university or educational program showing reporting relationships and academic oversight of the Community EMS Education Program;

(ii) The name, contact information, and curriculum vitae of the individual supervising the conduct of the Community EMS Education Program. The curriculum vitae of supervising individuals must demonstrate by experience and education that the individual is qualified to provide the required supervision and instruction. Examples of acceptable qualifications include, but are not limited to:

(A) Experience or academic qualifications in teaching Community EMS Education Programs;

(B) Experience and familiarity with the provision of Emergency Medical Services;

(D) Academic credentials demonstrating the ability to teach at the baccalaureate level; or

(E) Experience in the provision of primary and public health services; and

(iii) The curriculum vitae of any adjunct or assistant faculty or instructors demonstrating the knowledge and experience to teach within the Community EMS Education Program. Examples of acceptable qualifications include, but are not limited to:

(A) Significant experience and education as a Community EMS Technician or Community EMS Clinician or a comparable license, certification or endorsement in another state;

(B) Professors of medicine, nursing or related disciplines;

(D) Clinicians with experience in the provision of primary or public health; and

(iv) A description of the proposed curricula addressing the requirements in subsection (a).

(e) The Division may periodically review the program to determine compliance with the requirements of these rules.

(f) The Division may revoke the approval of a Community EMS Education Program for failure to maintain compliance with the requirements of this section.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 5 Community EMS Technician and Community EMS Clinician Scope of Practice and Authority

(a) The authorized acts and scope of practice for a Community EMS Technician or Community EMS Clinician are limited to those skills listed for the individual's EMS license level as described in chapter 16 of these rules, and may only be exercised in accordance with protocols or standing orders approved by the Physician Medical Director of the Community EMS Agency.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 6 Agency Approval Requirements

(a) EMS Agencies may apply for approval to provide services at one of the following levels:

(i) Community EMS Technician (CET) Agency. The activities of these agencies are directed towards reducing the burden of patients accessing the larger health care system through the emergency medical system. Community EMS Technician Agencies may utilize either Community EMS Technicians or Community EMS Clinicians to perform the following activities:

(A) Appropriately treating and releasing patients, rather than providing transport to a hospital or emergency department;

(B) Treating and transporting patients to appropriate destinations other than a hospital or an emergency department if the Community EMS Technician Agency is operated under a valid Ambulance Business License;

(D) Assessment of the patient and reporting to a primary care provider to determine an appropriate course of action.

(ii) Community EMS Clinician (CEC) Agency. The activities of these programs are directed toward the integration of EMS personnel in addressing specific gaps in a community's primary and public health care systems, and may incorporate the activities of a Community EMS Technician program. Community EMS Clinician Agencies may utilize Community EMS Clinicians for the purpose of integrating EMS personnel in addressing specific gaps in a community's primary and public health care systems. Community EMS Clinician Agencies may also utilize either Community EMS Technicians or Clinicians for activities listed in Section 4(c).

(b) Prior to initiation of operations as a Community EMS Agency, proposals for programs shall be submitted to the Division for approval. Proposals shall contain and describe:

(i) The area and population to be served;

(ii) The conclusions or recommendations of a healthcare gap assessment in the area and population;

(iii) The healthcare goals and objectives;

(iv) The benchmarks and performance measures that will be utilized to measure the efficacy of the program;

(v) The treatment protocols intended to meet the healthcare goals and objectives;

(vi) The name and contact information of the Physician Medical Director providing clinical oversight to the program;

(vii) The name and contact information of the person serving as the administrator of the program; and

(A) A Memorandum of Agreement with the local ambulance service or services operating in the same area if the Community EMS Agency is not the ambulance service typically providing transport. Memoranda of Agreement must address:

(B) An acknowledgement by the local ambulance service or services that a Community EMS Agency is operating in the same service area;

(C) Coordination for the transport of a patient seen by the Community EMS Agency in the event of a real or perceived emergency;

(D) Coordination for the continuance of care in the event that a patient of the Community EMS Agency requires transport. If the Community EMS Technician or Clinician is licensed at the same level or lower than the EMT of the ambulance service, the ambulance service Agency shall assume control of the patient for transport. If the Community EMS Technician or Clinician is licensed at a level higher than that of the attending EMT of the ambulance service, the Community EMS Technician or Clinician may continue as the primary caregiver, assuming that the ambulance service has agreed to relinquish care in the Memorandum of Agreement; and

(E) Memoranda of Agreement must contain the signatures of the Ambulance Service Administrator, the Community EMS Agency Director or administrator, and the Physician Medical Directors of both the ambulance service and the Community EMS Agency.

(c) If a patient has a care plan, then the Community EMS Technician or Clinician may provide services of the care plan only if the plan has been developed by the patient's primary care provider and there is no duplication of services to the patient from another provider.

(d) The Community EMS Technician or Clinician shall provide only those services listed in a care plan that are within the scope of services and practice of the Community EMS Agency, and that are approved in protocols or standing orders by the medical director of the Community EMS Agency.

(e) The Division may approve the Community EMS Agency proposal when the Division is satisfied that the proposal adequately addresses the requirements of this section. The Division may request supplemental information or clarification of any information contained in the proposal prior to approval.

(f) Approval as a Community EMS Agency shall remain valid for a period of five (5) years from the date of approval.

(g) No later than one hundred and twenty (120) days prior to the expiration of the current approval, the Community EMS Agency must submit a request for continuation as a Community EMS Agency utilizing the requirements specified under paragraph (b) of this section. Requests for continued approval must include an evaluation of the efficacy of the Community EMS Agency in meeting its stated goals and objectives, supported by valid clinical and financial data.

(h) An approved Community EMS Agency may request an amendment to its proposal and functions at any time by a submitting the requested amendment in writing to the Division.

(i) The Division may revoke a Community EMS Agency's approval for:

(i) Failure to operate the Community EMS Agency in accordance with the approved proposal;

(ii) Failure to utilize EMTs endorsed at the appropriate level for the Community EMS Agency; or

(iii) Failure to maintain compliance with any of these rules or the Wyoming Emergency Medical Services Act of 1977.

History

Effective 2023-08-11

Wyo. Code R. 048.0023.14.08112023 § 7 Documentation and Reporting

(a) Community EMS Technician programs shall utilize the electronic patient care reporting system provided by the Division for the documentation of clinical care. It is the responsibility of the individual Community EMS Technician to ensure completion of the patient care report.

(b) Community EMS Clinician programs may utilize locally developed and approved forms or electronic reporting systems for documenting the provision of clinical care. Emergency requests for service must be documented in accordance with the requirements of chapter 4 of these rules.

(c) Community EMS Technician and Clinician programs shall provide reports of patient care activities as periodically required by the Division, in a format approved by the Division.

History

Effective 2023-08-11

Chapter 15 Assessment, Triage, Treatment and Transport of Time Sensitive Emergencies

Wyo. Code R. 048.0023.15.03222017 § 1 Authority

The authority for this chapter is Wyo. Stat. Ann. §§ 35-1-801 and 35-2-1001.

History

Effective 2017-03-22

Wyo. Code R. 048.0023.15.03222017 § 2 Definitions

(a) For the purposes of this chapter and enforcement of other rules in relation to this chapter, the following definitions shall apply:

(i) "Advanced Life Support personnel" or "ALS personnel" means EMS providers licensed to function with a scope of practice that exceeds that of an Advanced Emergency Medical Technician as defined in chapter 5 of these rules and functioning as a crew member assigned to an EMS agency that maintains the equipment and medications allowable to these scopes of practice.

(ii) "Acute stroke patient" means a patient who has been exhibiting the signs and symptoms of stroke for less than six (6) hours and is not hypoglycemic.

(iii) "Decisional boundary" means a geographical point at which the clinical benefits to the patient of transport to one facility outweigh the benefits of transport to another facility.

(iv) "Effective treatment window" means that period of time in which a patient may experience a better clinical outcome if they receive appropriate treatment. Effective treatment windows vary by treatment and pathophysiology.

(v) "Evidence-based prehospital care protocols" means those treatment modalities that reflect the most current and recommended standards of medical practice based on significant clinical evidence.

(vi) "EMS agency" means an EMS agency as defined in chapter 4 of these rules.

(vii) "Emergency medical service providers" or "EMS providers" means an employee of an EMS agency or a person acting as an agent or otherwise on behalf of an EMS agency.

(viii) "FAST" means the acronym developed by the American Stroke Association (ASA) for the rapid identification of an acute stroke patient and activation of the 911 system. FAST stands for: Facial droop; Arm droop; Slurred speech; and Time to call for help.

(ix) "High index of suspicion" means the provider has sufficient or significant cause to believe that the patient is or may soon be acutely ill or injured.

(x) "Index of suspicion" means the degree to which a healthcare provider suspects that a patient may be suffering from a particular illness or injury based on the provider's training and experience, the patient's clinical presentation of signs and symptoms, and the mechanism of injury if applicable.

(xi) "Local system design" means the interrelation of the structure, hierarchy, and relationship of all of the components of the comprehensive EMS and trauma system within a specific community. In well-designed local systems of care, hospitals, TSE facilities, EMS agencies, dispatch organizations, and other healthcare and public health providers work cooperatively to ensure that patients are receiving care that is based on current clinical evidence and recommended practice, and are transported to a facility best suited for providing optimal care in the shortest time possible.

(xii) "Operational procedures" means those policies and procedures adopted by an EMS agency under these rules that direct the administrative and operational practices affecting the decision making process of the individual.

(xiii) "Scene time" means that portion of time between when an ambulance arrives at the location of the patient and when the ambulance departs the scene.

(xiv) "Stroke Alert" means a notification given by EMS providers to a Stroke Center that will be receiving a patient that has a positive FAST assessment.

(xv) "System design" means the structure, hierarchy, and relationship of all of the components of the comprehensive EMS and trauma system.

(xvi) "Time sensitive emergency" or "TSE" means a condition for which there is substantial clinical evidence demonstrating that minimal time delays in the provision of correct treatment and transport to the most appropriate facility results in improved clinical outcomes. For the purposes of these rules time sensitive emergencies are limited to traumatic injuries, heart attacks, and strokes.

(xvii) "Trauma Center" means a hospital designated as a "Regional Trauma Center" under Rules Wyoming Department of Health, Trauma Program, Chapter 4 or a hospital verified by the American College of Surgeons as a Level I or Level II Trauma Center.

(xviii) "Triage" means the process of assessing a patient or patients to determine the priority of patient treatment or transport based on the severity of injury or illness. In the case of a single patient, triage is utilized to determine the need for transport to a TSE facility. In the case of multiple patients, triage is used to determine the need for transport to a TSE facility, as well as the priority of needs of all of the patients.

(xix) "TSE facility" means:

(A) A Wyoming hospital that has been designated in one of the categories specified in Chapter 13, Section 4(a) of these rules;

(B) A hospital outside of the state that is accredited by the American Heart Association (AHA), the Society for Cardiovascular Patient Care or the Joint Commission as a hospital equivalent to one of the categories in Chapter 13, Section 4(a) of these rules;

(C) A Trauma Center or a facility designated in one of the categories specified in Rules Wyoming Department of Health, Trauma Program, Chapter 4.

History

Effective 2017-03-22

Wyo. Code R. 048.0023.15.03222017 § 3 General Operation Requirements for EMS Agencies

(a) The Division adopts the standards listed in this subsection. These standards shall control except as otherwise provided in this chapter. The adoption of these standards does not include later amendments or editions of the incorporated matters and shall not be interpreted as adding to or subtracting from the scope of practice for EMS providers. EMS agencies and EMS providers shall incorporate these standards into their local system design to the extent possible.

(i) The triage decision scheme for trauma patients shall be U.S. Dep't of Health and Human Servs., Ctrs. for Disease Control and Prevention, Guidelines for Field Triage of Injured Patients (2012). Copies are available from the Division upon request, and may be obtained through the CDC at: http://www.cdc.gov/mmwr/pdf/rr/rr6101.pdf.

(ii) The basis for the development of local systems of cardiac care shall be Am. Heart Ass'n, 2015 Guidelines for CPR and ECC (2015). Copies are available from the Division upon request, and may be obtained through the AHA at: https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/.

(iii) The basis for the development of local systems of stroke care and evidence based prehospital care protocols shall be:

(A) Am. Heart Ass'n & Am. Stroke Ass'n, Guidelines for the Early Management of Patients with Acute Ischemic Stroke (2013); copies are available from the Division upon request, and may be obtained through the AHA at: http://stroke.ahajournals.org/content/44/3/870.full.pdf+htmland; and

(B) Am. Heart Ass'n & Am. Stroke Ass'n, 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment (2015); copies are available from the Division upon request, and may be obtained through the AHA at: http://stroke.ahajournals.org/content/early/2015/06/26/STR.0000000000000074.full.pdf+html.

(b) EMS agency operations shall be conducted in accordance with the standards adopted in subsection (a) of this section and in accordance with the following principles:

(i) Ambulances shall transport patients to the facility best suited to care for the patient suffering a TSE, based on achieving the following principles:

(A) Transport of the trauma patient to a Trauma Center within one (1) hour of the time of injury;

(B) Transport of the patient suffering an acute heart attack to a facility with the capability to perform cardiac percutaneous coronary intervention (PCI) that minimizes the time between the onset of symptoms and the PCI procedure. Current evidence shows improved clinical outcomes when the PCI is performed less than 90 minutes from the onset of symptoms;

(C) Transport of the patient suffering an acute stroke to a primary or comprehensive stroke center as soon as possible. Current evidence indicates that the effective treatment window for the acute stroke patient is up to six hours.

(ii) The times listed in subsection (b)(i)(A)-(C) reflect benchmarks for ideal care. Patients may still benefit from transport to or treatment by a higher level TSE facility when these times are exceeded.

(iii) The bypass of a facility in favor of a facility with a higher capability shall be considered even if the required transport time exceeds that of the transport time to a closer facility. Factors influencing the decision to bypass include, but are not limited to:

(A) The additional time required to reach the facility with higher capability;

(B) The stability of the patient's condition;

(D) The time that will be expended at the initial facility prior to the transfer of the patient.

(i) Evidence-based prehospital care protocols using the standards adopted in subsection (a) of this section;

(ii) Operational procedures that address the requirements of this chapter and incorporate the principles of section 3(b) within the specific resources of the local community and region. The operational procedures shall include, but are not limited to:

(A) Procedures for limiting the scene time for each TSE;

(B) Procedures for assessing the incident scene to determine:

(I) Hazards to EMS providers, the patient, and bystanders;

(II) The number of patients and the mechanism of injury;

(III) The need for additional resources and the benefits and risks of waiting for additional resources rather than providing rapid transport to definitive care;

(IV) The need to declare a mass casualty incident;

(C) The proximity of hospitals and TSE facilities relative to the EMS response area and their specific capability to treat a TSE;

(D) Decisional boundaries where the transport of a patient to a TSE specific facility may prove to be beneficial to a patient experiencing a TSE;

(E) Procedures for the intercept of an ambulance service by another ambulance service capable of providing a higher level of care;

(F) The optimal course of action for the treatment and transport of a TSE during normal, day-to-day operations;

(G) Alternative courses of action that address circumstances under which the optimal course of action is prohibited or would not prove of benefit to the patient including, but not limited to:

(I) Adverse weather conditions;

(II) Permanent or temporary factors that increase the time required to transport a patient to the ideal TSE facility such as road closures;

(III) Closure of or non-availability of the optimal TSE facility due to compromised infrastructure or loss of specialized equipment, personnel, or resources;

(IV) Transport to alternative destinations in the event of mass-casualty incidents or public health emergencies.

(H) The means and circumstances for requesting additional resources;

(I) Standardized methods of notifying receiving facilities of the arrival of a possible TSE as soon as practicable;

(J) The means and circumstances for requesting the dispatch of air medical resources to the scene to facilitate rapid transport.

(d) An EMS agency shall not prohibit EMS providers from requesting an air ambulance transport from the field.

History

Effective 2017-03-22

Wyo. Code R. 048.0023.15.03222017 § 4 Assessment, Triage, Treatment and Transport of the Trauma Patient by EMS Providers

(a) Assessment of the Trauma Patient.

(i) An initial assessment shall be performed to identify patients with major hemorrhage, hemodynamic instability, penetrating torso trauma, or signs of traumatic brain injury who may require immediate management of life-threatening injuries or rapid surgical intervention.

(ii) After the initial assessment is complete and immediately identifiable life threatening injuries or conditions have been addressed, a secondary assessment to identify other injuries shall be performed unless a patient's condition and the requirement to continue treating an injury or condition prohibits the completion of an entire secondary assessment.

(iii) Continuous monitoring for deterioration over time, including serial vital signs and repeated neurologic status assessment, shall be performed.

(b) Treatment of the Trauma Patient.

(i) All treatment provided to the trauma patient shall be done in conjunction with the preparation of the patient for rapid transport to a trauma facility.

(ii) Hemorrhage control shall include appropriate dressing and bandaging and the early application of tourniquets in extremity trauma.

(iii) Airway management shall be done with an appropriate level of cervical spine precautions.

(iv) Spinal immobilization is not warranted in every trauma patient, and EMS protocols may be developed to allow discretion in determining which patients should receive this treatment.

(v) The management of the patient may incorporate the concepts of permissive hypotension.

(vi) EMS providers may withhold or terminate resuscitative efforts in the presence of:

(A) Decapitation;

(B) Hemicorpectomy;

(D) A mechanism of blunt trauma, and the patient is apneic, pulseless, and has no organized electrical activity on a cardiac monitor;

(E) Cardiac arrest after a mechanism of trauma and who have no return to spontaneous circulation after 15-30 minutes of resuscitative efforts, including minimally interrupted cardiopulmonary resuscitation.

(i) Patients who are assessed to have injuries consistent with Step One or Step Two as specified under Section 3(c)(i) of this chapter should be considered priority for transport to the facility with the highest level of capability.

(ii) Any patient who does not qualify for immediate transport to a Trauma Center, but is determined to have injuries consistent with Step Three and Step Four as specified in Section 3(c)(i) of this chapter may be transported to the most appropriate facility in accordance with regional or local system guidelines.

(iii) A transport may be refused, or an alternate destination requested, if the patient is determined to be of legal age, has the mental capacity to make an informed decision related to healthcare, and is not otherwise legally constrained from making such a decision. Under these circumstances, non-transport of the patient or transport of the patient to an alternate destination shall not violate this rule and shall not constitute refusal of care.

(iv) When the required transport time is equal to or less than the required transport time to a facility with a lower level of capability, the ambulance shall transport to the higher level of capability as listed below in descending order of capability:

(A) Trauma centers as defined in this chapter.

(B) Area Trauma Hospital

(D) Trauma Receiving Facility

(v) The following exceptions apply to this subpart:

(A) Ambulances will not transport chemical or radiation contaminated patients prior to decontamination;

(B) If the Trauma Center chosen as the patient's destination is overloaded and cannot treat the patient, then the patient's destination shall be determined pursuant to regional or local system guidelines;

(C) A transport may be diverted from the original destination if a patient's condition becomes unmanageable or exceeds the capabilities of the transporting ambulance.

(vi) Situations giving rise to any exceptions listed in subpart (v) of this subsection should prompt review of that transport by the quality improvement process of the entire system.

History

Effective 2017-03-22

Wyo. Code R. 048.0023.15.03222017 § 5 Assessment, Triage, Treatment and Transport of the Heart Attack Patient by EMS Providers

(a) Assessment of the Heart Attack Patient.

(i) EMS providers shall maintain a high index of suspicion that a patient may be suffering a myocardial infarction or acute coronary syndrome when the patient presents with signs or symptoms that include, but are not limited to:

(A) A prior history of myocardial infarction, acute coronary syndrome, or other cardiac related health problems;

(B) Chest pain;

(D) Shortness of breath;

(E) Sweating;

(F) Nausea or vomiting;

(G) Dizziness;

(H) Atypical or unusual symptoms, particularly in women, the elderly, and diabetic patients;

(I) Congestive heart failure (CHF);

(J) Syncope or shock.

(ii) The 12-lead ECG is the primary diagnostic tool that identifies an ST segment elevation myocardial infarction (STEMI). EMS providers shall acquire a 12-lead ECG, and transmit the recording as soon as possible for all patients.

(b) Triage of the Heart Attack Patient. Heart attack patients shall be triaged to the most appropriate facility based on the index of suspicion formed by the cumulative assessed findings.

(c) Treatment of the Heart Attack Patient. The care provided by EMS providers shall be directed toward reducing the following time factors:

(i) The time between the first indication of a myocardial infarction or acute coronary syndrome and the administration of aspirin;

(ii) The time between the arrival on scene to the time of 12-lead ECG acquisition;

(iii) The time between 12-lead ECG acquisition and transmission of the recording;

(iv) The time between 12-lead ECG acquisition and the identification of a STEMI;

(v) The time between the identification of a STEMI and notification of the findings to the receiving facility;

(vi) The time between the onset of a STEMI patient's symptoms and their ultimate arrival at a PCI center;

(vii) The time between EMS agency notification and the time of activation of a cardiac catheterization laboratory;

(viii) The time between arrival at the PCI center and the time of cardiac catheterization (door-to-balloon time);

(ix) The time between prehospital 12-lead ECG acquisition and the time of cardiac catheterization (ECG-to-balloon time).

(d) ALS personnel shall assess the patient's cardiac rhythm utilizing a cardiac monitor and 12-lead ECG and treat in accordance with the appropriate local protocols and standing orders.

(e) If the patient is dyspneic, hypoxemic, or has obvious signs of heart failure and there are no other contraindications, EMS providers shall perform the following to the extent allowed by the individual's scope of practice:

(i) Titrate oxygen therapy to achieve an oxygen saturation of greater than or equal to 94%;

(ii) Administer aspirin - chewable, non-enteric-coated, 160 to 325 mg is preferred;

(iii) Establish intravenous access;

(iv) Transmit a 12-lead ECG at the earliest opportunity for remote interpretation or confirmation by a physician;

(v) Provide advance notification as soon as possible to the receiving hospital for patients identified as having STEMI;

(vi) Perform serial ECGs and make copies of all ECGs available to treating personnel at the receiving hospital, whether they are presented in hard copy or transmitted from the field;

(vii) Administer nitroglycerin (tablets or spray) every three to five minutes as long as the patient's systolic blood pressure remains greater than 100mmHg.

(A) Nitrates in all forms are contraindicated in patients with a systolic blood pressure less than 90 mmHg, in patients with suspected right ventricular infarction, or when patients have taken an erectile dysfunction medication within 24 hours, or within 48 hours of the use of tadalafil (Adcirca, Cialis);

(viii) Analgesia is indicated in STEMI when chest discomfort is unresponsive to nitrates. Morphine should be used with caution in unstable angina due to an association with increased mortality.

(f) Transport of the Heart Attack Patient. Ambulance destination decisions shall be preferential based on the following descending order of preference and capability:

(i) Heart Attack Receiving Center or a hospital with a PCI facility;

(ii) Heart Attack Referring Center;

(iii) A hospital with an emergency department.

History

Effective 2017-03-22

Wyo. Code R. 048.0023.15.03222017 § 6 Assessment, Triage, Treatment and Transport of the Stroke Patient by EMS Providers

(a) Assessment of the Stroke Patient.

(i) Adult patients exhibiting signs and symptoms of a stroke or transient ischemic attack (TIA) shall be assessed with a validated stroke screening scale such as the Miami Emergency Neurologic Deficit (MEND) checklist or the Cincinnati Stroke Scale.

(ii) EMS providers shall maintain a high index of suspicion that the patient is experiencing a stroke or TIA when the patient is exhibiting signs and symptoms that include, but are not limited to:

(A) Neurologic deficits, such as facial droop, localized weakness, gait disturbance, slurred speech or altered mentation;

(B) Hemiparesis or hemiplegia;

(C) A dysconjugate, forced, or crossed gaze accompanied by a low level of consciousness (LOC), including an inability to follow commands, complete tasks, or make a discernible effort to respond;

(D) Severe headache, neck pain or stiffness, or difficulty seeing.

(iii) In assessing a patient exhibiting signs and symptoms of a stroke EMS providers shall:

(A) Utilize the FAST exam to rapidly evaluate patients;

(B) Perform a blood glucose analysis;

(b) Triage of the stroke patient.

(i) Acute stroke patients shall be triaged to the most appropriate facility based on the index of suspicion formed by the cumulative assessed findings.

(ii) Notification of a Stroke Alert shall be made as soon as possible to enable the receiving facility to take necessary steps to ensure the facility is prepared to receive the patient.

(i) For the adult patient exhibiting the signs and symptoms of stroke or TIA, EMS providers shall:

(A) Provide oxygen only if the patient's oxygen saturation is determined to be less than 94% and titrated to achieve a saturation of 94%;

(B) Manage seizures according to local protocol;

(C) Provide glucose only if the patient's blood glucose level is determined to be less than 60 milligrams per deciliter (60mg/dcl);

(D) Acquire and transmit a 12-lead electrocardiogram (ECG);

(E) Provide continuous cardiac monitoring.

(ii) Generally, hypertension should not be treated with pharmacological agents. Management of the blood pressure may include:

(A) Positioning the patient in the supine position if the systolic blood pressure is less than 120 mmHg;

(B) Positioning the patient with the head and torso at approximately a 30 degree angle if the systolic blood is greater than 120 mmHg;

(C) If the patient's systolic blood pressure is greater than 220 mm Hg, and if the heart rate is at least forty-five beats per minute, administer labetalol, ten (10) milligrams every ten (10) minutes, if authorized by scope of practice.

(iii) Patients exhibiting signs and symptoms of acute stroke shall be considered "nothing passed orally" (NPO), unless the patient is in need of glucose and intravenous glucose cannot be given, and the patient has been cleared for swallowing.

(d) Transport.

(i) Ambulance destination decisions shall be preferential based on the following descending order of preference and capability:

(A) Comprehensive Stroke Center;

(B) Primary Stroke Center;

(D) A hospital with an emergency department.

(ii) Transport to a more distant, designated facility, with a higher level of designation, shall be considered if the additional transport time is less than sixty (60) minutes more than the transport time to the nearest designated facility.

History

Effective 2017-03-22

Chapter 16 Licensing of Personnel

Wyo. Code R. 048.0023.16.08132018 § 1 Definitions

(a) As used in these Rules, the following definitions apply:

(i) "Abuse" means inappropriate or offensive physical, sexual or verbal contact or interaction with another person. Abuse includes, but is not limited to, the following:

(A) Physical abuse, which includes conduct by a licensee which causes, by physical contact, physical injury, or serious or protracted impairment of the physical, mental, or emotional condition of a patient, or which causes the likelihood of such injury or impairment. Such conduct includes, but is not limited to, slapping, hitting, kicking, biting, chocking, smothering, shoving, dragging, pinching, punching, shaking, sitting upon, burning, cutting, strangling, striking, using corporal punishment, or throwing objects at a patient. Physical abuse does not include reasonable emergency interventions necessary to protect the safety of any person.

(B) Psychological abuse, which includes verbal or non-verbal conduct by a licensee, directed to a patient, which insults, denigrates, humiliates, shocks, mocks, threatens, harasses, or alarms the patient. Psychological abuse does not include verbal or non-verbal conduct which has medical or therapeutic purpose or justification; and

(C) Offensive sexual contact or interaction, which may include, but is not limited to, engaging in, or facilitating sexual contact, exposure, performances, photography or any other form of sexual image collection or dissemination, irrespective of the patient's consent or receptiveness to the conduct.

(ii) "Deceive the Division" means to withhold information in any form or provide false, inaccurate, or misleading information to the Division.

(iii) "Emergency," in the context of an emergency license, means an event or circumstance exists that requires the presence of ambulance services, EMRs, EMTs, AEMTs, IEMTs, or Paramedics beyond the number of resources normally available to the area and beyond the control of the local area, such as a disaster, wildland fire, or public health emergency. The need for ambulance services on a routine basis does not constitute an emergency.

(iv) "Emergency Medical Services" or "EMS" means those organizations, people, and vehicles involved in the provision of medical care in a field environment. Generally, these services provide response to emergency calls for assistance for medical care and may provide medical care at the scene of the response, transport by ambulance to a hospital or other medical facility, and medical care during the transport. EMS primarily relies on the care provided by an EMR, EMT, AEMT, IEMT or Paramedic, but may involve care provided by other professions. This definition shall not be construed as limiting the EMR, EMT, AEMT, IEMT or Paramedic from providing care within their scope of practice in any setting or place of employment.

(v) "Incompetence" means a lack of, or loss of, skill or knowledge to practice the profession or practicing with negligence, as negligence is defined in this part, on one or more occasions while treating a patient.

(vi) "Negligence" means a failure to perform, as an ordinary, reasonable, similarly situated license holder licensed at the same level would, as delineated in controlling protocols, curricula, and policies and as demonstrated by an ordinary, reasonable license holder's prevailing standards of practice.

(vii) "Non-criminal offense" means a finding of inappropriate conduct or misconduct not constituting a criminal offense in any jurisdiction, including, but not limited to, a finding by either a designated governmental authority or a court of law of patient abuse, neglect, mistreatment, or misappropriation of patient property; spousal or intimate partner violence; unpermitted sexual contact; child abuse, neglect or abandonment; abuse, neglect or abandonment of the elderly or other vulnerable persons; vehicle and traffic findings involving reckless or aggressive driving; findings by any governmental entity of diversion of controlled substances from any health care facility, health care provider, or pharmacy; findings involving dishonesty or other unethical conduct; and other abusive acts which compromise the public trust in the profession, regardless of the circumstances, including whether the licensee is acting in the capacity of an EMS provider or "on-duty."

(viii) "Patient abandonment" means the termination of patient care prior to delivering the patient for medical evaluation or treatment or securing a proper refusal of medical attention in accordance with applicable protocol. Patient abandonment may be effected through means including, but not limited to, leaving a patient unattended after establishing patient contact or leaving a patient to the care of a person licensed at a lower level when the licensee knew or should have known that the patient required a higher level of care.

(ix) "Prevailing standards of practice" means those clinical or operational standards usually applied in the emergency medical services.

(x) "Public trust in the profession" means the reasonable trust and confidence held by the public that persons licensed by the Division are competent in the provision of medical care and do not present a threat to the public's person or property.

(xi) "Reasonable request by the Division" means any request for information or action from the Division to a person or entity in the course of the Division performing its duties.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 2 License Required

(a) Unless appropriately licensed by the Division or as otherwise provided by law, a person may not:

(i) Profess or represent himself to be an Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), Intermediate Emergency Medical Technician (IEMT), or Paramedic; or

(ii) Practice as or assume the duties incident to an EMR, EMT, AEMT, IEMT, or Paramedic.

(iii) Act in the capacity of an attendant or represent that they are licensed to do so without obtaining a license as specified under Subsection (a) of this Section and affiliating with an ambulance service licensed under Chapter 2, of these Rules. As used in this section, "attendant" means a person licensed under this Chapter who is employed by or a member of a licensed ambulance service, and is responsible for the provision of care to a patient.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 3 Eligibility for Licensure

(a) An applicant is eligible to be licensed as an EMR, EMT, AEMT, IEMT, or Paramedic if the applicant:

(i) Is at least sixteen (16) years of age when applying to be licensed as an EMR or is at least eighteen (18) years of age when applying to be licensed as an EMT, AEMT, IEMT, or Paramedic;

(ii) Has completed the appropriate course of education under Section 5 of this Chapter;

(iii) Has passed the appropriate examination under Section 6 of this Chapter;

(iv) Has not been convicted of a felony nor has a pending felony charge;

(v) Has not been convicted of, nor has a pending charge involving a misdemeanor that impacts the public trust in the profession or the ability to practice as a licensee;

(vi) Has not had the applicant's right to practice in a health care profession limited, suspended, terminated, or voluntarily surrendered in any jurisdiction.

(b) An applicant may request the Division to waive the eligibility requirements under Sections 3(a)(iv) and (v) of this Chapter by submitting to the Division a request for waiver in the format prescribed by the Division.

(i) A request for waiver must be submitted concurrent with the applicant's application for licensure.

(ii) A request for waiver must address the following factors:

(A) The nature and seriousness of the convicted crime;

(B) The length of time since the crime was committed;

(D) Compliance with court orders related to the conviction; and

(E) Other information the Division may determine is necessary to establish the applicant's character and fitness to provide emergency medical services.

(iii) A request for waiver may not address whether the applicant was duly convicted.

(i) The applicant submitted a timely and complete request for waiver; and

(ii) The Division finds that the applicant does not present a potential danger to the health, safety, and welfare of the citizens of Wyoming nor threaten the public trust in the profession if the applicant is licensed as an EMR, EMT, AEMT, IEMT, or Paramedic.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 4 Application for Licensure

(a) To be licensed as an EMR, EMT, AEMT, IEMT, or Paramedic, an applicant shall submit to the Division an application for licensure in the format prescribed by the Division.

(b) If an applicant desires to be licensed as an EMT, AEMT, IEMT, or Paramedic, the applicant shall complete and submit to a criminal check as part of the application process.

(i) The criminal background check must:

(A) Be in the format prescribed by the Division; and

(B) Contain federal and state criminal information.

(ii) The applicant shall pay all costs for the criminal background check.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 5 Education Requirements

(a) Except as otherwise provided in these rules, the standards for the course of education for an EMR, EMT, AEMT, Paramedic, and, to the extent that is practicable, IEMT, are those described in the United States Department of Transportation, National Highway Traffic and Safety Administration (NHTSA), DOT HS 811 077A, National Emergency Medical Services Education Standards (Jan. 2009), available at https://www.ems.gov/‌pdf/‌education/‌EMS-Education-for-the-Future-A-Systems-Approach/‌National_EMS_Education_Standards.pdf ("NHTSA National EMS Education Standards").

(i) The Division incorporates the NHTSA National EMS Education Standards into these rules by this reference.

(ii) The Division has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of these rules.

(iii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date noted in subsection (a) of this section.

(iv) The incorporated standard is maintained at https://‌health.wyo.gov/‌public‌health/‌ems/ and is available for public inspection and copying at cost from the Division.

(b) To be eligible for licensure by the Division, an applicant shall complete the appropriate course of education for the level of licensure desired.

(i) For the EMR, EMT and AEMT levels, an appropriate course of education is based on the NHTSA National EMS Education Standards.

(ii) For the IEMT level, an appropriate course of education is based on the NHTSA National EMS Education Standards for the AEMT, and includes additional curricula developed by the Division.

(iii) For the Paramedic level, an appropriate course of instruction is based on the NHTSA National EMS Education Standards and is accredited by the Commission on Accreditation of Allied Health Programs (CAAHEP).

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 6 Examination Requirements

(a) To be eligible for licensure by the Division, an applicant shall pass the appropriate examination for the level of licensure desired.

(i) If applying for licensure as an EMR, the applicant shall pass the appropriate Division Licensure Exam. Applicants for licensure as an EMR may take the National Registry of Emergency Medical Technicians (NREMT) exam as an alternative to the Division Licensure Exam.

(ii) If applying for licensure as an IEMT, the applicant shall pass the appropriate Division Licensure Exam.

(iii) If applying for licensure as an EMT, AEMT, or Paramedic, the applicant shall pass the appropriate NREMT exam.

(b) The Division Licensure Exam is comprised of a practical skills demonstration and a written examination appropriate for the level of licensure desired. An applicant that fails only one of these two components will only be required to reattempt the failed component.

(i) An applicant may attempt to pass the appropriate Division Licensure Exam six times. A successive attempt must occur more than seven (7) days and less than thirty (30) days after the previous attempt, unless the applicant is required to complete a remedial course of instruction.

(ii) If an applicant has not passed the appropriate Division Licensure Exam after three attempts, the applicant must complete a remedial course of instruction prior to a fourth attempt. The remedial course of instruction must be equivalent to the National Continued Competency Program requirements as outlined by the NREMT and appropriate to the level of licensure. The applicant has 180 days from the date of the third attempt to complete the remedial instruction and make the fourth attempt.

(iii) If an applicant has not passed the appropriate Division Licensure Exam after six attempts, the applicant may not retake the exam until the applicant again completes an appropriate course of education for the level of licensure desired under Section 5 of this Chapter.

(iv) If an applicant has not passed the appropriate Division Licensure Exam, and fails to make a successive attempt within the required time frame, the applicant may not retake the exam until the applicant again completes an appropriate course of education for the level of licensure desired under Section 5 of this Chapter.

(i) Is licensed or certified in another state or through the NREMT; and

(ii) Satisfies all other requirements for licensure under this Chapter.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 7 Decision on Application

(a) Upon the receipt of a complete application for licensure, the Division may take up to forty-five (45) days to issue or deny a license. An application is complete when the Division has received all required documentation, any requested supplemental information, and the results of a criminal background check indicating that there is no conviction or pending charge related to Section 3(a) of this chapter or a resolution has been reached with regard to any issues identified in the criminal background check.

(b) If the Division denies a license, the Division shall send written notice to the applicant. The written notice must state the reason for denial.

(i) Is eligible for licensure; and

(ii) Has submitted a complete application for licensure.

(d) The Division may deny an applicant a license if the Division finds:

(i) The applicant is ineligible for licensure;

(ii) The applicant has failed to submit a complete application for licensure;

(iii) Grounds for denial under Section 12 of this Chapter.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 8 License Terms

(a) If the Division issues an initial license under Section 7 of this Chapter, the license is valid until a date determined by the Division, not to exceed three years and not to be less than two years from the date of issuance.

(b) If the Division upgrades or downgrades a license under Section 9 of this Chapter, the upgraded or downgraded license is valid until the expiration date of the previous license.

(c) If the Division renews a license under Section 10 or issues a recovered license under Section 11 of this Chapter, the renewed or recovered license is valid until a date determined by the Division, not to exceed two years and not to be less than one year from the date of issuance.

(d) If the Division reinstates a license revoked under Section 12 of this Chapter, the reinstated license retains the original expiration date. A reinstated licensee shall renew the license under Section 10 of this Chapter if the original expiration date occurs before the date of reinstatement.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 9 Application to Upgrade or Downgrade a License

(a) A licensee is eligible for an upgraded or downgraded license if the licensee:

(i) Is eligible to be licensed at the level of licensure desired; and

(ii) Is not the subject of an ongoing investigation or other administrative action by the Division.

(b) To be issued an upgraded or downgraded license, a licensee shall submit to the Division a complete application to upgrade or downgrade a license in the format prescribed by the Division.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 10 Application to Renew a License

(a) A licensee is eligible for the renewal of a license if the licensee has completed the appropriate continuing medical education requirements under Chapter 8 of these Rules.

(b) To be issued a renewed license, a licensee shall submit to the Division a renewal application in the format prescribed by the Division. The renewal application must be submitted to the Division not less than thirty (30) days but not more than ninety (90) days before the licensee's license expires.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 11 Criteria to Recover a License and Recovered License Terms

(a) A former licensee is eligible to recover a license under the following conditions.

(i) If a license has been expired for less than or equal to one (1) year, the former licensee must be otherwise eligible for renewal under Section 10 of this Chapter.

(ii) If a license has been expired for more than one (1) year and less than or equal to four (4) years, the former licensee must:

(A) Complete a refresher course approved by the Division for the appropriate level of licensure; and

(B) Be otherwise eligible for renewal under Section 10 of this Chapter.

(iii) If a license has been expired for more than four (4) years, the former licensee must:

(A) Have a comparable license in another state or certification through the NREMT; and

(B) Be otherwise eligible for renewal under Section 10 of this Chapter.

(b) To recover a license, the former licensee shall submit to the Division an application in the format prescribed by the Division.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 12 Disciplinary Action

(a) The Division may take disciplinary action against a licensee or refuse to issue a license for one (1) or more of the following acts or conduct:

(i) Inability to function with reasonable skill and safety as a licensee including, but not limited to, the following reasons:

(A) Physical or mental disability;

(B) Negligence or incompetence;

(D) Patient abandonment or abuse;

(E) Fraud or deceit;

(F) Violation of patient privacy or confidentiality; or

(G) Exceeding the authorized scope of practice or representing oneself to be licensed at a higher level of licensure;

(ii) Misappropriation of money or property from any source while acting as a licensee;

(iii) Felony conviction;

(iv) Misdemeanor conviction that impacts the public trust in the profession or the ability to practice as a licensee;

(v) Drug diversion for self or others;

(vi) Distribution, sale, unauthorized use, illegal possession, or manufacturing of controlled or illicit drugs;

(vii) Failure to comply with a reasonable request from the Division including, but not limited to, the failure to:

(A) Respond to an administrative complaint or notice;

(B) Respond to a request for explanation or clarification;

(D) Comply with a term, condition, or obligation imposed by the Division;

(viii) Failure to conform to the standards of acceptable and prevailing emergency medical services practice, in which case actual injury need not be established;

(ix) Failure to comply with the requirements of these rules or the Act;

(x) Knowingly aiding or abetting another in the violation of these rules or the Act;

(xi) Deceiving or attempting to deceive the Division; and

(xii) Disciplinary action in any jurisdiction related to the right to practice in a health care profession;

(xiii) Commission of a non-criminal offense as defined under Section 1 of this Chapter.

(b) Disciplinary action may include a reprimand, conditions, restrictions, non-renewal, suspension, revocation, other appropriate action, or a combination thereof.

(c) The Division may initiate investigations or proceedings under this section on its own motion or on the written or oral complaint of any person. The identity of a complainant is confidential. The Division shall make reasonable efforts to protect the identity of a complainant. The Division shall not disclose identifying information related to a complainant except upon waiver by the complainant, court order, request of law enforcement, or request of the Attorney General's Office.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 13 Displaying of Licensure

While on duty, a licensee shall display the licensee's level of licensure on the licensee's outer clothing by means of the Division-approved insignia or other means approved by the Division.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 14 Emergency Licensing

(a) Pursuant to Wyoming Statute § 35-4-114(b), the Division may issue a license to an ambulance service or an individual in order to manage a declared public health emergency within the state in accordance with the following conditions:

(i) The Division may grant an emergency license to an ambulance service not licensed in this state, based on written or electronic confirmation that the ambulance service is licensed within another state; and

(ii) An emergency license for an ambulance service or an individual terminates upon the Governor's declaration that the public health emergency has ended.

(b) Pursuant to Wyoming Statute § 33-36-110(h), the Division may grant an Emergency License to an individual as an EMR, EMT, AEMT, IEMT or Paramedic based on written or electronic confirmation that the individual is currently licensed or was previously licensed at a comparable level in another state.

(i) An Emergency License expires upon whichever arise first of the following:

(A) Notification to the Division that the emergency no longer exists;

(B) Notification to the Division that the licensee's services are no longer required; or

(ii) An applicant for an Emergency License shall comply with one of the following:

(A) Submission via electronic means of a completed application for an Emergency License found at https://health.wyo.gov/publichealth/ems/ems-forms/;

(B) Submission via electronic means of a National Wildfire Coordinating Group Limited Request for Recognition found at https://www.nwcg.gov/‌sites/‌default/‌files/request_recognition.pdf or on the Division website: https://health.wyo.gov/‌publichealth/‌ems/ems-forms/.

(iii) The Division may deny approval of an application for an Emergency License if the Division determines:

(A) An emergency does not exist or that issuing the license is otherwise not warranted; or

(B) An applicant has submitted an incomplete or fraudulent application.

(c) The Division may issue an Emergency License equivalent to the level requested. The Division may also restrict or limit an Emergency License issued under this Section.

(d) An individual issued an Emergency License shall comply with the relevant scope of practice established under these rules.

(e) An individual issued an Emergency License is exempt from any other licensing requirements of this Chapter.

History

Effective 2018-08-13

Wyo. Code R. 048.0023.16.08132018 § 15 Conditional Licensing

(a) Pursuant to Wyoming Statute § 33-36-103(d), an applicant for licensure may request that the Division issue a conditional license while the results of a criminal background check are pending. To qualify for a conditional license, the applicant shall:

(i) Satisfy all eligibility requirements for the relevant level of licensure, except for those related to the criminal background check; and

(ii) Submit an attestation by notarized signature that the applicant has no prior criminal convictions nor pending criminal charges.

(b) If the Division grants a conditional license, the conditional licensee may provide care consistent with the scope of practice established for the relevant level of licensure. An entity that utilizes or employs a conditional licensee retains the right to limit the practice of the conditional licensee as a condition of employment.

(c) A conditional license expires ninety (90) days after the date of issuance. The Division may, at its sole discretion, grant a single ninety (90) day extension of a conditional license if the Division determines that circumstances beyond the conditional licensee's control prohibited the processing of the criminal background check.

(d) The Division shall immediately revoke a conditional license if the Division discovers any fact that would disqualify the conditional licensee from licensure. The Division may use the immediate revocation of a conditional license as grounds for the permanent denial of licensure.

History

Effective 2018-08-13

Chapter 17 Scopes of Practice

Wyo. Code R. 048.0023.17.01152020 § 1 Authorized Acts or Scope of Practice, Generally

(a) Except as otherwise provided in these rules, the authorized acts or scope of practice for an EMR, EMT, AEMT, IEMT, or Paramedic in this state are those described in United States Department of Transportation, National Highway Traffic and Safety Administration (NHTSA), DOT HS 812 471, National EMS Scope of Practice Model (Dec. 2017), available at https://www.ems.gov/pdf/812471_2007-National-EMS-Scope-Practice-Mode_Change-Notices-1-and-2.pdf ("NHTSA National EMS Scope of Practice Model").

(i) The Division incorporates the NHTSA National EMS Scope of Practice Model into these rules by this reference.

(ii) The Division has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of these rules.

(iii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date noted in subsection (a) of this section.

(iv) The incorporated standard is maintained at https://‌health.wyo.gov/‌public‌health/ems/ and is available for public inspection and copying at cost from the Division.

(b) An EMR, EMT, AEMT, IEMT, or Paramedic may not practice beyond the scope of practice outlined in this Chapter unless licensed or certified to do so by another professional board or agency under Wyoming Statutes.

(c) The acts an EMR, EMT, AEMT, IEMT, or Paramedic may perform within the licensee's scope of practice are limited to the written or verbal orders of a physician. A written order from a physician must be through one of the following means:

(i) A standing order authorizing a licensee at any level to perform a skill or administer a medication;

(ii) A protocol that addresses unforeseen or unusual circumstances and authorizes the licensee to perform a skill or administer a medication not previously addressed in a standing order; or

(iii) A written order on the appropriate patient care form utilized by a medical facility.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 2 Duties of a Physician Medical Director

(a) A physician medical director shall:

(i) Promulgate written protocols and standing orders as contemplated by this section; and

(ii) Indicate by signature on each written protocol and standing order that:

(A) The written protocol or standing order has been reviewed and approved at least once every two years;

(B) Any amendment to the written protocol or standing order was approved at the time of adoption; and

(C) Any pre-existing written protocol or standing order at the time a new physician medical director or supervising physician assumes responsibility has been approved by the new physician medical director.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 3 Authorized Acts or Scope of Practice for an EMR

(a) An EMR may:

(i) Administer up to 324 milligrams of aspirin orally to patients complaining of chest pain;

(ii) Insert a nasopharyngeal airway;

(iii) Utilize a mechanical device approved by the Division for the provision of CPR;

(iv) Utilize an electronic device for the measurement of vital signs;

(v) Provide immobilization of the spinal column through manual means and the use of appropriate equipment;

(vi) Provide splinting of an extremity, including the use of traction splints for the femur;

(vii) Administer epinephrine intramuscularly via an auto-injection device in the treatment of an allergic reaction or anaphylaxis; and

(viii) Utilize a person's prescribed medication to treat or prevent an Addisonian Crisis.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 4 Authorized Acts or Scope of Practice for an EMT

(a) An EMT may not utilize automatic transport ventilators.

(b) An EMT may:

(i) Perform the authorized acts of an EMR;

(ii) Utilize a syringe and needle to administer epinephrine in the treatment of anaphylaxis;

(iii) Perform capillary blood glucose testing; and

(iv) Utilize twelve (12) lead electrocardiograph (ECG) machines to capture and transmit a patient's ECG to a receiving facility.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 5 Authorized Acts or Scope of Practice for an AEMT

(a) An AEMT may:

(i) Perform the authorized acts of an EMT;

(ii) Provide nebulized ipratropium (Atrovent) or combinations of albuterol and ipratropium;

(iii) Utilize a continuous positive airway pressure (CPAP) device; and

(iv) Perform intra-osseous access, with the administration of lidocaine as a local anesthetic, on adult and pediatric patients.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 6 Authorized Acts or Scope of Practice for an IEMT

(a) An IEMT may:

(i) Perform the authorized acts of an AEMT;

(ii) Administer the following additional medications in accordance with written standing orders and protocols and the prevailing standards of practice:

(A) Amiodarone bolus and maintenance drip infusion;

(B) Ativan;

(D) Benadryl;

(E) Diazepam;

(F) Epinephrine, 1:10,000;

(G) Fentanyl;

(H) Furosemide;

(I) Glucagon;

(J) Heparin, monitoring and discontinuation of infusion drips initiated by a hospital or healthcare facility;

(K) Lidocaine, bolus and maintenance drip infusion;

(L) Morphine sulfate;

(M) Naloxone via any appropriate route;

(N) Nitroglycerin administered:

(I) Sublingual as a tablet or spray; or

(II) Through the monitoring, titrating, and discontinuing of infusion drips initiated by a hospital or healthcare facility;

(O) Ondansetron;

(P) Sodium bicarbonate;

(Q) Thiamine;

(R) Vasopressin;

(S) Xopenex.

(iii) Perform manual defibrillation;

(iv) Apply non-invasive patient monitoring devices, including the application of cardiac monitoring devices;

(v) Perform needle thoracotomy;

(vi) Perform endotracheal intubation if specifically authorized by the Division; and

(vii) Monitor antibiotic infusions.

(b) An individual that was certified or licensed at an Intermediate level that exceeds the scope of practice for that of the EMT level in this section prior to the adoption of this Chapter, shall be considered to be "grandfathered" and shall retain the authorization to perform those specific skills unless one of the following occurs:

(i) The license is revoked subsequent to a disciplinary action.

(ii) The license is upgraded as specified in Chapter 16, Section 9 of these Rules.

(iii) The licensee completes a Transition Course approved by the Division. Transition Courses shall not be considered to meet the entirety of the Continuing Education Requirements for license renewal under Chapter 8 of these Rules.

(iv) The licensee is granted a voluntary downgrade under Chapter 16, Section 9 of these Rules.

(v) The license has been expired more than one (1) year. In these circumstances, the applicant may only recover an EMT or AEMT level license as specified in Section 11(a)(i) of Chapter 16.

History

Effective 2020-01-15

Wyo. Code R. 048.0023.17.01152020 § 7 Authorized Acts or Scope of Practice for a Paramedic

(a) A Paramedic may:

(i) Perform the authorized acts of an IEMT;

(ii) Perform urethral catheterization;

(iii) Perform rapid sequence intubation (RSI) with the administration of paralyzing agents if the EMS agency with which the Paramedic is affiliated has received prior written approval to implement an RSI protocol from the Division. To receive approval RSI protocols must:

(A) Emphasize that less invasive airway and ventilation support as preferable to RSI;

(B) Comport with generally accepted standards of practice in the performance of RSI;

(D) Mandate the continuous use of end tidal carbon dioxide monitoring for intubated patients; and

(E) Address circumstances for the performance of surgical airways or percutaneous devices that allow for adequate respiration.

History

Effective 2020-01-15

Chapter 18 Personnel Licensure Renewal Requirements

Wyo. Code R. 048.0023.18.05212020 § 1 Purpose & Applicability

(a) This Chapter establishes the continuing medical education (CME) requirements to renew a license under Chapter 16 of these Rules.

(b) This Chapter applies to licensed Emergency Medical Responders (EMRs), Emergency Medical Technicians (EMTs), Advanced Emergency Medical Technicians (AEMTs), Intermediate Emergency Medical Technicians (IEMTs), and Paramedics.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 2 Continuing Medical Education Required

(a) A licensee is not eligible for the renewal of a license under Chapter 16 of these Rules unless the licensee:

(i) Possesses valid and current cardiopulmonary resuscitation (CPR) certification from a national organization approved by the Division;

(ii) Possesses, if the licensee is an IEMT or paramedic, valid and current Advanced Cardiac Life Support (ACLS) certification from a national organization approved by the Division; and

(iii) Either:

(A) Has completed the required hours of CME course work specific to the licensee's level of licensure, as established under this Chapter; or

(B) Is currently certified by the National Registry of Emergency Medical Technicians (NREMT) at the licensee's level of licensure.

(b) As part of a licensee's renewal application required under Chapter 16 of these Rules, the licensee shall provide documentary proof of eligibility pursuant to the requirements of this Chapter. Documentary proof of eligibility includes:

(i) Valid certificates of course work completion or attendance rosters, which indicate the topic of instruction, date of completion, location where instruction occurred, time of instruction, the name and signature of the instructor or teacher, and CME credit hours awarded; or

(ii) Official transcripts from a college or university; or

(iii) A valid certification card issued by the NREMT.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 3 Continuing Medical Education Standards and Conditions

(a) CME course work may take the form of:

(i) Live and in-person lecture style instruction; or

(ii) Distributed Continuing Medical Education (DCME), which is any educational activity in which the licensee is unable to interact in person or in real time with an instructor, including education through websites and digital media.

(b) A licensee may receive credit for the completion of CME course work only if the Division has accredited the CME course work.

(i) An "hour" of CME course work means sixty (60) minutes of attendance or participation.

(ii) Credit is awarded in increments according to the nearest quarter of an hour.

(iii) If a licensee provides the live and in-person instruction for CME course work, the licensee may receive credit for each hour of instruction. If the licensee provided instruction in tandem or as part of a group, the credit received is divided by the total number of fellow instructors.

(iv) A licensee may receive credit for the completion of DCME for no more than one half of the total required hours of CME course work specific to the licensee's level of licensure.

(v) A licensee may not receive credit for substantially-identical CME course work unless the CME course work occurred at least twelve months apart.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 4 Continuing Medical Education Accreditation

(a) CME course work is deemed to have been accredited by the Division if one of the following conditions is satisfied:

(i) The CME course work is provided by the Division or at a national, state or regional conference pre-approved by the Division;

(ii) The CME course work is DCME, and the DCME has been accredited through the Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE); or

(iii) The CME course work is live and in-person lecture style instruction and provided by a qualified instructor in the subject matter at, as part of the organization's regular training program or schedule, a licensed ambulance service, authorized fire service, approved EMS educational program, or hospital.

(b) A provider of CME course work may apply for accreditation by the Division no less than 30 days prior to the date of instruction in the form and manner established by the Division. At a minimum, the application must demonstrate that:

(i) The course work constitutes an organized program of learning, including a workshop or symposium, which contributes directly to the professional competency of a licensee;

(ii) The course work pertains to subjects which directly relate to the EMS profession;

(iii) The purpose of the course work is the education of medical professionals, including EMS personnel;

(iv) The course work is conducted or taught by EMS personnel, although it may also be conducted or taught in part by individuals who have special education, training, and experience by reason of which they should be considered subject matter; and

(v) The activity is accompanied by a paper, manual, or written outline which substantively pertains to the subject matter of the program.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 5 Discretionary Authority of the Division

(a) The Division may grant a waiver of the requirements under this Chapter if the Division finds that a waiver would be in the best interest of the public.

(b) The Division may remove a deemed status or accreditation if it determines that the provider of CME course work provided fraudulent documentation or failed to provide proper or adequate instruction.

(c) The Division may require additional CME course work, as well as establish a required timeframe to complete the CME course work, of all licensees or of licensees belonging to a particular geographic area, if the Division finds the additional CME course work necessary to:

(i) Enhance the capacity of the comprehensive EMS and trauma system; or

(ii) Respond to an emergency scenario, including a declared emergency, a public health emergency, or other scenario when the appropriate practices and procedures to respond to the emergency may require additional health and safety training.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 6 CME Requirements for an EMR

(a) During the term of his or her license, an EMR shall complete twenty (20) hours of CME course work, according to the following increments in the following subjects:

(i) Two (2) hours of CME course work regarding airway management;

(ii) Two (2) hours of CME course work regarding the management of pediatric patients;

(iii) Five (5) hours of CME course work regarding the management of trauma patients;

(iv) Five (5) hours of CME course work regarding the management of medical patients; and

(v) Six (6) hours of CME course work in electives of the EMR's choice.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 7 CME Requirements for an EMT

(a) During the term of his or her license, an EMT shall complete forty-two (42) hours of CME course work, according to the following increments in the following subjects:

(i) Six (6) hours of CME course work regarding airway management;

(ii) Six (6) hours of CME course work regarding the management of pediatric patients;

(iii) Ten (10) hours of CME course work regarding the management of the trauma patients;

(iv) Ten (10) hours in of CME course work regarding management of medical patients; and

(v) Ten (10) hours of CME course work in electives of the EMT's choice.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 8 CME Requirements for an AEMT

(a) During the term of his or her license, an AEMT shall complete fifty-four (54) hours of CME course work, according to the following increments in the following subjects:

(i) Eight (8) hours of CME course work regarding airway management;

(ii) Eight (8) hours of CME course work regarding the management of pediatric patients;

(iii) Twelve (12) hours of CME course work regarding the management of trauma patients;

(iv) Twelve (12) hours of CME course work regarding the management of medical patients; and

(v) Fourteen (14) hours of CME course work in electives of the AEMT's choice.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 9 CME Requirements for an IEMT

(a) During the term of his or her license, an IEMT shall complete sixty (60) hours of CME course work, according to the following increments in the following subjects:

(i) Six (6) hours of CME course work regarding airway management;

(ii) Six (6) hours of CME course work regarding the management of pediatric patients;

(iii) Sixteen (16) hours of CME course work regarding the management of trauma patients;

(iv) Sixteen (16) hours of CME course work regarding the management of medical patients; and

(v) Sixteen (16) hours of CME course work in electives of the IEMT's choice.

History

Effective 2020-05-21

Wyo. Code R. 048.0023.18.05212020 § 10 CME Requirements for a Paramedic

(a) During the term of his or her license, a paramedic shall complete sixty (60) hours of CME course work, according to the following increments in the following subjects:

(i) Six (6) hours of CME course work regarding airway management;

(ii) Six (6) hours of CME course work regarding the management of pediatric patients;

(iii) Sixteen (16) hours of CME course work regarding the management of trauma patients;

(iv) Sixteen (16) hours of CME course work regarding the management of medical patients; and

(v) Sixteen (16) hours of CME course work in electives of the paramedic's choice.

History

Effective 2020-05-21

398 Emergency Waivers for Health Care Facilities

Chapter 1 Emergency Waivers for Health Care Facilities

Wyo. Code R. 048.0078.1.11202020 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter pursuant to Wyoming Statutes 9-2-1204, 35-1-240(a)(ii), 35-2-908, and 35-4-101.

History

Effective 2020-11-20

Wyo. Code R. 048.0078.1.11202020 § 2 Purpose and Applicability

(a) This chapter establishes the Department's authority to waive Department rules regarding the licensing and operations of health care facilities in order to:

(i) Manage the spread of communicable disease; and

(ii) Respond to emergency situations that significantly impact a facility's capability to provide safe care.

History

Effective 2020-11-20

Wyo. Code R. 048.0078.1.11202020 § 3 Waivers

(a) Upon the request of a health care facility or at the Department's own motion, the Department may waive a requirement established under the rules identified in subsection (b) of this section if the Department determines the waiver is necessary:

(i) To manage and control a communicable disease; or

(ii) To protect the health, safety, and welfare of patients in response to an emergency.

(b) Pursuant to the conditions of subsection (a) of this section, the Department may waive a requirement established under the following rules:

(i) Rules, Department of Health, Aging Division, chapter 7 (1999);

(ii) Rules, Department of Health, Aging Division, chapter 8 (1998);

(iii) Rules, Department of Health, Aging Division, chapter 9 (2001);

(iv) Rules, Department of Health, Aging Division, chapter 10 (2016);

(v) Rules, Department of Health, Aging Division, chapter 11 (2000);

(vi) Rules, Department of Health, Aging Division, chapter 12 (2007);

(vii) Rules, Department of Health, Aging Division, chapter 13 (2008);

(viii) Rules, Department of Health, Health Quality, chapter 1 (1998);

(ix) Rules, Department of Health, Health Quality, chapter 2 (2000);

(x) Rules, Department of Health, Health Quality, chapter 4 (2001);

(xi) Rules, Department of Health, Health Quality, chapter 5 (2003);

(xii) Rules, Department of Health, Health Quality, chapter 7 (1998);

(xiii) Rules, Department of Health, Health Quality, chapter 8 (1998);

(xiv) Rules, Department of Health, Health Quality, chapter 10 (2001);

(xv) Rules, Department of Health, Health Quality, chapter 13 (2001);

(xvi) Rules, Department of Health, Health Quality, chapter 14 (1997);

(xvii) Rules, Department of Health, Health Quality, chapter 15 (1999);

(xviii) Rules, Department of Health, Health Quality, chapter 16 (1997);

(xix) Rules, Department of Health, Health Quality, chapter 18 (1998);

(xx) Rules, Department of Health, Health Quality, chapter 19 (2000);

(xxi) Rules, Department of Health, Health Quality, chapter 26 (2019);

(xxii) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 1 (1994);

(xxiii) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 3 (2008);

(xxiv) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 12 (2012);

(xxv) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 17 (2004);

(xxvi) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 20 (2004);

(xxvii) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 21 (2010);

(xxviii) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 22 (2012);

(xxix) Rules, Department of Health, Healthcare Licensing and Surveys, chapter 25 (2019); and

(xxx) Any other rule promulgated pursuant to the Department's authority over the licensing and operations of health care facilities, including W.S. 9-2-1201 to -1215 and W.S. 35-2-901 to -913.

(c) If the Department denies a facility's request for waiver, the facility is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(d) If the Department waives a requirement of rule pursuant to this section, the Department may require the impacted facility to implement an alternative action plan. The alternative action plan must include standards and conditions the Department deems necessary to protect the health, safety, and welfare of patients while managing and controlling the communicable disease or responding to the emergency.

History

Effective 2020-11-20

392 Health Care Innovation Studies

Chapter 1 Rules and Regulations for Health Care Innovation Studies

Wyo. Code R. 048.0075.1.11182019 § 1 Authority

The Wyoming Department of Health ("Department") promulgates these rules pursuant to Wyoming Statutes 9-2-128 and -129.

History

Effective 2019-11-18

Wyo. Code R. 048.0075.1.11182019 § 2 Purpose & Applicability

(a) These rules establish the standards and procedures of the Department's health care innovation account program and apply to applicants seeking to receive:

(i) Health care innovation account funding under W.S. 9-2-128; or

(ii) A waiver of existing rules under W.S. 9-2-129.

History

Effective 2019-11-18

Wyo. Code R. 048.0075.1.11182019 § 3 Definitions

(a) The following definitions apply to these rules:

(i) "Director" means the Director of the Wyoming Department of Health, including the Director's designee;

(ii) "Health care innovation account funding" means the provision of funds from the health care innovation account established under W.S. 9-2-128(b); and

(iii) "Innovative study" means as defined under W.S. 9-2-128(g)(i) and (ii).

History

Effective 2019-11-18

Wyo. Code R. 048.0075.1.11182019 § 4 Application for Health Care Innovation Account Funding

(a) If the Department elects to make health care innovation account funding available to persons undertaking innovative studies, the Department shall post an open call for applications. An open call for applications must:

(i) Be open for a period no less than three months but no more than one year;

(ii) Be publically posted online at the Department's website: https://health.wyo.gov; and

(iii) Establish the required form and manner to apply for funding.

(b) A person undertaking an innovative study is eligible to apply for health care innovation account funding if the purpose of the innovative study relates to one of the following:

(i) Reduction of costs associated with long-term care, chronic disease, or other health care services to the state of Wyoming;

(ii) Allowing individuals in need of long-term care to remain in their homes and communities;

(iii) Developing necessary long-term care or other health care services in Wyoming; or

(iv) Use of broadband internet to access health care services.

(c) In order to apply for health care innovation account funding, a person undertaking an innovative study shall timely submit a complete application in the form and manner established by the Department under Subsection (a) of this Section.

(d) An application for health care innovation account funding must include, at a minimum:

(i) A summary of the qualifications, experience, and capacity of the principal investigators and staff to conduct the innovative study, including licensure status and whether adverse action has ever been taken against an individual's license;

(ii) A summary of existing models of service delivery that are currently available in Wyoming and the need filled by the innovative service or model of service delivery to be studied;

(iii) The study question;

(iv) The proposed study design;

(v) A summary of potential harms to patients or clients participating in the study and strategies to mitigate those harms;

(vi) A summary of anticipated results and implications for health care service delivery in Wyoming; and

(vii) The amount of funding requested and a budget proposal summarizing how funds will be allocated to complete the study, including any outside funds that have already been secured for the purpose of undertaking the study.

History

Effective 2019-11-18

Wyo. Code R. 048.0075.1.11182019 § 5 Award or Denial of Health Care Innovation Account Funding

(a) At the close of the open call period established by the Department, the Department shall convene a review committee to evaluate each complete and timely-submitted application that has been submitted pursuant to Section 4 of this Chapter. The review committee must be comprised of at least three Department officials or employees, who possess relevant subject matter expertise and no conflict of interest.

(b) The review committee shall evaluate each application packet based on the criteria established under Section 4 of this Chapter. The committee may request additional information from the applicant or from outside experts as needed to evaluate the application.

(c) Based on the review committee's evaluation, the review committee shall recommend the Director to either approve or deny an application for funding.

(d) After receipt of the review committee's recommendations for all evaluated applications submitted during the open call period, the Director shall either approve or deny each application for funding. The Director shall base the decision on the review committee's recommendation and availability of funds.

(i) If the Director approves an application, the Department and applicant shall execute an agreement pursuant to W.S. 9-2-128. If an agreement cannot be reached or the Attorney General does not approve of the agreement, the Director's approval of health care innovation account funding is deemed revoked.

(ii) If the Director denies an application, the applicant is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(e) Prior to entering into an agreement with an applicant, the Department may require an applicant's innovative study to undergo Investigational Review Board ("IRB") review pursuant to federal law or Department policy, as relevant, including 45 CFR part 46 (the "Common Rule") and Wyoming Department of Health, Institutional Review Board, Policy and Procedures (2005), available at: https://health.wyo.gov/‌admin/irb/wdhirbguidelines/. If the Department requires IRB review and the innovative study does not receive approval from the IRB, the Director's approval of the applicant's application for health care innovation account funding is deemed revoked.

History

Effective 2019-11-18

Wyo. Code R. 048.0075.1.11182019 § 6 Application for Waiver of Rules to Conduct an Innovative Study

(a) A person conducting an innovative study may request a waiver of Department rules if necessary to carry out the innovative study.

(b) In order to receive a waiver of rules to conduct an innovative study, a person undertaking an innovative study shall submit a waiver application to the Department. The waiver application must be submitted in the manner and form established by the Department and include a description of:

(i) The particular rule or rules for which a waiver is requested; and

(ii) The justifications for a waiver, including why no alternative exists to accomplish the purposes of the study but for a waiver being granted.

(c) The waiver application shall be submitted concurrent to an application for healthcare innovation funding as specified in Section 4 of this Chapter. The application for healthcare innovation funding may request a zero dollar amount if the applicant requires only a waiver of rule to conduct the innovative study, but the application must satisfy the other requirements of Section 4 of this Chapter.

(d) The review committee established under Section 5 of this Chapter shall evaluate waiver applications concurrent with the applications for health care innovation account funding. The committee may request additional information from the applicant or from outside experts as needed to evaluate the application.

(e) Based on the review committee's evaluation, the review committee shall recommend the Director to either approve or deny a waiver application.

(f) After receipt of the review committee's recommendations for all evaluated applications submitted during the open call period, the Director shall either approve or deny each waiver application.

(i) The Director shall base the decision on the review committee's recommendation and a determination that:

(A) The grant of a waiver does not pose a threat to the health, safety, or welfare of Wyoming residents; and

(B) No reasonable alternative exists to accomplish the purposes of the innovative study but for a waiver being granted.

(ii) If the Director approves a waiver request, the Department shall provide the applicant written notice that states:

(A) The rules being waived; and

(B) The purpose for the waiver.

(iii) The Director's approval of a waiver request is contingent upon successful execution of an agreement for the innovative study approved by the committee.

(A) An approved waiver request is in effect only while a successfully executed agreement is also in effect;

(B) If an agreement cannot be reached or the Attorney General does not approve of the agreement, the Director's approval of the waiver is deemed revoked.

(iv) If the Director denies a waiver request, the applicant is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(g) If an innovative study is conducted under a waiver granted by the Director, the applicant shall provide notice of the waiver to all parties involved in the study. The notice must include the elements listed under Subsection (f)(ii)(A) and (B) of this Section as well as the time period for which the waiver is active.

(h) The Director may revoke a waiver at any time.

(i) The Director's decision to revoke a waiver must be based on a finding that:

(A) The grant of a waiver poses a threat to the health, safety, or welfare of Wyoming residents;

(B) A reasonable alternative to a waiver exists to accomplish the purposes of the innovative study; or

(C) The applicant or others responsible for conducting or overseeing the innovative study have violated the law or Department policies.

(ii) If the Director revokes a waiver, the Department shall provide written notice, including an effective date. The applicant is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(i) If an innovative study was conducted under a waiver which has been revoked by the Department, the applicant shall provide notice of the revocation, including the effective date, to all parties involved in the study.

History

Effective 2019-11-18

150 Health Quality

Chapter 1 Health Care Facilities Licensure Fees

Wyo. Code R. 048.0026.1.03301998 Health Care Facilities Licensure Fees

RULES AND REGULATIONS FOR HEALTH CARE FACILITIES LICENSURE FEES

CHAPTER 1

Assessment of Fees to Wyoming Health Care Facilities

Section 1. Authority. The Department of Health, pursuant to W.S. 35-2-904(a)(ii) of the Hospitals, Health Care Facilities, and Health Services Act and the Wyoming Administrative Procedure Act (W.S.16-3-101 through 16-3-115) is authorized to establish reasonable fees to recover administrative and operational expenses of the department in conducting its licensure program under this article.

Section 2. Definitions.

(a) "Adult Day Care Facility" means any facility not otherwise certified by the Department of Health, engaged in the business of providing activities of daily living support and supervision services programming based on a SOCIAL MODEL, to four (4) or more persons twenty-one (21) years of age or older with physical or mental disabilities.

(b) "Accrediting Agency" means an inspecting body nationally recognized and approved by federal regulations and having facility standards that meet or exceed the state standards for licensure;

(d) "Ambulatory Surgical Center" means a facility which provides surgical treatment to patients not requiring hospitalization and is not part of a hospital or office of private physicians, dentists or podiatrists;

(e) "Assisted Living Facility" means a dwelling operated by any person, firm or corporation engaged in providing limited nursing care, personal care and boarding home care but not habilitative care, for persons not related to the owner of the facility;

(f) "Bed Capacity" means the number of beds the facility is requesting a license for;

(g) "Birthing Center" means a facility which operates for the primary purpose of performing deliveries and is not part of a hospital;

(h) "Boarding Home" means a dwelling or rooming house operated by any person, firm, or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided;

(i) "Department" means the department of health;

(j) "Freestanding Diagnostic Testing Center" means a mobile or permanent facility which provides diagnostic testing but not treatment and is not part of the private offices of health care professionals operating within the scope of their licenses;

(k) "Freestanding Emergency Center" means a clinic built to provide emergency or routine treatment but does not include the private offices of health care professionals operating within the scope of their licenses;

(l) "Health Care Facility" means any ambulatory surgical center, assisted living facility, birthing center, boarding home, freestanding diagnostic testing center, freestanding emergency center, home health agency, hospice, hospital, intermediate care facility for the mentally retarded, medical assistance facility, nursing care facility, rehabilitation facility or renal dialysis center;

(m) "Home Health Agency" means an agency primarily engaged in arranging and directly providing nursing or other health care services to persons at their residence;

(n) "Hospice" means a program of care for the terminally ill and their families given in a home or health facility which provides medical, palliative, psychological, spiritual and supportive care and treatment;

(o) "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;

(i) Diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons;

(ii) Rehabilitation services for the rehabilitation of injured, disabled or sick persons;

(iii) Acute care;

(iv) Psychiatric care;

(v) Swing beds.

(p) "Intermediate Care Facility For The Mentally Retarded" means a facility which provides on a regular basis health related care and training to mentally retarded individuals or persons with related conditions, who do not require the degree of care and treatment of a hospital or nursing facility but who do require services in excess of those provided by a boarding home;

(q) "Medical Assistance Facility" means a facility which provides inpatient care to ill or injured persons prior to their transportation to a hospital or provides inpatient care to persons needing that care for a period of no longer than sixty (60) hours and is located more than thirty (30) miles from the nearest Wyoming hospital;

(r) "Nursing Care Facility" means a facility providing nursing care, rehabilitative and other related services;

(s) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine or surgery under state law;

(t) "Psychiatric Care" means the inpatient care and treatment of persons with a mental diagnosis;

(u) "Rehabilitation Facility" means an outpatient facility which is operated for the primary purpose of assisting the rehabilitation of disabled persons by providing comprehensive medical evaluations and services, psychological and social services, or vocational evaluations and training or any combination of these services and in which the major portion of the services is furnished within the facility;

(v) "Renal Dialysis Center" means a freestanding facility for treatment of kidney diseases;

(w) "Revised License" means a new license issued to a facility because of changes incurred in the facility's name, location, or number of beds;

(x) "This Act" means W.S. 35-2-901 through 35-2-910.

Section 3. License Fees.

(a) Health care facilities shall pay a fee for the issuance of a license, as applicable. Health care facilities shall also pay a fee to reapply for a license. The total of fees collected by the department must be sufficient to cover the general costs of issuing health care facilities licenses under the Hospitals, Health Care Facilities, and Health Services Act.

(b) Said licensure fee amounts shall be set by the department and shall be based on the health care facility bed capacity or the type of health services provided. Said licensure fee shall be assessed and payable at least annually. The methodology used to determine the amount of said fees is found in Section and Section 7 of this Chapter.

Section 4. Fee for Revised License. If, after a health care facility is issued a license, it changes its name, location, or the number of beds, the health care facility must pay a fee to cover the cost of issuing revised license.

(a) Revised License fees shall be assessed at $50 per health care facility.

Section 5. Fee for License of an Accredited Hospital. A hospital shall be issued a license after notification of approval of accreditation from an accrediting agency.

(a) Except for accredited hospitals with swing bed programs, license fees shall be $100 per accredited hospital.

(b) License fees for Accredited Hospitals with swing bed programs shall be $200.

Section 6. Fee Schedule Amounts for Health Care Facilities with Beds. Other than Accredited Hospitals.

(a) There are five (5) schedules of health care facilities for the purpose of determining the fee amount health care facility is assessed. Each health care facility is placed into one of the five following schedules based on the health care facility's bed capacity:

(i) Schedule A. The health care facility has a bed capacity of at least one (1) but not more than fifty (50);

(ii) Schedule B. The health care facility has a bed capacity of more than fifty (50) but not more than one hundred (100);

(iii) Schedule C. The health care facility has a bed capacity of more than one hundred (100) but not more than one hundred fifty (150);

(iv) Schedule D. The health care facility has a bed capacity of more than one hundred fifty

(150) but not more than two hundred (200);

(v) Schedule E. The health care facility has a bed capacity of more than two hundred (200).

(b) License fees for health care facilities in this section shall be:

(i) Schedule A facility - $100;

(ii) Schedule B facility - $200;

(iii) Schedule C facility - $300;

(iv) Schedule D facility - $400;

(v) Schedule E facility - $500.

Section 7. Fee Schedule Amounts for Health Care Facilities with Services.

(a) The following types of health care facilities shall be assessed a license fee of $100:

(i) Adult Day Care Facility;

(ii) Ambulatory Surgical Center;

(iii) Birthing Center;

(iv) Freestanding Diagnostic Testing Center;

(v) Freestanding Emergency Center;

(vi) Home Health Agency;

(vii) Hospice;

(viii) Intermediate Care Facility For The Mentally Retarded;

(ix) Medical Assistance Facility;

(x) Rehabilitation Facility;

(xi) Renal Dialysis Center.

History

Effective 1998-03-30

Chapter 2 Licensure of Adult Day Care Programs

Wyo. Code R. 048.0026.2.04202000 Licensure of Adult Day Care Programs

RULES AND REGULATIONS FOR LICENSURE OF ADULT DAY CARE FACILITIES

CHAPTER 2

Section 1. Authority. These rules are promulgated by the Department of Health, pursuant to the Health Facilities Act at W.S. 35-2-901 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.

Section 2. Purpose. These licensure rules have been adopted to protect the health, safety, and welfare of clients being provided services in Adult Day Care Facilities per W.S. 35-2-901(a)(xxiii).

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

(a) "Acceptable Plan of Correction" means the Licensing Division approved the plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division. The plan of correction shall be a written document and shall provide:

(i) Who is responsible for the correction;

(ii) What was done to correct the problem;

(iii) Who will monitor to ensure that the situation does not develop again; and

(iv) An appropriate date, not to exceed sixty (60) days after the last day of the survey, for the correction of deficiencies.

(b) "Adult Day Care Facility" means any facility not otherwise certified by the Department of Health, engaged in the business of providing activities of daily living support and supervision services programming based on a social model, to four (4) or more persons eighteen (18) years of age or older with physical and mental disabilities.

(c) "Adverse action" means the facility is in disagreement or opposition to the decision of noncompliance rendered by the licensing agency.

(d) "Complaint Investigations" means those investigations required to be performed by the Long Term Care Ombudsman per W.S. 9-2-1305.

(e) "Fire Prevention and Building Construction" means those standards as adopted by the Wyoming Department of Fire Prevention and Electrical Safety or designated representative.

(f) "License" means the authority granted by the Licensing Division to operate an Adult Day Care Facility.

(g) "Licensee" means any person, association, limited liability company, partnership, or corporation to whom an Adult Day Care Facility license is issued.

(h) "Licensing Division" means the Department of Health, Office of Health Quality, Planning and Program Evaluation.

(i) "Ombudsman" means the Long Term Care Ombudsman as established in W.S. 9-2-1301 through 9-2-1308.

(j) "Program Administration" means the rules and regulations promulgated by the Department of Health and developed by the Program Division for the day-to-day operation of Adult Day Care Facilities per W.S. 9-2-1208.

(k) "Program Division" means the Department of Health, Division on Aging.

(l) "Survey" means an on-site evaluation conducted by the Survey Division to determine compliance with State of Wyoming rules and regulations for Adult Day Care Facilities.

(m) "Survey Division" means the Wyoming Department of Health, Division on Aging.

Section 5. Licensure. Applicants must demonstrate full compliance with paragraphs (a) and (b) of this section.

(a) Licensing Procedure.

(i) In order to issue an initial license, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division;

(B) The required licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees;

(1) The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) In order to issue a renewal of a full license for a period of one year beginning July 1st, and unless suspended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and annual renewal licensure survey deficiencies cited by the Survey Division;

(ii) Fire prevention and/or building construction deficiencies cited by the Wyoming Department of Fire Prevention and Electrical Safety or designated representative;

(iii) Complaint investigations and resolutions per W.S. 9-2-1305 and W.S. 9-2-1306; and

(iv) Compliance with all laws and standards relating to communicable and reportable diseases as required by the Department of Health, State Health Officer and Public Health Division.

(i) No license granted shall be assigned or transferred by the licensee without the prior approval of the Licensing Division.

(A) Requests to assign or transfer an Adult Day Care Facility license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer; and

(B) Any license approved for assignment or transfer by the Licensing Division shall be subject to the plan of correction for licensure submitted by the previous licensee.

(ii) If the Adult Day Care Facility's name is changed, the Licensing Division shall be advised in writing by the current licensee and a new license could be issued upon the receipt of an application and licensure fee.

(d) Conditions for Denying, Revoking, or Suspending a License.

(i) The Licensing Division may deny, revoke, or suspend a license upon noncompliance with any provisions of these licensure rules.

(e) Hearings.

(i) Any Adult Day Care Facility aggrieved by a decision of the Licensure Division may request a hearing by submitting a written request within ten (10) days of the notice of the adverse action.

(ii) Except in matters concerned with the spread of communicable disease, the Licensure Division (Senior Management Consultant or designated representative) shall present the preliminary decisions and reasons to the parties concerned and shall provide an opportunity for a hearing. Any request for hearing shall adhere to the time frames of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons to the parties concerned and shall provide an opportunity for a hearing. Any request for a hearing shall adhere to the time frames of (i) above.

(iv) Hearings requested under the terms of these licensure rules shall be held in accordance with the provisions of the Wyoming Administrative Procedures Act and the contested rules and regulations of the Wyoming Department of Health.

(f) Posting of License. The current license issued by the Licensing Division shall be displayed in a public area within the Adult Day Care Facility.

(g) Surveys for Licensure.

(i) The Survey Division shall perform initial and annual renewal licensure surveys.

(A) These surveys shall be based on the current Licensure and Program Administration Rules and Regulations for Adult Day Care Facilities as promulgated by the Wyoming Department of Health. If there are conflicts between the Licensure and Program Administration Rules, the Licensure Rules shall take precedence.

(B) The Survey Division shall provide, within ten (10) working days after the last day of the survey, copies of its cited deficiencies to the Adult Day Care Facility and to the Licensing Division.

(C) The Adult Day Care Facility shall provide an acceptable plan of correction for all cited survey deficiencies, within ten (10) working days following the receipt of the cited deficiencies from the Survey Division, to the Licensing Division.

(D) The Licensing Division shall provide written notification to the Adult Day Care Facility and to the Program Division as to whether the plan of correction is or is not acceptable.

This notification shall be provided within ten (10) working days after receipt of the plan of correction.

(h) Voluntary Closure.

(i) If an Adult Day Care Facility voluntarily ceases to operate, it shall notify the Licensing Division in writing at least thirty (30) working days prior to the closure.

(ii) The first working day after closure, the Adult Day Care Facility license shall be hand carried to or sent by certified mail to the Office of Health Quality; 2020 Carey Avenue, Eighth Floor; Cheyenne, WY 82002.

(iii) Personnel, financial and patient medical records shall be maintained by the licensee for a minimum of six (6) years after the month of closure.

(A) All recipients of Adult Day Care Facility services shall be notified of the date of voluntary closure and copies shall be provided to each recipient at a reasonable cost.

History

Effective 2000-04-20

Chapter 4 Licensure of Assisted Living Facilities

Wyo. Code R. 048.0026.4.06282001 Licensure of Assisted Living Facilities

RULES AND REGULATIONS FOR LICENSURE OF ASSISTED LIVING FACILITIES

CHAPTER 4

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Act at W.S. 35-2-901 et seq. and the Wyoming Administrative Act at W.S. 16-3-101 et seq.

Section 2. Purpose. These rules have been adopted to protect the health, safety, and welfare of residents and employees in Assisted Living Facilities.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions.

(a) "Acceptable Plan of Correction" means the Licensing Division approved the plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division's desig- nated representative. The plan of correction shall be a written document and shall provide:

(i) Who is responsible for the correction;

(ii) What was done to correct the problem;

(iii) Who will monitor to ensure that the situation does not reoccur,

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) "Assisted Living Facility" means a non-institutional dwelling operated by a person, firm, or corporation engaged in providing limited nursing care, personal care and boarding home care, but not habilitative care, for persons not related to the owner of the facility.

Single-bed means one piece of furniture in which to lie and sleep. Multiple-beds means two or more pieces of furniture in a sleeping room in which to lie and sleep.

(d) "Boarding Home" means a non-institutional dwelling or rooming house operated by any person, firm, or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative, or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided.

(e) "Chief Administrative Officer" means the Director, Department of Health per W.S.9-2- 101(e), or the designated licensure representative.

(f) "Complaint Investigations" means those investigations required to be performed by the State Long Term Care Ombudsman per W.S. 9-2-1301 through 9-2-1309.

(g) "License" means the authority granted by the Licensing Division to operate an Assisted Living Facility.

(h) "Licensee" means any person, association, partnership, or corporation to whom an As- sisted Living Facility license is issued.

(i) "Licensed Beds" means the pieces of furniture on or in which residents lie and sleep that the authority is granted by the Licensing Division to operate an Assisted Living facility.

(j) "Licensing Division" means the Wyoming Department of Health, Office of Health Qual- ity.

(k) "Life Safety Code (LSC)" means NFPA 101 Life Safety Code.

(l) "NFPA" means the National Fire Protection Association.

(m) "Ombudsman" means the State Long Term Care Ombudsman as established in W.S. 9-2-1301 through 9-2-1309.

(n) "Program Administration" means the rules and regulations promulgated by the Depart- ment of Health and developed by the Program Division for the day-to-day operation of an Assisted Living Facility per W.S. § 9-2-1204.

(o) "Program Division" means the Wyoming Department of Health, Aging Division.

(p) "Survey" means an on-site evaluation conducted by the Survey Division's designated representative, in accordance with W.S. 35-2-907(c) to determine compliance with State rules and regulations for Assisted Living Facilities.

(q) "Survey Division" means the Department of Health, Office of Health Quality.

(r) "Survey Fee" means the fee charged to do an inspection of the Assisted Living Facility as authorized in Wyoming Statute 35-2-907(c).

Section 5. Licensure. Applicants must demonstrate full compliance with paragraphs (a) and

(b) of this section.

(a) Licensing Procedure.

(i) A provisional license may be issued when:

(A) a facility is in the process of becoming licensed; and/or

(B) the facility is not in compliance with the Licensure and Program Admin- istration Rules and Regulations for Assisted Living Facilities; and/or

(D) at the discretion of the Licensing Division.

(ii) The period of a provisional license shall be for no longer than sixty (60) days.

(iii) A provisional license may be renewed at the discretion of the Licensing Divi- sion.

(iv) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division.

(B) Each completed application shall be accompanied by the required licen- sure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(v) For renewal of a full license for one year beginning July 1st, and unless sus- pended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and periodic renewal licensure survey deficiencies cited by the Survey Division;

(ii) Life Safety Code deficiencies cited by the Survey Division;

(iii) Complaint investigations and resolutions per W.S. 9-2-1306; and

(iv) Compliance with all laws and standards relating to communicable and report- able diseases as required by the Department of Health, State Health Officer and Public Health Division.

(i) No license granted shall be assigned or transferred by the licensee without prior approval of the Licensing Division.

(A) Requests to assign or transfer an Assisted Living Facility license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer.

(B) Any license approved for assignment of transfer by the Licensing Divi- sion shall be subject to the plan of correction for licensure submitted by the previous owner.

(ii) If the Assisted Living Facility's name is changed, the Licensing Division shall be advised in writing by the current licensee and a new license will be issued upon the receipt of an application and licensure fee.

Change in License Status.

(i) If the Assisted Living Facility has a change in license status, such as, but not limited to, change in facility name, change in number of beds, etc. the Licensing Division shall be advised in writing by the current licensee and a new license will be issued upon the receipt of an application and license fee.

(e) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(f) Suspension of Admissions.

(i) The Licensing Division may suspend new admissions or re-admissions to the Assisted Living Facility when conditions are such that resident needs cannot be met. Conditions in an Assisted Living Facility shall not jeopardize the residents' health and safety.

(g) Monitor.

(i) The Licensing Division may place a Departmental approved monitor at the owner's expense when conditions are such that residents' needs are not being met by the Assisted Living Facility. The monitor shall insure that the health or the safety of the residents is not in jeopardy.

(h) Hearings.

(i) Any Assisted Living Facility aggrieved by a decision of the Licensure Division may submit a written request within ten (10) days of receipt of the adverse action to the Licensure Division.

(ii) Except in matters concerned with the spread of communicable disease, the Li- censure Division (Nurse I or designated representative) shall review the information submitted and provide a written response and reasons for the decision to the parties concerned within ten (10) days of receipt of the request.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall review the information submitted and provide a written response to the Licensing Division with ten (10) days of receipt of the request. The Licensing Division will then notify the parties concerned within ten (10) days of the Wyoming State Health Officer or designated representative response.

(iv) Any Assisted Living Facility still aggrieved by a decision of the Licensure Divi- sion may submit a written request a hearing within ten (10) days of receipt of the Licensing Division response in paragraphs (h)(ii) and (h)(iii) of this section

(v) Hearings requested under the terms of these licensure rules shall be held in ac- cordance with the provisions of the Wyoming Administrative Procedures Act and the contested rules and regulations of the Wyoming Department of Health.

(i) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Assisted Living Facility.

(j) Surveys for Licensure.

(i) The Survey Division's designated representative shall perform initial and peri- odic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Licensure and Program Ad- ministration Rules and Regulations for Assisted Living Facilities as promulgated by the Wyoming Department of Health. If there are conflicts between the Licensure and Program Administration Rules, the Licensure Rules take precedence.

(B) The Survey Division shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the Assisted Living Facility and Program Division.

(C) The Assisted Living Facility shall provide an acceptable plan of correc- tion for all cited deficiencies, within ten (10) calendar days after receipt of the deficiencies, to the Licensing Division.

(D) If the facility fails to provide an acceptable plan of correction, license revokation proceedings may ensue.

(E) The Assisted Living Facility shall post the survey results in a manner conducive for public review.

(k) Voluntary Closure.

(i) If an Assisted Living Facility voluntarily ceases to operate, it shall notify the Licensing Division in writing at least thirty (30) working days prior to the closure.

(ii) The first working day after closure, the Assisted Living Facility's license shall be hand carried to or sent by certified mail to the Office of Health Quality; 2020 Carey Avenue, Eighth Floor; Cheyenne, WY 82002.

(iii) Personnel, financial and client medical records shall be maintained by the lic- ensee for a minimum of six (6) years after the month of closure.

(iv) The Assisted Living Facility shall take appropriate discharge action to ensure each resident is properly placed in an alternate and proper care setting prior to closure.

Section 6. Furnishings, Building, Physical Plant.

(a) Sleeping room size shall not be less than one hundred twenty (120) square feet in single- bed rooms and eighty (80) square feet per bed in multiple-bed rooms, exclusive of toilets, closets, wardrobes, alcoves, or vestibules, in both cases.

(b) Multiple-bed sleeping rooms shall not be occupied by more than two (2) residents re- gardless of the size.

(c) Single-bed sleeping rooms shall have a minimum dimension of eight (8) feet. Mul- tiple-bed sleeping rooms shall have a minimum of dimension of ten (10) feet.

(d) Each sleeping room shall be an outside room, provided with windows operable from the inside without the use of tools. The bottom of the opening shall not be more than forty-four (44) inches above the floor.

(e) Sleeping rooms shall not be in an attic, basement, stairwell, hall, or any room commonly used for other than bedroom purposes.

(f) Ceiling heights in sleeping rooms shall not be less than seven feet, six inches (7'6").

(g) No room shall be used for a resident's sleeping room which can only be reached by passing through another resident's sleeping room.

(h) One half of the licensed beds shall be private rooms.

(i) All drapery and curtains shall be flame retardant.

(j) Every bathroom door lock shall be designed to allow the opening of the locked door from the outside in an emergency.

(k) Site requirements - The building location shall be:

(i) In a lawfully constituted fire district;

(ii) Serviced by an all-weather road kept open to motor vehicles at all times of the year; and

(iii) Accessible to physician and/or emergency medical services (ambulance service) within thirty (30) minutes driving time.

(l) Occupancy approval - Any building proposed for conversion to a facility shall be ap- proved by the Licensing Division before issuance of a license. Any items of noncompliance shall be corrected before issuance of the license.

(m) All facilities exceeding one story in height shall be equipped with an automatic elevator.

(o) Multi-storied wood frame buildings shall be protected by an automatic sprinkler sys- tem.

Section 7. Physical Environment.

(a) At least one (1) flush toilet shall be provided for every two (2) beds.

(b) At least one (1) tub or shower shall be provided for every ten (10) beds.

(d) All toilet-lavatory, shower and tub areas shall have floors and walls of impermeable, cleanable, and easily sanitized materials.

(e) Every resident shall have access to toilet, hand washing and bathing facilities without having to pass through another resident's sleeping room.

(f) The floor of the tub and shower shall have non skid surfaces. Handrails and grab bars shall be appropriately installed in or adjacent to the tubs, toilets and showers.

(g) All bathrooms and toilet facilities shall be properly lighted, and shall be mechanically vented.

Section 8. Mobile Homes. Mobile homes shall not be permitted for use as Assisted Living Facilities or additions to existing Assisted Living Facilities.

Section 9. Construction/remodeling. Department of Health Chapter III, Construction Rules for Health Facilities apply.

Section 10. Life Safety and Electrical Safety. The requirements in the Department of Health Chapter III, Construction Rules for Health Facilities apply.

(i) Boarding homes operating prior to the effective date of these rules and convert- ing to an Assisted Living Facility shall have written verification from a certified electrician that all wiring in the facility meets code.

(ii) Assisted Living Facilities operating prior to the effective date of these rules, shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as an Assisted Living Facility.

History

Effective 2001-06-28

Chapter 5 Licensure of Ambulatory Surgical Centers

Wyo. Code R. 048.0026.5.03282003 Licensure of Ambulatory Surgical Centers

RULES AND REGULATIONS FOR LICENSURE OF AMBULATORY SURGICAL CENTERS

CHAPTER 5

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Licensure Act at W. S. 35-2-901 et seq. and the Wyoming Administrative Procedures Act at W. S. 16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the licensure of Ambulatory Surgical Centers. These standards are designed to protect the health and safety of patients and employees.

Section 3. Severability. If any portion of these rules are found invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

(a) "Administrator" means the person in charge of the operation of the facility; and is:

(i) A Physician,

(ii) A Registered Nurse, or

(iii) A person qualified with training and experience in health service management.

(b) "Acceptable plan of correction" means Wyoming Department of Health, Office of Health Quality, approved the plan to correct the deficiencies identified through an onsite survey. The plan of correction shall be a written document and must contain who is responsible for correction, what was done to correct the problem and who will monitor to ensure that the situation does not develop again and must contain a appropriate date for completion of the correction.

(c) "Ambulatory Surgical Center" means a facility which provides surgical treatment to patients not requiring hospitalization and is not part of a hospital or an office of private physicians, dentists or podiatrists.

(d) "Central Registry" means the registry operated by the Wyoming Department of Family Services pursuant to Wyoming Statute §14-3-213, which indexes perpetrators of child abuse or neglect and abuse and neglect, exploitation or abandonment of disabled adults.

(e) "Governing body" means the individual(s), group, or agency that has ultimate authority and responsibility for establishing patient care policies, personnel policies, and providing for organizational management and planning.

(f) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(g) "Physician" means a person licensed to practice medicine in Wyoming by the Wyoming Board of Medicine.

(h) "Registered Nurse (RN)" means a graduate of an approved school of professional nursing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

Section 5. Licensing.

(a) Licensing requirements. The Office of Health Quality has been authorized to issue licenses to Ambulatory Surgical Centers and has established a system of licensure to comply with minimum requirements for the purpose of protecting the health, welfare and safety of patients receiving this type of service.

(b) Licensing procedure.

(i) For an initial license to be issued the Office of Health Quality shall receive:

(A) A completed application form as supplied by the Office of Health Quality.

(B) The required licensure fee is outlined in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(C) Demonstrated compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation shall be available to the Office of Health Quality following the onsite survey.

(D) The effective date of the initial license shall be:

(I) The date of the survey, if there are no deficiencies, or

(II) If deficiencies exist, the date that a plan of correction is approved.

(E) The length of the license shall be from the effective date of the license until the next June 30th.

(ii) For renewal of a full license for one year beginning July 1st, and unless suspended, or revoked, shall expire on June 30th of the following year, the Office of Health Quality shall receive:

(A) A completed application form by the date requested in the cover letter.

(B) The license fee as required in paragraph (b) of this section.

(C) Demonstrated compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation is maintained on file at the Office of Health Quality following the onsite surveys.

(i) The ambulatory surgical center shall be in conformity with all laws and standards relating to communicable and reportable diseases as promulgated by the Department of Health, Division of Public Health.

(ii) The existing deficiencies that may create a hazard to the health, safety or welfare of the clients.

(iii) The agency shall correct existing deficiencies.

(iv) There shall be adequate policies and procedures in place to guide operations.

(d) Transfer of license.

(i) No license granted shall be assignable or transferrable. A license shall apply only to the ambulatory surgical center described in the license application.

(A) Whenever ownership of an ambulatory surgical center is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The transferee shall notify the Office of Health Quality of the transfer and apply for a new license.

(I) The transferor shall notify the Office of Health Quality at least thirty (30) days prior to the final transfer.

(1) Any license granted to the transferee shall be subject to the plan of correction submitted by the previous owner as approved by the Office of Health Quality.

(ii) If the ambulatory surgical center's name or address is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(e) Conditions for revoking a license.

(i) Denial of application - revocation of license.

(A) An application for license may be denied or a previously issued license may be revoked for noncompliance with minimum standards as herein set forth when noncompliance jeopardizes the health, safety or welfare of patients.

(ii) Hearings.

(A) Any ambulatory surgical center aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within ten (10) days of the receipt date of the notice of adverse action.

(B) Except in matters concerned with the spread of communicable disease as required in sections (c)(i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the aggrieved ambulatory surgical center and provide an opportunity for a hearing (if such is requested within the appropriate time frame).

(I) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing (if such is requested within the appropriate time frame).

(C) Hearings requested under the terms of these rules and regulations shall be held by the Office of Health Quality in accordance with the provisions of the Wyoming Administrative Procedures Act at W.S. §16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

(f) Posting of license.

(i) The current license issued by the Office of Health Quality shall be displayed in a public area within the ambulatory surgical center.

(g) Survey of the ambulatory surgical center.

(i) Shall be arranged by the Office of Health Quality through its duly authorized officers, agents, or consultants. The survey shall be made unannounced and at periodic intervals dependant on the results of the previous survey and funding. All records of the ambulatory surgical center shall be made available to the surveyor.

(h) Requirements of the Office of Health Quality.

(i) The Office of Health Quality shall provide each ambulatory surgical center with:

(A) A copy of the list of deficiencies found, if any; and

(B) A copy of these rules and regulations.

(i) Voluntary closure.

(i) If an ambulatory surgical center voluntarily ceases to operate, it shall notify the Office of Health Quality in writing at least five working days prior to the closure.

(ii) The first working day after closure, the ambulatory surgical center shall return its license to the Office of Health Quality.

Section 6. Organization and Administration.

(a) Governing Body. The ambulatory surgical center shall have a governing body which has legal authority and responsibility to operate the ambulatory surgical center. The governing body shall:

(i) Appoint an administrator who is responsible for managing the ambulatory surgical center.

(ii) Adopt, revise, and approve personnel policies; including:

(A) Frequency of employee evaluations;

(iii) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the patient care level.

(iv) The governing body shall ensure that all services provided are consistent with accepted standards of practice.

(v) The governing body shall ensure that all procedures do not exceed twenty-three (23) hours of combined operating and recovery and/or convalescent time.

(vi) The governing body shall be accountable for the quality of care provided to the patient.

(vii) Personnel Records.

(A) There shall be one person designated responsible for maintaining the confidentiality.

(viii) Employee Health.

(A) Policies and procedures shall be developed to protect the employees health, and to prevent the spread of disease from employee to patient.

(B) Policies shall include but not limited to:

(I) Policies which are specific to blood borne pathogens as defined by OSHA;

(II) Communicable disease vaccines as recommended by current CDC Prevention Guidelines for Health Care Workers and endorsed by the State Health Department, Division of Public Health.

(ix) Notification.

(A) Prior to admission all perspective patients shall be notified if the ambulatory surgical center is not Medicare/Medicaid certified.

(x) Services.

(A) Furnished services, including the contracted services, shall comply with all applicable licensure standards;

(B) Medical and nursing staff shall be licensed, certified, or registered according to Wyoming laws and rules; and

Section 7. Admissions.

(a) All persons admitted to the ambulatory surgical center shall be under the direct care of a member of the provider staff. The provider staff shall ensure the continuity of care for each patient including pre-operative, intra-operative, and post-operative care. Each patient shall be provided prior to admission all necessary instruction and education for pre and post-surgical care.

(b) Restrictions: Surgical care shall be limited to the following:

(i) Those that do not exceed twenty-three (23) hours of combined operating and recovery and/or convalescent time; and

(ii) Those that do not generally result in extensive blood loss, require major or prolonged invasion of body cavities, directly involving major blood vessels, or constitute an emergency or life threatening procedure.

(i) Each patient admitted to the center shall have a visible means of identification placed and maintained on his/her person until discharge.

(ii) In cases of off-site, pre-planned transfer, such means of identification shall be maintained throughout the period of transfer and until such time as the patient becomes a patient in another licensed health care facility.

(d) Admission Requirements:

(i) All such admissions shall be in accordance with appropriate written policies and procedures which reflect the admission requirements established in this section, recommended by the provider staff and adopted by the Governing Body, specific to the ambulatory surgical center operations, that include at least the following:

(A) The patient must be in good health or have mild systemic disease which is under good control and does not require special management. Patient status shall be documented by the admitting physician.

(B) The patient or a responsible person acting on behalf of the patient must be able to strictly follow instructions related to the ingestion of fluids or solids within the specified time frame prior to the surgery.

(C) If the patient is to receive sedation or anesthetic which will result in impaired mental status following surgery, the patient must be accompanied upon discharge by a responsible adult.

(D) Patients who may require post-operative ventilation following surgery, either because of the procedure to be performed or because of a pre-existing condition, shall not be admitted for surgery.

(E) Surgery which requires the presence of special equipment, personnel, and/or facilities due to the risk of the operation involved shall not be performed in the center unless such equipment, personnel, and/or facilities are available in the ambulatory surgical center.

(F) When overnight care is provided, appropriate services shall be rendered within the defined capabilities of the organization. If overnight care is to be provided by the ambulatory surgical center, notice of such shall be provided to the Office of Health Quality.

(G) The Governing Body of the ambulatory surgical center shall have an organization wide policy on the use of smoking materials in the facility which shall be posted and disclosed to the patient upon admission.

(e) Off-Site Pre-Planned Transfers:

(i) Off-site pre-planned transfer of patients shall be limited to only those licensed health care facilities, that are physically located off-site or off-campus, when it is known in advance that further post-surgical patient care will be needed.

(A) Off-site pre-planned transfers do not include discharges to the patient's place of residence where further care will be provided by home health or home care providers.

(ii) Ambulatory surgical centers providing off-site pre-planned transfer service options shall adhere to the following requirements:

(A) Disclosure. Ambulatory surgical centers offering surgical services which include an off-site pre-planned transfer to another licensed health care facility following post-operative recovery shall disclose in written form to the patient all the details of the transfer prior to admission to the ambulatory surgical center. Disclosure includes but is not limited to the cost of the transfer, whether or not such costs shall be covered by insurance or other third party payer, and the details of the actual transfer, including but not limited to the mode of transport. Disclosure shall be made prior to the time for admission to the ambulatory surgical center. The patient shall acknowledge such disclosure in writing, and the date 5-7 thereof. Such disclosures on ambulatory surgical center policies regarding off-site pre-planned transfers shall be in addition to the requirements for informed consent.

(B) Off-site pre-planned transfers shall be made only to other licensed health care facilities that can provide the level of care necessary to meet the needs of the patient. The ambulatory surgical center shall have a written agreement with any and each licensed health care facility that admits patients for post-surgical care from an ambulatory surgical center. The ambulatory surgical center shall provide written discharge instructions, including patient progress information to the receiving health care facility.

(I) An ambulatory surgical center shall allow pre-planned transfers only with the written authorization of the attending operating surgeon or physician. The attending operating surgeon or physician shall approve such transfer if there are assurances that the continuity of care for the patient shall be maintained and contact with the patient's attending physician is continuous.

(C) All pre-planned transfers shall be by ambulance. The ambulatory surgical center shall have a written agreement with the provider(s) of ambulance services. Such transfer agreements shall include the provision for an appropriate level of care commensurate with the needs of a post-surgical recovering patient. If necessary, as determined by the attending or operating physician, licensed provider staff from the ambulatory surgical center shall accompany the patient on the ambulance to provide continuity of care that meets the post-operative needs of the patient.

(D) Ambulatory surgical centers engaging in pre-planned transfers shall provide space at the entrance to the building to facilitate patient transfers. The ambulatory surgical center shall provide close-in parking that shall be accessible at all times and shall not be obstructed by other parked vehicles or architectural barriers. The space provided shall include adequate height clearance for ambulances.

(E) Ambulatory surgical centers located above the ground level of the building that admits patients for which a pre-planned transfer is anticipated shall have at least one elevator available for the transport of such patients. The elevator shall be large enough to accommodate an ambulance cot in a horizontal position and a minimum of two attendants.

(f) On-Site Pre-Planned Transfers:

(i) On-site pre-planned transfers of patients are also authorized where it is known in advance that further post-surgical care will be needed. Such transfers are limited to:

(A) Other licensed health care facilities located on-site or on-campus and are physically connected to the ambulatory surgical center.

(B) Ambulatory surgical centers that provide extended recovery care services within the physical confines of the centers.

(ii) Extended Recovery Care Services:

(A) Extended recovery care services provided by an ambulatory surgical center shall not exceed twenty-three (23) hours combined operating and recovery and/or convalescent time.

(B) Extended recovery care services shall not be provided to more than four patients anywhere in the ambulatory surgical center, between the hours of 10:00 p.m. and 6:00 a.m.

(I) Direct visual observation of all patients;

(II) Medicine administration;

(III) Medical charting;

(IV) Toileting;

(V) Hand washing;

(VI) Oxygen;

(VII) Emergency call system;

(VIII) Storage space for supplies and equipment; and

(IX) Bed space. There must be at least 3'0" on each side or between recovery care area beds and space at the foot of each bed for work and/or circulation.

(D) A minimum of two health care workers, one of which shall be a registered nurse with Advanced Cardiac Life Support (ACLS) certification, shall be on duty when patients are in the extended recovery care unit.

(E) Extended recovery care services shall have policies and procedures that describe the nature and extent of the extended recovery services provided, which are consistent with ambulatory surgery and anesthesia services.

(F) Extended recovery care services shall be integrated with other departments and services of the facility.

(G) In addition to the items required in a patient's medical record, the physician shall document the following:

(I) The reason(s) or need for a patient's admission to the extended recovery care unit, and

(II) Dietary orders to meet the nutritional needs of the patient.

(H) The facility shall obtain a Food Service Establishment Permit, if required by the county health department.

(I) Inspection reports by the county health department shall be maintained at the facility for review by the Office of Health Quality.

(II) All personnel who prepare or serve food shall observe personal hygiene and sanitation practices which protect food from contamination.

(g) Emergency Services:

(i) Ambulatory surgical centers shall have policies and procedures which provide for adequate care of the center's patients in the event of an emergency.

(ii) There shall be a policy and procedure for obtaining ambulance services to a hospital including the notification of the next of kin or responsible party.

(iii) There shall be a written transfer agreement with a hospital or all physicians performing surgery in the ambulatory surgical center shall have admitting privileges at the hospital.

(iv) Emergency equipment and supplies shall be available on the premises.

(v) An ambulatory surgical center transferring a patient to a hospital on an emergency basis, shall submit to the receiving hospital at the time of transfer a copy of all medical records related to the patient's condition, including observations of the patient's signs and symptoms, preliminary diagnosis, treatment provided, results of any tests, and a copy of the informed written consent.

Section 8. Physical Environment.

(a) The ambulatory surgical center shall be constructed, arranged, and maintained to ensure health and safety of the patient.

(i) The building interior and exterior shall be clean, orderly, sanitary, and free of odors.

(b) Ambulatory surgical centers, certified prior to the effective date of these regulations and were lawfully constructed and in compliance with the regulations at the time of initial certification and found to be in continuing compliance during any subsequent surveys may continue to utilize existing, approved life safety systems provided that they present no hazard to life, health, or property and that there are no changes in the scope of services and utilization patterns in the ambulatory surgical center.

(i) Any renovations of the certified ambulatory surgical centers shall, after the effective date of these regulations, comply with the requirements as outlined in Section 9.

(c) All new ambulatory surgical centers shall meet the 1994 edition of the Life Safety Code of the National Fire Protection Association that is applicable to health care facilities.

(d) Medical gas and vacuum piped systems shall not be shared with non-licensed health care facilities.

(e) The critical branch of the emergency system powered by the generator shall not be shared with non-licensed health care facilities.

(f) The ventilation system shall not be share with non-licensed health care facilities.

Section 9. Construction/Remodeling.

This section applies to modernization, renovation, change of space use, and new construction of ambulatory surgical centers.

(a) The ambulatory surgical center shall meet all requirements established in:

(i) Guidelines for Construction and Equipment of Hospital and Medical Facilities, Chapter 9. Outpatient Facilities, specifically described in Outpatient Surgical Facilities (Section 9. 5).

(b) All plans and specifications for construction and/or remodeling shall be approved by the Office of Health Quality prior to construction.

History

Effective 2003-03-28

Chapter 7 Boarding Homes

Wyo. Code R. 048.0026.7.12101998 Boarding Homes

RULES AND REGULATIONS FOR LICENSURE OF BOARDING HOMES

CHAPTER 7

Section 1. Authority. These rules and regulations are promulgated by the Depart- ment of Health pursuant to the Health Facilities Act at W.S. 35-2-901 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.

Section 2. Purpose. These licensure rules have been adopted to protect the health, safety, and welfare of residents and employees in Boarding Homes.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

(a) Acceptable Plan of Correction means the Licensing Division approved the plan to correct the deficiencies identified during an on-site survey conducted by the Sur- vey Division or designated representative. The plan of correction shall be a written docu- ment and shall provide:

(i) Who is responsible for the correction;

(ii) What was done to correct the problem;

(iii) Who will monitor to ensure that the situation does not develop again; and

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) Boarding Home means a dwelling or rooming house operated by any per- son, firm or corporation engaged in the business of operating a home for the purpose of letting rooms for rental, and providing meals and personal daily living care, but not habilitative or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided.

(c) Complaint Investigations means those investigations required to be per- formed by the Long Term Care Ombudsman per W.S. 9-2-1305.

(d) License means the authority granted by the Licensing Division to operate a Boarding Home.

(e) Licensee means any person, association, partnership, or corporation to whom a Boarding Home license is issued.

(f) Licensing Division means the Department of Health, Office of Health Qual- ity, Planning and Program Evaluation.

(g) LSC means NFPA 101 Life Safety Code cited in the Department of Health, Chapter III, Construction Rules for Health Facilities.

(h) NFPA means the National Fire Protection Association.

(i) Ombudsman means the Long Term Care Ombudsman as established in W.S. 9-2-1301 through 9-2-1309.

(j) Program Administration means the rules and regulations promulgated by the Department of Health and developed by the program division for the day-to-day opera- tion of Boarding Homes per W.S. 9-2-1208.

(k) Program Division means the Department of Health, Division on Aging.

(l) Survey means an on-site evaluation conducted by the Survey Division to determine compliance with State rules and regulations for Boarding Homes.

(m) Survey Division means the Department of Health, Office of Health Quality, Planning and Program Evaluation.

Section 5. Licensure. Applicants must demonstrate full compliance with para- graphs (a) and (b) of this section.

(a) Licensing Procedure.

(i) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Divi- sion.

(B) Each completed application shall be accompanied by the re- quired licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facili- ties Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one year beginning July 1st, and un- less suspended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the applica- tion cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and periodic renewal licensure survey deficiencies cited by the Survey Division;

(ii) Life Safety Code deficiencies cited by the Survey Division;

(iii) Complaint investigations and resolutions per W.S. 9-2-1306; and

(iv) Compliance with all laws and standards relating to communicable and reportable diseases as required by the Department of Health, State Health Officer and Public Health Division.

(i) No license granted shall be assigned or transferred by the licensee without prior approval of the Licensing Division.

(A) Requests to assign or transfer a Boarding Home license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer.

(B) Any license approved for assignment or transfer by the Licens- ing Division shall be subject to the plan of correction for licensure submitted by the previ- ous licensee.

(ii) If the Boarding Home name is changed, the Licensing Division shall be ad- vised in writing by the current licensee and a new license will be issued upon the receipt of an application and licensure fee.

(d) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncom- pliance with any provisions of these licensure rules.

(e) Hearings.

(i) Any Boarding Home aggrieved by a decision of the Licensure Division may request a hearing by submitting a written request within ten (10) days of receipt of the adverse action.

(ii) Except in matters concerned with the spread of communicable dis- ease, the Licensure Division (Senior Management Consultant or designated representative) shall present the preliminary decisions and reasons for the decision to the parties con- cerned and shall provide an opportunity for a hearing. Any request for hearing shall ad- here to the time frames of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an op- portunity for a hearing. Any request for a hearing shall adhere to the time frames in (i) above.

(f) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Boarding Home.

(g) Surveys for Licensure.

(i) The Survey Division shall perform initial and periodic surveys for re- newal of licensure.

(A) These surveys shall be based on the current Licensure and Program Administration Rules and Regulations for Boarding Homes as promulgated by the Wyoming Department of Health. If there are conflicts between the Licensure and Program Administration Rules, the Licensure Rules take precedence.

(B) The Survey Division shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the Boarding Home and to the Program Division.

(C) The Boarding Home shall provide an acceptable plan of correc- tion for all cited survey deficiencies, within ten (10) working days after receipt of the deficiencies, to the Licensing Division.

(D) The Licensing Division shall provide written notification to the Boarding Home and to the Program Division as to whether the plan of correction is or is not acceptable. This notification shall be provided within ten (10) working days after receipt of the plan of correction.

(h) Voluntary Closure.

(i) If a Boarding Home voluntarily ceases to operate, it shall notify the Licensing Division in writing at least five (5) working days prior to the closure.

(ii) The first working day after closure, the Boarding Home license shall be hand carried to or sent by certified mail to the Office of Health Quality,; 2020 Carey Avenue, Eighth Floor; Cheyenne, WY 82002.

Section 6. Building and Physical Plant.

(a) At least one flush toilet shall be provided for every eight (8) residents.

(b) At least one tub or shower shall be provided for every ten (10) residents.

(d) All toilet-lavatory, shower tub areas shall have floors and walls of imperme- able, cleanable, and easily sanitized materials.

(e) Residents shall have access to toilet, hand washing and bathing facilities without having to pass through another residents bedroom.

(f) The floor of the tub and shower shall have non-skid surfaces. Handrails and/ or grab bars shall be adjacent to the tubs, toilets and showers.

(g) All bathrooms and toilet areas shall be properly lighted, and shall be vented.

(h) Boarding homes licensed prior to March 1, 1987 shall have sleeping rooms to allow for sufficient space for not less than seventy-five (75) square feet of floor space per resident in a single-bed sleeping room and not less than sixty (60) square feet of floor space per resident in a multi-bed sleeping room with minimum of three (3) feet between beds.

(i) Boarding homes licensed on or after March 1, 1987 shall provide sleeping rooms which allow for not less than one hundred (100) square feet of floor space per resident in a single-bed sleeping room and not less than seventy (70) square feet of floor space per resident in a multi-bed sleeping room with a minimum of three (3) feet between beds.

(j) Each sleeping room shall be an outside room, provided with windows oper- able from the inside without the use of tools. The bottom of the opening shall not be more than 44 inches above the floor.

(k) Boarding homes licensed on/or after the date of these Licensure Rules shall not have sleeping rooms below grade level; in an attic; basement; stairwell; hall; or any room commonly used for other than bedroom purposes.

(l) Ceiling heights in sleeping rooms shall not be less than seven feet, six inches (76") .

(m) Site requirements. The building locations shall be:

(i) In a lawfully constituted fire district;

(ii) Serviced by an all-weather road kept open to motor vehicles at all times of the year; and

(iii) Accessible to physician and emergency medical services within thirty (30) minutes driving time.

(n) Occupancy Approval. Any building proposed for conversion to a boarding home shall be approved by the Licensing Division prior to issuance of a license. Any items of noncompliance shall be corrected prior to issuance of the license.

(o) All facilities exceeding one story in height shall be equipped with an auto- matic elevator. Facilities licensed prior to the effective date of these rules, shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as a boarding home. Multi-storied wood frame buildings shall be sprinklered.

Section 7. Mobile Homes. Mobile homes shall not be permitted for use as board- ing homes or additions to existing boarding homes.

Section 8. Construction/remodeling. Department of Health Chapter III, Construc- tion Rules for Health Facilities apply.

Section 9. Life Safety and Electrical Safety. The requirements in the Department of Health Chapter III, Construction Rules for Health Facilities apply.

History

Effective 1998-12-10

Chapter 8 Licensure of Freestanding Diagnostic Testing Centers

Wyo. Code R. 048.0026.8.09031998 Licensure of Freestanding Diagnostic Testing Centers

RULES AND REGULATIONS FOR LICENSURE OF FREESTANDING DIAGNOSTIC TESTING CENTERS

CHAPTER 8

Section 2. Purpose. These rules have been adopted for the licensure of Mobile, Transportable or Relocatable Freestanding Diagnostic Testing Centers. The standards adopted in these rules shall not duplicate existing federal regulations, state statutes, or rules adopted by other State of Wyoming Agencies.

Section 3. Severability. If any portion of these rules are found invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Exceptions. The licensing or registration of radioactive material, the control of radiation, the disposal of radioactive material, and the licensing of persons who apply ionizing radiation or radiopharmaceutical agents to humans for diagnostic or therapeutic pur- poses are not within the purview of these rules.

(a) The Wyoming Workers Safety shall be contacted for information related to em- ployee protection from ionizing radiation or disposal of waste radioactive material.

(b) The applicable State of Wyoming Licensing Board, such as: the Board of Medi- cine, the Board of Nursing, and the Board of Radiologic Technologist Examiners shall be con- tacted for criteria on the licensure of persons who apply ionizing radiation or radiopharmaceuti- cal agents.

(c) Freestanding Diagnostic Testing Centers which provide services to four or more individuals simultaneously, shall meet the standards set forth in the Wyoming Department of Health's Chapter III Construction Rules for Health Facilities.

Section 5. Exemptions. Freestanding Diagnostic Testing Centers which are physi- cally located in the private offices of State of Wyoming licensed health care practitioners or are included in the State of Wyoming licensure of an existing health care facility are exempt from these rules.

Section 6. Definitions. "Acceptable Plan of Correction" means Wyoming Department of Health, Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) approved the plan to correct the deficiencies identified during a survey. The plan of correction shall be a written document and must contain:

(i) Who is responsible for the correction,

(ii) What was done to correct the problem,

(iii) Who will monitor to ensure the situation does not develop again, and

(iv) The correction of each deficiency shall not exceed sixty (60) days from the last day of the survey.

(b) "Diagnostic Testing Services" means the use of any diagnostic procedure device, by a State of Wyoming licensed practitioner or radiologic technologist, such as: fluoroscopy, radiography, mammography, tomography, computerized tomography scanning, ultrasound, magnetic resonance, angiography, and other similar techniques.

(c) "Freestanding Diagnostic Testing Center" means a mobile, relocatable, or trans- portable facility which is capable of providing a wide array of outpatient diagnostic testing services and minimally invasive procedures.

(d) "Licensed Practitioner" means a person licensed or otherwise authorized by law to practice medicine, dentistry, podiatry, osteopathy, or chiropractic and includes properly certified physician assistants and properly licensed advanced practice nurses as defined under W. S. 33- 21-120(a)(i).

(e) "Mobile" means any premanufactured structure, trailer, or self-propelled unit equipped with a chassis on wheels and intended to provide diagnostic testing services on a temporary basis.

(f) "Radiation" means ionizing radiation including gamma rays and x-rays,alpha particles, beta particles, electrons, neutrons, protons and other nuclear particles but not sound or visible, infrared or ultraviolet light.

(g) "Radioactive Material" means any solid, liquid, or gas which emits radiation spontaneously.

(h) "Radiologic Technologist" means a person other than a licensed practitioner who applies ionizing radiation or radiopharmaceutical agents to humans for diagnostic or therapeutic purposes.

(i) "Relocatable" means any structure, not on wheels, built to be relocated at any time and provides diagnostic testing services.

(j) "Survey" means an examination or observation including, but not limited to, on- site inspections to determine compliance with licensure rules. These surveys shall be conducted by the Office of Health Quality or its authorized representatives.

(k) "Transportable" means any premanufactured structures or trailer, equipped with a chassis on wheels, intended to provide diagnostic testing services on an extended temporary basis.

Section 7. Licensing.

The Office of Health Quality has been authorized to issue licenses to Freestanding Diagnostic Testing Centers which are in compliance with:

(i) National Fire Protection Association's Life Safety Code 101, 1994 edition;

(ii) Guidelines for Design and Construction of Hospital and Health Care Facilities, current edition; and

(iii) The National Fire Protection Association's National Electric Code 70 as adopted by the Wyoming State Department of Fire Prevention and Electrical Safety.

(b) Licensing procedure.

For an initial license to be issued, the Office of Health Quality shall receive:

A completed application form as supplied by the Office of Health Quality.

The required licensure fee as outlined in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Trea- surer, State of Wyoming.

The effective date of the initial license shall be:

(l) The date of survey, if there are no deficiencies, or

(ll) If deficiencies exist, the date that a plan of correction is approved by the Office of Health Quality.

(D) The duration of the license shall be from the effective date of the license until the next June 30th.

(ii) For renewal of a full license for one year beginning July 1st, and unless sus- pended, shall expire on June 30th of the following year, the Office of Health Quality shall re- ceive:

(A) A completed application form by the date requested in the cover letter.

(B) The license fee as required in paragraph (b) of this section.

(i) No license granted shall be assignable or transferrable. A license shall apply only to the Freestanding Diagnostic Testing Center described in the license application.

(A) Whenever ownership of a Freestanding Diagnostic Testing Center is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The transferee shall notify the Office of Health Quality of the transfer and apply for a new license. The transferor shall notify the Office of Health Quality at least thirty (30) days prior to the final transfer. Any license granted to the transferee shall be subject to the plan of correc- tion submitted by the previous owner as approved by the Office of Health Quality. If the Freestanding Diagnostic Testing Center's name or address is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(d) Conditions for revoking a license.

(i) Denial of application - revocation of license. An application for license may be denied or a previously issued license may be revoked for noncompliance with minimum standards as herein set forth when noncompli- ance jeopardizes the health, safety or welfare of patients.

(ii) Hearings.

(A) Any Freestanding Diagnostic Testing Center aggrieved by a deci- sion of the Office of Health Quality or its authorized representatives may request a hearing by submitting a written request within ten (10) days of the receipt date of the notice of adverse action. Hearings requested under the terms of these rules and regulations shall be held by the Office of Health Quality in accordance with the provisions of the Wyoming Ad- ministrative Procedures Act at W.S. §16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

(e) Posting of license.

(i) The current license issued by the Office of Health Quality shall be dis- played in a public area within the Freestanding Diagnostic Testing Center.

(f) Survey of the Freestanding Diagnostic Testing Center shall:

(i) Be arranged by the Office of Health Quality through its duly authorized officers, agents, or consultants.

(ii) Surveys shall be announced and made at periodic intervals dependent on the results of the previous survey and funding.

(g) Requirements of the Office of Health Quality.

(i) The Office of Health Quality shall provide each Freestanding Diagnostic Testing Center with:

(A) A list of the cited deficiencies, if any; and

(B) A copy of these rules and regulations.

(h) Voluntary closure.

(i) If a Freestanding Diagnostic Testing Center voluntarily ceases to operate, it shall notify the Office of Health Quality in writing at least five working days prior to the closure.

(ii) The first working day after closure, the Freestanding Diagnostic Testing Center shall return its license to the Office of Health Quality.

Section 8. Physical Environment.

(a) Freestanding Diagnostic Testing Centers shall meet the following requirements:

(b) Life Safety Code.

(A) The 1994 edition of The National Fire Protection Association's, Life Safety Code 101, and all codes referenced therein, as modified by the 1996-97 edition of Guidelines for Design and Construction of Hospitals and Health Facilities referenced in Section 8(c).

National Fire Protection Association #1 Batterymarch Park P.O. Box 9101 Quincy, MA 02269-9101 Phone: (617) 770-3000

(c) The 1996-97 edition of Guidelines for Design and Construction of Hospital and Health Facilities, Chapter 12, Mobile, Transportable, and Relocatable Units, and all codes refer- enced therein. The America Institute of Architects Order Department Jay Gould Court P.O. Box 753 Waldorf, MD 20601 Phone: (202) 626-7474

(d) Electrical Safety.

(A) Electrical installations shall be in accordance with W.S. 35-9-119 including plan reviews and inspections. State of Wyoming Department of Fire Prevention and Electrical Safety Herschler Building, 1W, 122 West 25th Street Cheyenne, Wyoming 82002 Phone: (307) 777-7288

Section 9. Licensure of Out-of-State Freestanding Diagnostic Centers.

(a) Prior to operating in the State of Wyoming, out-of-state based Freestanding Diagnostic Testing Centers shall be licensed in Wyoming. Licensure shall be obtained by:

(i) Completing an application form as supplied by the Office of Health Qual- ity;

(ii) Providing a notarized statement from a state licensed architect which attests the Freestanding Diagnostic Testing Center is in compliance with the National Fire Pro- tection Association's, Life Safety Code 101, 1994 edition, Chapter 27 Existing Business Occu- pancies and the Guidelines for Design and Construction of Hospital and Health Facilities, current edition, Chapter 12 Mobile, Transportable, and Relocatable Units.

(iii) Providing a notarized statement from the licensure applicant which attests the Freestanding Diagnostic Testing Center is in compliance with the electrical safety require- ments as adopted by the State of Wyoming Department of Fire Prevention and Electrical Safety.

(b) As requested by the Office of Health Quality, the licensee shall provide a schedule which shall include:

(i) The type of Freestanding Diagnostic Testing Center to be used;

(ii) The nature, duration, and scope of use;

(iii) The exact location(s) where the Freestanding Diagnostic Testing Center machine is to be used; and

(iv) States in which the Freestanding Diagnostic Testing Center is registered and/or licensed.

(c) The preceding sections of these rules shall also apply for State of Wyoming licensure of out-of-state based Freestanding Diagnostic Testing Centers.

History

Effective 1998-09-03

Chapter 10 Licensure of Home Health Agency

Wyo. Code R. 048.0026.10.11012001 Licensure of Home Health Agency

RULES AND REGULATIONS FOR LICENSURE OF HOME HEALTH AGENCIES

CHAPTER 10

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Act at W.S. §35-2-901 et seq. and the Wyoming Administrative Procedures Act at W.S. §16-3-101 et.seq.

Section 2. Purpose. These licensure rules have been adopted to protect the health, safety, and welfare of clients and employees of Home Health Agencies.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules gender pronouns are used interchangeable. 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 purpose of these rules, the following shall apply:

(a) "Acceptable plan of correction" means the Licensing Division approved the plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division or its designated representative. The plan of correction shall be a written document and shall provide:

(i) Who is responsible for the correction;

(ii) What was done or will be done to correct the problem;

(iii) Who will monitor to ensure that the situation does not develop again; and

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) "Branch office" means a location or site from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is a part of the home health agency and is located sufficiently close to share administration, supervision, and services in a manner that renders it unnecessary for the branch to independently meet the licensure as a home health agency. Exception: Branch offices located out of state will be individually licensed in the State of Wyoming.

(d) "Complaint Investigations" means those investigations required to be performed by the Long Term Care Ombudsman per W.S. §9-2-1301 through W.S. §9-2-1309 or by the State Survey Agency as per the agreement dated June 18, 1985 between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming.

(e) "Health Care Services" includes, but is not limited to, nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, medical social work, home health aide, and dietary services. All staff shall be licensed in accordance with Wyoming State Statutes.

(f) "Home Health Agency" means any group, public agency, private organization, or any individual person who is primarily engaged in arranging for and directly providing two or more health care services to persons at their residence.

(g) "License" means the authority granted by the Licensing Division to operate a Home Health Agency.

(h) "Licensee" means any person, association, partnership, or corporation to whom a Home Health Agency license is issued.

(i) "Licensing Division" means the Department of Health, Office of Health Quality.

(j) "Primarily Engaged" means a relationship between a provider of services and a client whereby a provider offers to arrange for or directly provide health care services at a client's residence and the client accepts the offer. When this relationship is agreed upon, the provider becomes primarily engaged in providing health care services to the client.

(k) "Program Administration" means the rules and regulations promulgated by the Depart- ment of Health and developed by the Program Division for the day-to-day operation of the Home Health Agency per W.S. §9-2-1208.

(l) "Program Division" means the Department of Health, Division on Aging.

(m) "Provider" means a licensed home health agency.

(n) "State Survey Agency" means the Department of Health, Office of Health Quality which has the primary responsibility to determine whether health care providers/suppliers do or do not meet federal certification standards to participate in the Medicaid and/or Medicare programs as per the agree- ment between the Secretary of U.S. Department of Health and Human Services and the State of Wyo- ming dated June 18, 1985.

(o) "Survey" means an on-site evaluation conducted by the Survey Division or its desig- nated representative to determine compliance with State rules and regulations for Home Health Agen- cies.

(p) "Survey Division" means the Department of Health, Office of Health Quality.

Section 5. Licensure. Applicants must demonstrate full compliance with paragraphs (a) and

(b) of this section.

(a) Licensing Procedure.

(i) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division;

(C) An applicant shall demonstrate full compliance with the licensure re- quirements in paragraph (b) of this section. The effective date of the initial license shall be: The date of the survey, if there are no defi- ciencies.

(II) If deficiencies exist, the date that an acceptable plan of correc- tion is developed after the survey.

(ii) For renewal of a full license for one year beginning July 1st and, unless sus- pended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and periodic renewal licensure survey deficiencies cited by the Survey Division;

(ii) Complaint investigations and resolutions; and

(iii) Compliance with all laws and standards relating to communicable and report- able diseases as required by the Department of Health, State Health Officer and Public Health Division.

(i) No license shall be assigned or transferred by the licensee without prior written approval of the Licensing Division.

(A) Requests to assign or transfer a Home Health Agency license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer.

(B) Any license approved for assignment or transfer by the Licensing Divi- sion shall be subject to the plan of correction for licensure submitted by the previous licensee.

(ii) If the Home Health Agency name is changed, the Licensing Division shall be advised in writing, before the name is changed, by the current licensee and a new license shall be issued upon the receipt of an application and licensure fee.

(d) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(e) Hearings.

(i) Any Home Health Agency aggrieved by a decision of the Licensure Division may request a hearing by submitting a written request to the Licensure Division within ten (10) days of receipt of the adverse action.

(ii) Except in matters concerned with the spread of communicable disease, the Li- censure Division (Nurse Administrator or designated representative) shall present the preliminary de- cisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for hearing shall adhere to the time frames of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for hearing shall adhere to the time frames in (i) above.

(iv) Hearings requested under the terms of these licensure rules shall be held in ac- cordance with the provisions of the Wyoming Administrative Procedures Act.

(f) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Home Health Agency.

(g) Surveys for Licensure.

(i) The Survey Division shall perform initial and periodic surveys for renewal of licensure.

(A) These surveys shall be based on but not limited to:

(i) The requirements of the current Licensure and Program Admin- istration Rules and Regulations for Home Health Agencies as promulgated by the Wyoming Depart- ment of Health. If there are conflicts between the Licensure and Program Administration Rules, the Licensure Rules take precedence.

(ii) Results of in home visits performed by survey staff;

(iii) Review of client medical records; and the

(iv) Effectiveness of the home health agency's quality management program.

(B) The Survey Division shall provide within ten (10) working days after the last day of survey, copies of its cited deficiencies to the Home Health Agency and the Program Division.

(C) The Home Health Agency shall provide an acceptable plan of correction for all cited survey deficiencies, within ten (10) working days after receipt of the deficiencies, to the Licensing Division.

(D) The Licensing Division shall provide written notification to the Home Health Agency and to the Program Division as to whether the plan of correction is or is not acceptable. This notification shall be provided within ten (10) working days after receipt of the plan of correction.

(h) Voluntary Closure.

(i) If a Home Health Agency voluntarily ceases to operate, it shall notify the Li- censing Division in writing at least thirty (30) calendar days prior to the closure.

(ii) The first working day after closure, the Home Health license shall be hand car- ried or sent by certified mail to the Office of Health Quality; 2020 Carey Avenue, Eighth Floor; Chey- enne, WY 82002.

(iii) Personnel, financial and client medical records shall be maintained by the lic- ensee for a minimum of six (6) years after the month of closure.

History

Effective 2001-11-01

Chapter 13 Licensure of Intermediate Care Facilities for the Mentally Retarded (ICF/MR)

Wyo. Code R. 048.0026.13.06082001 Licensure of Intermediate Care Facilities for the Mentally Retarded (ICF/MR)

RULES AND REGULATIONS FOR LICENSURE OF INTERMEDIATE CARE FACILITIES FOR THE MENTALLY RETARDED (ICF/MR)

CHAPTER 13

Section 2. Purpose. These rules have been adopted for the licensure of Intermediate Care Facilities for the Mentally Retarded. These standards are designed to protect the health and safety of clients and employees.

Section 3. Severability. If any portion of these rules are found invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions.

(a) "Acceptable plan of correction" means Wyoming Department of Health, Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) approved the plan to correct the deficiencies identified through an onsite survey. The plan of correction shall be a written document and must contain who is responsible for correction, what was done to correct the problem and who will monitor to ensure that the situation does not develop again and must contain a appropriate date for completion of the correction.

(b) "Acquired Brain Injured" means any combination of focal and diffuse central nervous system dysfunction both immediate and/or delayed at the brain stem and above. These dysfunctions are acquired through the interaction of any external force and the body, oxygen deprivation, infection, toxicity, surgery and vascular disorders not associated with aging. These dysfunctions are not develop- mental or degenerative in nature.

(c) "Central Registry" means the registry operated by the Wyoming Department of Family Services pursuant to Wyoming Statute §14-3-213, which indexes perpetrators of child abuse or neglect and abuse and neglect, exploitation or abandonment of disabled adults.

(d) "Related Conditions" means acquired brain injured individuals who require services like those individuals who are mentally retarded.

(e) "Intermediate Care Facility for the Mentally Retarded (ICF/MR)" means a facility which provides on a regular basis health related care and training to mentally retarded individuals or persons with related conditions, who do not require the degree of care and treatment of a hospital or nursing facility and services above the need of a boarding home.

(f) "Fidelity bond" means a contract of fidelity insurance. One agrees to ensure another against loss arising from the want of honesty, integrity or fidelity of an employee of the ICF/MR.

(g) "Governing body" means the individual(s), group, or agency that has ultimate authority and responsibility for establishing client policies, personnel policies, and providing for organizational management and planning.

(h) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(i) "Physician" means a person licensed to practice medicine in Wyoming by the Wyo- ming Board of Medicine.

(j) "Registered Nurse (RN)" means a graduate of an approved school of professional nurs- ing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

Section 5. Licensing.

(a) Licensing requirements. The Office of Health Quality has been authorized to issue licenses to ICF/MR's and has established a system of licensure to comply with minimum requirements for the purpose of protecting the health, welfare and safety of clients receiving this type of service.

(b) Licensing procedure.

(i) For an initial license to be issued the Office of Health Quality shall receive:

(A) A completed application form as supplied by the Office of Health Qual- ity.

(B) The required licensure fee as outlined in Chapter 1, Rules and Regula- tions for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(D) The effective date of the initial license shall be:

(1) The date of the survey, if there are no deficiencies, or

(2) If deficiencies exist, the date that a plan of correction is approved.

(E) The length of the license shall be from the effective date of the license until the next June 30th.

(ii) For renewal of a full license for one year beginning July 1st, and unless suspended, or revoked, shall expire on June 30th of the following year, the Office of Health Quality shall receive:

(A) A completed application form by the date requested in the cover letter.

(B) The license fee as required in paragraph (b) of this section.

(i) The ICF/MR shall be in conformity with all laws and standards relating to commu- nicable and reportable diseases as promulgated by the Department of Health, Division of Public Health.

(ii) The existing deficiencies that may create a hazard to the health, safety or welfare of the clients.

(iii) The agency shall correct existing deficiencies.

(iv) There shall be adequate policies and procedures in place to guide operations.

(v) All applicants for initial licensure shall be reviewed by the Department of Health, Developmental Disabilities Division. The Division shall determine whether there is or is not a valid need for the new service and suitability of the applicant to provide this service. The Division shall forward written justification to the Office of Health Quality which states whether there is or is not a valid need for the new service.

(d) Transfer of license.

(i) No license granted shall be assignable or transferrable. A license shall apply only to the ICF/MR described in the license application.

(A) Whenever ownership of an ICF/MR is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The transferee shall notify the Office of Health Quality of the transfer and apply for a new license.

(1) The transferor shall notify the Office of Health Quality at least thirty (30) days prior to the final transfer.

(I) Any license granted to the transferee shall be subject to the plan of correction submitted by the previous owner as approved by the Office of Health Quality.

(ii) If the ICF/MR's name or address is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(e) Conditions for revoking a license.

(i) Denial of application - revocation of license.

(ii) Hearings.

(A) Any ICF/MR aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within ten (10) days of the receipt date of the notice of adverse action.

(B) Except in matters concerned with the spread of communicable disease as required in sections (c)(i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the aggrieved ICF/MR and provide an opportunity for hearing (if such is requested within the appropriate time frame).

(1) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer shall present the preliminary decisions and reasons to the parties con- cerned and provide an opportunity for a hearing (if such is requested within the appropriate time frame).

(C) Hearings requested under the terms of these rules and regulations shall be held by the Office of Health Quality in accordance with the provisions of the Wyoming Administra- tive Procedures Act at W.S. §16-3-113, and with the contested case rules and regulations of the Wyo- ming Department of Health.

(f) Posting of license.

(i) The current license issued by the Office of Health Quality shall be displayed in a public area within the ICF/MR.

(g) Survey of the ICF/MR.

(i) Shall be arranged by the Office of Health Quality through its duly authorized officers, agents, or consultants. The survey shall be made unannounced and at periodic intervals de- pendant on the results of the previous survey and funding. All records of the ICF/MR shall be made available to the surveyor.

(h) Requirements of the Office of Health Quality.

(i) The Office of Health Quality shall provide each ICF/MR with:

(A) A copy of the list of deficiencies found, if any; and

(B) A copy of these rules and regulations.

(i) Voluntary closure

(i) If an ICF/MR voluntarily ceases to operate, it shall notify the Office of Health Quality in writing at least thirty working days prior to the closure.

(ii) Five working days after closure, the ICF/MR shall return its license to the Office of Health Quality.

Section 6. Organization and Administration.

(a) Governing Body. The ICF/MR shall have a governing body which has legal authority and responsibility to operate the ICF/MR. The governing body shall:

(i) Appoint an administrator who is responsible for managing the ICF/MR.

(ii) Obtain a fidelity bond for client protection arising from the want of honesty, integrity or fidelity of an employee. The bond shall consist of no less than $2500 and shall be aug- mented in relation to the number of employees.

(iii) Provide verification of a central registry checks on all employees hired on or after the filing of these rules. Each ICF/MR is responsible to initiate and follow this process to completion.

Central registry information can be obtained by contacting the Department of Family Services at 307-777-5366. (This number may be subject to change.)

(iv) Adopt, revise, and approve personnel policies; including:

(A) Frequency of employee evaluations;

(B) Insuring confidentiality of central registry information checks.

(v) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client level.

(vi) The governing body shall ensure in accordance with State Statute 35-2-910, effective , ongoing, facility wide written quality improvement program which ensures and evaluates the quality of care provided to all clients.

(vii) The governing body shall be accountable for the quality of care provided to the client.

(viii) Personnel Records.

(A) There shall be one person designated responsible for maintaining confi- dentiality.

(B) The personnel records for an employee shall include:

(1) Central registry information checks, which shall be maintained in locked cabinet at all times.

(ix) Notification.

(A) Prior to admission all perspective clients shall be notified if the ICF/MR is not Medicare/Medicaid certified.

(x) Services.

(A) Furnished services, including the contracted services, shall comply with all applicable licensure standards;

(B) Medical and nursing staff shall be licensed, certified, or registered accord- ing to Wyoming laws and rules; and

Section 7. Physical Environment.

(a) The ICF/MR shall be constructed, arranged, and maintained to ensure health and safety of the client.

(i) The building interior and exterior shall be clean, orderly, sanitary, and free of odors.

Section 8. Construction/Remodeling. Department of Health Chapter 3, Construction Rules for Health Facilities apply.

Section 9. Life Safety and Electrical Safety. Department of Health Chapter III, Construction Rules for Health Facilities apply.

(a) Intermediate Care Facilities for Mentally Retarted (ICF/MR) operating prior to the effec- tive date of these rules, shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as a ICF/MR.

(b) All plans and specifications for construction and/or remodeling shall be approved by the Office of Health Quality prior to construction.

History

Effective 2001-06-08

Chapter 14 Licensure of Medical Assistance Facilities

Wyo. Code R. 048.0026.14.07151997 Licensure of Medical Assistance Facilities

RULES AND REGULATIONS FOR LICENSURE OF MEDICAL ASSISTANCE FACILITIES

CHAPTER 14

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Licensure Act at W. S. 35-2-901 et seq. and the Wyo- ming Administrative Procedures Act at W. S. 16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the licensure of Medical Assistance Facilities. The purpose of these standards is to provide minimum requirements for services, structure, operation and personnel practices designed to protect the health and safety of patients and employees.

Section 3. Severability. If any portion of this rule is found invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions.

(a) Administrator is the person in charge of the operation of the facility twenty-four hours per day; and is:

(i) A Physician,

(ii) A Mid-level Practitioner,

(iii) A registered nurse, or

(iv) aAn individual with training and experience in health service adminis- tration.

(b) Central Registry means the registry operated by the Wyoming Department of Family Services pursuant to Wyoming Statute §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults. The registry information is available by calling 307-777-5366.

(c) Certified Nurse Aide means a person who has successfully completed Wyoming Board of Nursing training program and competency evaluation.

(d) Clinical Laboratory Improvement Act (CLIA) means the clinical laboratories approved by the U.S. Department of Health and Human Services, Health Care Financing Administration as required by 42 CFR Part 493, Section 1861 (e) and (j), the sentence following section 1861 (s)(13), and 1902(a)(9) of the Social Security Act and Section 353 of the Public Health Service Act.

(e) Collaborative Practice means the implementation of the formal written plan that outlines procedures for consultation and collaboration with other health care professionals, e. g., licensed physicians and mid-level practitioners.

(f) Collaborative Plan means the formal written plan between the mid-level practitioners and a licensed physician.

(g) Dietitian means a person who is registered by the American Dietetic Asso- ciation and provides nutritional and dietary consultation services.

(h) Facility means a medical assistance facility.

(i) Hospital means an institution licensed pursuant to W.S. 35-2-901 et seq.

(j) Licensed Practical Nurse (LPN) means, a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21- 120.

(k) Medical Assistance Facility means a facility which provides inpatient care to ill or injured persons prior to their transportation to a hospital, or provides inpatient care to persons needing care for a period of no longer than sixty hours, and is located more than thirty miles from the nearest Wyoming hospital.

(l) Mid-level practitioner means either an advanced practitioner of nursing or a physician assistant.

(l) Registered Nurse is a graduate of an approved school of professional nurs- ing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(m) Physician means a person licensed to practice medicine in Wyoming by the Wyoming Board of Medicine.

(n) Physician assistant means a person who is approved by the Wyoming Board of Medicine to practice as a physician assistant.

(o) Practitioner means a physician, mid-level practitioner of nursing, or physi- cian assistant.

Section 5. Licensing.

(a) Licensing requirements. The Wyoming Department of Health, Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) has been duly authorized to issue licenses to Medical Assistance Facilities. The Office of Health Quality has established a system of licensure to comply with minimum requirements for the pur- pose of protecting the health, welfare and safety of patients receiving this type of service.

(b) Licensing procedure.

(i) For an initial license to be issued the Office of Health Quality shall receive:

(A) A completed application form shall be submitted to the Office of Health Quality.

(B) Licensure fee. Each application shall be accompanied by the required licensure fee outlined in Chapter 1 Rules and Regulations for Health Care Facili- ties Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a license the Office of Health Quality shall require:

(A) A completed application form returned by the date indicated in the cover letter.

(I) The application forms shall be mailed by the Office of Health Quality to the facility.

(B) License fee. Each application shall be accompanied by the required licensure fee outlined in Chapter 1, Rules and Regulations for Health Care Facili- ties Licensure Fees. The check shall be made payable to the Treasurer, State of Wyo- ming.

(i) The medical assistance facility shall be in conformity with all laws and standards relating to communicable and reportable diseases as promulgated by the De- partment of Health, Division of Preventive Medicine.

(ii) Existing deficiencies shall not create a hazard to the health, safety or welfare of the patients.

(iii) The medical assistance facility shall make a positive effort to correct all existing deficiencies.

(iv) Policies and procedures shall be in place to guide operations.

(v) There is adequate and appropriately trained staff.

(vi) The medical assistance facility shall have an organized and imple- mented quality improvement plan.

(vii) There shall be an approved plan of correction for all cited deficiencies.

(d) Issuance of license.

(i) For initial licensure the date of the license shall be:

(A) The date of the survey, if there are no deficiencies, or

(B) If deficiencies exist, the date that an acceptable plan of correc- tion is developed.

(C) The period of the license shall be one year beginning on July 1st, and unless suspended or revoked, shall expire on June 30th of the following year.

(e) Transfer of license.

(i) No license granted shall be assignable or transferrable. A license shall apply only to the geographical location described in the license application.

(A) Whenever ownership of a facility is transferred from the indi- vidual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The transferee shall notify the Office of Health Quality of the transfer and apply for a new license.

(I) Any license granted to the transferee shall be subject to the plan of correction submitted by the previous owner as approved by the Office of Health Quality.

(B) The transferor shall notify the Office of Health Quality at least thirty (30) days before the final transfer.

(ii) If the medical assistance facilitys name is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(f) Conditioning or revoking a license.

(i) Denial of application - suspension or revocation of license.

(A) An application for license may be denied or a previously issued license may be suspended or revoked for noncompliance with minimum standards as herein set forth when noncompliance jeopardizes the health, safety or welfare of patients.

(ii) Suspension of admissions.

(A) The Office of Health Quality may suspend new admissions or re-admissions to a medical assistance facility when conditions in the facility are such that patient needs cannot be met. Conditions in a medical assistance facility shall not jeopar- dize the patients health and/or safety.

(iii) Hearings.

(A) Any medical assistance facility aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within thirty (30) days of the date of the decision.

(B) Except in matters concerned with the spread of communicable disease, as required in Sections (c) (i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing, if a hearing is requested, within thirty (30) days.

(C) Hearings requested under the terms of these rules and regula- tions shall be held by the Office of Health Quality according to the provisions of the Wyo- ming Administrative Procedures Act at W.S. 16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

(g) Posting of license.

(i) The current license issued by the Office of Health Quality shall be displayed in a public area within the medical assistance facility.

(h) Survey of the medical assistance facility.

(i) The survey of the medical assistance facility shall be arranged by the Office of Health Quality. The survey shall be performed periodically. All records of the facility shall be available to the surveyor.

(i) Requirements of the Office of Health Quality.

(i) The Office of Health Quality shall provide each medical assistance facility with:

(A) A copy of these standards; and

(B) A copy of any deficiencies found.

Section 6. Organization and Management.

(a) Governing Body. The medical assistance facility shall have a governing body which has the legal authority and responsibility to operate the medical assistance facility. The governing body shall:

(i) Appoint an administrator who is responsible for managing the facility.

(iii) Provide verification of a central registry and criminal background infor- mation check on all employees hired at the time of or after the filing of these rules. The individual agencies or corporations are responsible to initiate and follow this process to completion.

Central registry information can be obtained by contacting The Depart- ment of Family Services at 307-777-5366. (This number is subject to change.)

(iv) Adopt, revise, and approve personnel policies; including:

(A) Frequency of evaluations;

(B) Insuring confidentiality of a central registry information checks.

(v) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client care level.

(vi) The governing body shall ensure that all services provided are consis- tent with accepted standards of practice.

(vii) The governing body shall be accountable for the quality of care pro- vided to the patient.

(viii) There shall be policies and procedures for services offered, which shall be reviewed annually by the governing body. Policies required but not limited to:

(A) Every patient shall be under the care of a physician or under the care of a mid-level practitioner supervised by a physician;

(B) Whenever a patient is admitted to the facility by a mid-level practitioner, the facilitys sponsoring physician shall be notified of that fact, by phone or otherwise, within 24 hours, and a written notation of the consultation and of the physicians approval or disapproval shall be maintained in the patients record;

(C) A physician, a mid-level practitioner or a registered nurse shall be on duty and be physically available in the facility.

(D) No patient is cared for in the facility for more than 60 hours.

(ix) ab Personnel Records.

(A) ab There shall be one person designated responsible for maintaining the confidentiality.

(x) Employee Health. The medical assistance facility shall:

(A) Develop policies and procedures for employee health including a policy identifying communicable diseases that could put the client population at risk.

(xi) Advanced Directives.

(A) The medical assistance facility shall adopt policies which assure that they provide information on advanced directives to clients. If the clients advanced directives are known they shall be followed by the medical assistance facility.

(xii) Services:

(A) Furnished services, including the contracted services, shall comply with all applicable licensure standards; and

(B) Medical and nursing staff shall be licensed, certified, or regis- tered according to Wyoming law and rules.

(C) Staff member shall provide health services only within the scope of his or her license, certification or registration.

Section 7. Medical Staff

(a) The facility shall have a medical staff that includes at least one physician, and may also include one or more mid-level practitioners, and does the following:

(i) Examines the credentials of candidates for medical staff membership and makes recommendations to the governing body on the appointment of the candidate;

(ii) Adopts a collaborative plan containing the following, and enforces the collaborative plan after approval by the governing body;

(A) A statement of the duties and privileges of each category of medical staff (e.g., physician and mid-level practitioner); and

(B) A requirement that a physical examination be made and medical history taken of a patient by a member of the medical staff no more than 24 hours after the patients admission to the facility.

(b) A physician on staff shall:

(i) Provide medical direction for the facilitys health care activities and consultation for non-physician health care providers;

(ii) In conjunction with the mid-level practitioner staff members, partici- pate in developing, executing, and periodically reviewing the facilitys written policies and the services provided to patients;

(iii) Review and sign the records of each patient admitted and treated by a mid-level practitioner no later than fifteen (15) days after that patients discharge from the facility;

(iv) Provide health care services to the patients in the facility, whenever needed and requested;

(v) Prepare guidelines for the medical management of health problems, including conditions requiring medical consultation and/or patient referral; and

(vi) At intervals no more than two weeks apart, be physically present in the facility for a sufficient time to provide the medical direction, medical care services, and staff consultation required by the collaborative plan;

(A) When not present, either be available through direct telecommu- nication for consultation and assistance with medical emergencies, and patient referral, or ensure that another physician is available for the purpose;

(B) However, the physical site visit for a given two week period is not required if, during that period, no inpatients have been treated in the facility.

(i) Participate in the development, execution, and periodic review of the guidelines and written policies governing the services furnished by the facility;

(ii) Participate with a physician in a review of each patients health records;

(iii) Provide health care services to patients according to the facilitys policies;

(iv) Arrange for, or refer patients to needed services that are not provided at the facility; and

(v) Assure that adequate patient health records are maintained and trans- ferred as necessary when a patient is referred.

Section 8. Nursing Services.

(a) A medical assistance facility shall have a nursing service program that pro- vides 24-hour services whenever a patient is in the facility and meets the following requirements:

(i) The director of nursing services shall:

(A) Be a Wyoming licensed registered nurse.

(B) Determine the type and number of nursing personnel and staff necessary to provide nursing care; and

(C) Schedule adequate numbers of licensed registered nurses, li- censed practical nurses, certified nursing assistants and other personnel to provide nurs- ing care as needed.

(ii) A registered nurse shall be on duty at least eight hours per day, and the director of nursing or another registered nurse designated as the directors alternate shall be on call and available within 20 minutes at all times.

(iii) All drugs and biologicals shall be administered by a nurse, a physician, or a mid-level practitioner according to;

(A) Federal and state law and regulations, including applicable li- censing requirements.

Section 9. Pharmaceutical Services.

(a) The facility shall have pharmaceutical services that meet the needs of the patients and comply with the following standards:

(i) A drug storage area under the supervision of the Director of Nursing who shall develop, supervise, and coordinate all of the pharmacy services.

(ii) The pharmacy or drug storage area shall be administered according to accepted professional standards.

(iii) All compounding, packaging, and dispensing of drugs and biologicals shall be consistent with federal and state law.

(iv) Drugs and biologicals shall be kept in a locked storage area.

(v) Outdated, mislabeled, or otherwise unusable drugs and biologicals shall be destroyed by grinding in a garbage disposal or incineration; and

(vi) Drug administration errors, adverse drug reactions, and incompatibili- ties shall be immediately reported to the attending practitioner.

Section 10. Radiologic Services.

(a) The facility shall maintain, or have available, diagnostic radiologic services, which shall meet the following standards:

(i) The radiologic services shall be free from radiation hazards for patients and personnel.

(ii) Annual inspection of equipment shall be made and hazards identified are promptly corrected.

(iii) Radiation workers shall continuously wear monitoring badges that are to be checked quarterly to determine the amount of radiation to which they are routinely exposed.

(iv) A qualified full-time, part-time, or consulting radiologist shall be uti- lized to interpret those radiographic tests that are determined by the medical staff to require a radiologists specialized knowledge.

(A) The radiologist or other practitioner who provides radiology services shall sign each report containing his/her interpretations.

(v) Only personnel designated as qualified by the medical staff, and meet- ing requirements of state law, may use the radiographic equipment and administer proce- dures.

(vi) The facility shall maintain any radiographic studies and their interpreta- tions for at least five years.

Section 11. Laboratory Services.

(a) The facility shall maintain, or have available, clinical laboratory services ad- equate to fulfill the needs of its patients and meeting the following standards:

(i) The facility, at a minimum, shall provide basic laboratory services essential to the immediate diagnosis and treatment of patients, including:

(A) Chemical examinations of urine by stick or tablet methods, or both (including urine ketones);

(B) Microscopic examinations of urine sediment;

(D) Blood sugar;

(E) Gram stain;

(F) Examination of stool specimens for occult blood;

(G) Pregnancy tests;

(H) Primary culturing for transmittal to a CLIA certified laboratory;

(I) Sediment rate, and

(J) CBC.

(ii) The facility shall have a contractual agreement with a CLIA approved hospital or independent laboratory for any additional laboratory services that are needed by a patient.

(iii) Emergency provision of basic laboratory services shall be available 24 hours a day.

(iv) Only personnel designated as qualified by the medical staff by virtue of education, experience, and training may perform and report laboratory test results.

(v) The laboratory shall be a CLIA certified laboratory.

Section 12. Food and Dietetic Services.

(a) The facility shall have dietary services that are directed and staffed by ad- equate personnel and meet the following standards:

(i) The facility shall assign an employee or contract with a consultant to direct the food and dietetic service and to be responsible for the daily management of the dietary service.

(A) The minimum qualifications would be an individual qualified by experience and training as a food service supervisor.

(ii) The facility shall utilize a qualified dietitian, full-time, part-time, or on consultant basis.

(iii) A therapeutic diet for a patient shall be prescribed by the practitioner responsible for the care of the patient.

(iv) Nutritional needs shall be met in accordance with recognized dietary practices and, at a minimum, the recommended daily dietary allowances established by the Food and Nutrition Board of the National Research Council, National Academy of Sciences, 1989.

(v) A current therapeutic diet manual approved by the dietitian and medi- cal staff shall be readily available to all medical, nursing, and food service personnel.

Section 13. Required Contracted Services.

(a) The facility shall enter into agreements with one or more hospitals participat- ing in Medicare/Medicaid program to provide services which the facility itself is unable to provide.

Section 14. Medical Records.

(a) The facility shall maintain a medical records system in accordance with writ- ten policies and procedures:

(i) The facility shall employ adequate personnel to ensure professional standards of practice for medical records are met.

(ii) The facility shall create and maintain a record for each person receiv- ing health care services from the facility that includes, if applicable:

(A) Identification and social data;

(B) Admitting diagnosis;

(D) Properly executed consent forms;

(E) Reports of physical examinations, diagnostic and laboratory test results, and consultation findings;

(F) All physicians orders, nurses notes, and reports of treatments and medications;

(G) Final diagnosis;

(H) Discharge summary; and

(I) Any other pertinent information necessary to monitor the patients prognosis.

(iii) Each record shall include the signatures of the physician and the health care professionals documentation.

(iv) Records of a discharged patient shall be completed within fifteen (15) days of the discharge date.

(v) The facility shall have written policies and procedures ensuring the confidentiality of patient records, safeguards against loss, destruction, or unauthorized use, in accordance with applicable state and federal law and including policies and proce- dures which:

(A) Govern the use and removal of records from the record storage area;

(B) Specify the conditions under which record information may be released and to whom;

Section 15. Quality Improvement

(a) The governing body in accordance with State Statute 35-2-910, shall ensure there is an effective, on-going, facility-wide, written quality improvement program which ensures and evaluates the quality of the patient care provided and includes:

(i) At least annually the quality improvement program shall review the following:

(A) The utilization of facility services, including at least the number of patients served and volume of services.

(B) The facilitys health care policies.

(b) The taking and documentation of appropriate remedial action to address deficiencies found through the quality assurance program, as well as documentation of the outcome of remedial action.

Section 16. Infection Control.

(a) The facility shall:

(i) Maintain a sanitary environment which prevents the transmission and sources of infections and communicable diseases.

(ii) Develop and implement policies governing control of infections and communicable diseases.

(iii) Maintain a log of incidents related to infections and communicable diseases.

Section 17. Physical Environment

(a) ab The medical assistance facility shall be constructed, arranged, and maintained to ensure the health and safety of the patient, and to provide for diagnosis and treatment.

(i) The building interior and exterior shall be clean, orderly, sanitary, and free of odors.

(ii) Each patient room must have a nurse call system which has an indica- tion light outside of the room and sounds an alarm at the nurses station.

(A) The nurse call system shall only be turned off in the patients room.

(B) The nurse call system shall function also in toilet and bath ar- eas.

(iii) A comfortable room temperature not to exceed 78o or less than 70o at 36 inches above the floor.

(iv) All essential mechanical and electrical equipment shall be maintained in safe operating condition.

(v) Continuous mechanical ventilation shall be provided.

(vi) Corridors shall be equipped with firmly secured handrails on each side.

(vii) Single patient rooms shall have at least 100 square feet of floor space and multiple patient rooms shall have at least 80 square feet of floor space per patient.

(A) The following areas shall not be counted in the floor space requirements:

(I) Floor space in a vestibule,

(II) Floor space under a door swing area,

(III) Floor space under permanent fixtures (e.g. closets);

(IV) Other floor space not usable by the patient.

(b) The medical assistance facility shall meet the 1994 edition of the Life Safety Code of the National Fire Protection Association applicable to health care facilities.

(i) Use of fire alarms;

(ii) Transmission of firm alarm to fire department;

(iii) Response to fire alarms;

(iv) Isolation of fire;

(v) Evacuation of area;

(vi) Preparing building for evacuation;

(vii) Fire extinguishment;

(viii) Protection of patients, visitors, staff; and

(ix) Cooperation with local fire fighting authorities.

Section 18. Construction/Remodeling

(a) If the physical plant was a Medicare/Medicaid certified hospital within twenty-four months prior to opening as a medical assistance facility and no renovation has been done, then the physical plant will be grandfathered.

(b) If there has been:

(i) Renovation to the physical plant; or

(ii) The building has been closed as a Medicare/Medicaid certified hospital for more than twenty-four months; or

(iii) The building is new construction;

(iv) Then the building shall meet all requirements established in:

(A) Current edition of Section 9. 6 Freestanding Emergency Facility of Guidelines for Construction of Hospitals and Medical Facilities, and

(B) Chapter III Construction Rules for Health Facilities.

(c) All plans and specifications for construction and/or remodeling shall be ap- proved by the Office of Health Quality prior to construction.

History

Effective 1997-07-15

Chapter 15 Licensure of Psychiatric Hospitals

Wyo. Code R. 048.0026.15.06181999 Licensure of Psychiatric Hospitals

RULES AND REGULATIONS FOR LICENSURE OF PSYCHIATRIC HOSPITALS

CHAPTER 15

Section 2. Purpose. These rules have been adopted to protect the health, safety and welfare of patients and employees in Psychiatric Hospitals.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules.Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and visa versa. Throughout these rules gender pronouns are used interchangeable. 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 purpose of these rules, the following shall apply:

(a) "Acceptable Plan of Correction " means the Licensing Divisionapproved the Psychi- atric Hospital's plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division or its designated representative. The plan of correction shall be a written document and shall provide, but not be limited to, the following information:

(i) Who is responsible for the correction.

(ii) What was done or will be done to correct the problem.

(iii) Who will monitor to ensure that the situation does not develop again.

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) "Certified Occupational Therapy Assistant" means a person licensed to assist in the practice of occupational therapy, and who works under the supervision of a registered occupational therapist pursuant to W.S. §33-40-102.

(c) "Clinical Director" means a physician who is licensed by the Wyoming Board of Medicine to practice medicine in Wyoming. The clinical director shall meet the training and other requirements for examination by the American Board of Psychiatry and Neurology or the American Osteopathic Board of Neurology and Psychiatry.

(d) "Clinical Laboratory" means a facility for the microbiological, serological, chemical, hematological, immunohematological, cytological or pathological examination of materials derived from a human body for the purpose of obtaining information for the diagnosis, prevention or treat- ment of disease or assessment of medical conditions.

(e) " Complaint Investigations" means those investigations required to be performed by the Licensing Division.

(f) "Dietitian" means a person who is registered by the American Dietetic Association and provides nutritional and dietary services.

(g) "Dietetic Manager/Supervisor" means an individual who has at a minimum a high school education or equivalent and has completed courses in food service supervision, but is not a registered dietitian.

(h) "Director of Psychiatric Nursing Services" shall be a registered nurse who has a master's degree in psychiatric or mental health nursing, or its equivalent from a school of nursing accredited by the National League for Nursing, or be qualified by education and experience in the care of the mentally ill.

(i) "Drug Administration" means an act in which a single dose of an identified drug is given to a patient.

(j) "Drug Dispensing" means the issuance of one or more doses of a prescribed medica- tion in containers that are correctly labeled to indicate the name of the patient, the contents of the containers, and all other vital information needed to facilitate correct patient usage and drug adminis- tration.

(k) "Facility" means a Psychiatric Hospital.

(l) "Governing Body" means the individual(s), group or corporation that is legally responsible for the Psychiatric Hospital.

(m) "Health Care Services" includes but is not limited to nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, social services, nurse assistant, and dietary ser- vices. Staff shall be licensed or registered in accordance with Wyoming State Statutes.

(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.

(i) Diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons;

(ii) Rehabilitation services for the rehabilitation of injured, disabled or sick persons;

(iii) Acute care;

(iv) Psychiatric care;

(vi) Swing beds.

(o) "Laboratory Director" means a person who is qualified by CLIA (federal) and state standards (e.g.; pathologist, medical doctor, or PhD, MS, BS degrees).

(p) "License" means the authority granted by the Licensing Division to operate a Psychiatric Hospital.

(q) "Licensee" means any person, association, partnership, or corporation holding a Psychiatric Hospital license.

(r) "Licensing Division" means the Department of Health, Office of Health Quality.

(s) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21- 120.

(t) "LSC" means NFPA 101 Life Safety Code cited in the Department of Health, Chapter III Construction Rules for Health Facilities.

(u) "Medical Record Administrator" means Accredited Record Technician (A.R.T.) who has passed the appropriate accreditation examination conducted by the American Medical Record Association, or who has the equivalent of such education and training.

(v) "Medical Technologist" means a person who is a graduate of a program in medical technology approved by the Council on Medical Education of the American Medical Association, or has the equivalent of such education and training.

(w) "NEC" means the National Electric Code.

(x) "NFPA" means the National Fire Protection Association.

(y ) " Nursing Service" means patient care services pertaining to the curative, restorative, and preventive aspects of nursing that are performed and/or supervised by a registered nurse pursuant to the psychiatric care plan of the practitioner and the nursing care plan.

(z) "Occupational Therapist" means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Registered Occupational Therapist pursuant to W.S. §33-40- 102.

(aa) "Pharmacist" means a person licensed as a Pharmacist in Wyoming.

(bb) "Physical Therapy Assistant" means a person who is licensed by the Wyoming Board of Physical Therapy to practice as a physical therapy assistant under the supervision of a registered Physical Therapist pursuant to §33-25-101.

(cc) "Physical Therapy Services" means services provided by a physical therapist or a physical therapy assistant licensed pursuant to W.S. §33-25-101.

(dd) "Physical Therapist" means a person who is licensed to practice physical therapy in the State of Wyoming pursuant to W.S. §33-25-101.

(ee) "Physician" means a person who is licensed by the Wyoming Board of Medicine to practice medicine in Wyoming.

(ff) "Quality Management Program" means a program developed and implemented by a Psychiatric Hospital to evaluate and improve patient care and services.

(gg) "Registered Nurse" means a person who is a graduate of an approved school of professional nursing, and who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

(hh) "Speech Language Pathologist" means a person who is licensed in the State of Wyo- ming to practice speech language pathology.

(ii) "Speech Pathology" means the application of principles, methods, and procedures for the evaluation, monitoring, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language for preventing, identifying, evaluating and reducing the effects of such disorders and conditions.

(jj) "Survey" means a periodic on-site evaluation conducted by the Survey Division or its designated representative to determine compliance with State Licensure Rules and Regulations for Psychiatric Hospitals.

(kk) "Survey Division" means the Department of Health, Office of Health Quality or its designated representative.

(ll) "Therapy Service" means physical therapy, occupational therapy, and speech lan- guage therapy.

Section 5. Licensure. Applicants must demonstrate full compliance with paragraphs

(a) and (b) of this section.

(a) Licensing Procedure.

(i) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division.

(B) Each completed application shall be accompanied by therequired licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one year beginning July 1st, and unless suspended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a) (i) (B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and annual renewal licensure survey deficiencies cited by the Survey Division;

(ii) Life Safety Code deficiencies cited by the Survey Division;

(iii) Complaint investigations and resolutions;

(iv) Compliance with all laws and standards relating to communicable and reportable diseases as required by the Department of Health, State Health Officer and Public Health Division; and

(v) The effectiveness of the quality management program to evaluate and improve patient care and services.

(i) No license granted shall be assigned or transferred by the licensee without prior approval of the Licensing Division.

(A) Requests to assign or transfer a Psychiatric Hospital license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer.

(B) Any license approved for assignment or transfer by the Licensing Division shall be subject to the plan of correction for licensure submitted by the previous owner.

(ii) If the Psychiatric Hospital's name is changed, the Licensing Division shall be advised in writing, before the name is changed, by the current licensee and a new license will be issued upon the receipt of an application and licensure fee.

(d) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(e) Suspension of Admissions.

(i) The Licensing Division may suspend new admissions or re-admissions to the Psychiatric Hospital when conditions are such that patient needs cannot be met. Conditions in a Psychiatric Hospital shall not jeopardize the patient's health or safety.

(f) Monitor.

(i) The Licensing Division shall place a Department of Health approved monitor at the Psychiatric Hospital's expense when conditions are such that patients' needs are not being met by the Psychiatric Hospital. The monitor shall insure that neither the health nor the safety of the patients is jeopardized.

(g) Hearings.

(i) Any Psychiatric Hospital aggrieved by a decision of the Licensing Division may request a hearing by submitting a written request to the Licensing Division within ten (10) days of receipt of the adverse action.

(ii) Except in matters concerned with the spread of communicable disease, the Licensing Division (Nurse Administrator or designated representative) shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for hearing shall adhere to the time frames of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for a hearing shall adhere to the time frames in (i) above.

(iv) Hearings requested under the terms of these licensure rules shall be held in accordance with the provisions of the Wyoming Administrative Procedures Act.

(h) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Psychiatric Hospital.

(i) Surveys for Licensure.

(i) The Survey Division or its designated representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Licensure Rules and Regulations for Psychiatric Hospitals as promulgated by the Wyoming Department of Health.

(B) The Survey Division shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the Psychiatric Hospital.

(C) The Psychiatric Hospital shall provide an acceptable plan of correction for all cited deficiencies, within ten (10) working days after receipt of the deficiencies, to the Licensing Division.

(ii) At the time of survey, all records, including patient medical records, pertaining to matters involved in the survey shall be made available to members of the survey team in their assigned disciplines.

(j) Voluntary Closure.

(i) If a Psychiatric Hospital voluntarily ceases to operate, it shall notify the Licensing Division in writing at least thirty (30) working days prior to closure.

(ii) The first working day after closure, the Psychiatric Hospital's license shall be hand carried to or sent by certified mail to the Office of Health Quality; 2020 Carey Avenue, Eighth Floor; Cheyenne, WY 82002.

Section 6. Governing Body. There shall be a governing body legally responsible for the management and operation of the Psychiatric Hospital.

(a) Bylaws shall be adopted by the governing body in accordance with legal requirements.

(i) The bylaws shall:

(A) Stipulate the basis upon which members are selected, term of office, and duties.

(B) Specify to whom responsibilities for the operation and management of the Psychiatric Hospital, including evaluation of Psychiatric Hospital practices, shall be delegated.

(b) Medical staff members shall be appointed by the governing body.

(i) There shall be a formal procedure established, governed by written rules and regulations, covering the application for medical staff membership and the method of processing applications.

(c) The Psychiatric Hospital Administrator, appointed by the governing body, shall be the executive officer of the hospital and shall be an individual qualified in hospital administration either by sufficient education or experience. He/She shall be responsible directly to such governing entities and shall execute all policies established by the governing body.

(d) All hospitals must receive and maintain formal designation through the Department of Health's Trauma System Enhancement Program (W.S. §35-1-801). The level of designation shall be at the discretion of the hospital.

(i) The administrator shall:

(A) Keep the governing body fully informed on the operation of the hospital through annual or monthly written or oral reports and by attendance at meetings of the governing body.

(B) Be responsible for developing current written personnel policies and for establishing continuing inservice programs as indicated by personnel needs.

(C) Maintain current employee records containing evidence of adequate health examinations and absence of active communicable disease.

(D) Insure that all unusual accidents and deaths are immediately reported verbally and in writing to the Licensing Division.

Section 7. Medical Staff. The hospital shall have a medical staff organized under bylaws approved by the governing body and be primarily engaged in providing psychiatric services for the diagnosis and treatment of mentally ill patients.

Section 8. Special Requirements For Inpatient Psychiatric Services.

(a) Staff Requirements. Psychiatric Hospitals shall have staff adequate in number and qualifications to carry out an active program of treatment for individuals who are furnished services in the facility.

(i) Inpatient psychiatric facilities (Psychiatric Hospitals, distinct parts of Psychiatric Hospitals or inpatient components of community mental health centers) shall be staffed with the number of qualified professional, technical, supporting personnel, and consultants required to carry out an intensive and comprehensive treatment program that shall include: evaluation of individual needs; establishment of treatment and rehabilitation goals; and implementation, directly or by arrangement, of a broad range of therapeutic programs including professional psychiatric, medical, surgical, nursing, social work, psychological and activity therapies required to carry out an individual treatment plan for each patient.

(A) Qualified professional, technical and consultant personnel shall be available to evaluate each patient at the time of admission. The evaluation shall include diagnosis of any inter-current disease. Services necessary for such evaluation shall include laboratory, radiological, and other diagnostic tests, psycho-social data, psychiatric and psychological evaluations, and a physical examination which includes a complete neurological examination when indicated, shortly after admission.

(B) The number of qualified professional personnel, consultants, technical and supporting personnel shall be adequate to assure representation of the disciplines necessary to establish short-range and long-term goals; to plan, carry out and periodically revise a written individualized treatment program for each patient based on scientific interpretation of:

(I) Degree of physical disability and indicated remedial or restorative measures (including nutrition, nursing, physical medicine and pharmacological therapeutic interventions).

(II) Degree of psychological impairment and appropriate measures to be taken relieving treatable distress and compensation for nonreversible impairments.

(III) Capacity for social interaction and appropriate nursing measures and milieu therapy to be undertaken (including group living experiences, occupational and recreational therapy and other prescribed rehabilitative activities to maintain or increase each patients capacity to manage activities of daily living).

(IV) Environmental and physical limitations required to safeguard each patient's health and safety.

(b) Director of Inpatient Psychiatric Services-Medical Staff.

(i) Inpatient psychiatric services shall be under the supervision of a clinical director, service chief or equivalent who shall be qualified to provide the leadership required for an intensive treatment program. The number and qualifications of physicians shall be adequate to provide essential psychiatric services.

(ii) The medical staff shall be qualified legally, professionally and ethically for the positions to which they are appointed.

(iii) Residency training shall be under the direction of a qualified psychiatrist.

(i) Nursing services shall be under the direct supervision of a registered nurse who shall be qualified by education and experience for the position. The number of registered nurses, licensed practical nurses and other nursing personnel shall be adequate to formulate and carry out the nursing components of the individualized treatment plan for each patient.

(ii) The number of registered nurses, including nurse consultants, shall be adequate to formulate in writing, that a nursing care plan for each patient is carried out.

(iii) Registered nurses and other nursing personnel shall be prepared by continuing inservice and staff development programs for active participation in interdisciplinary meetings affecting the planning or implementation of nursing care plans for patients (including diagnostic conferences, treatment planning sessions, and meetings held to consider alternative facilities and community resources).

(d) Psychological Services.

(i) Psychology services shall be under the supervision of a psychologist with a doctoral degree in psychology from an American Psychological Association approved program in clinical psychology or its equivalent.

(i) The psychology staff, including consultants shall be adequate in numbers and by qualifications to plan and carry out assigned responsibilities.

Note: Where a psychologist who does not hold the doctoral degree directs the program, he/she shall have attained recognition of competency through the American Board of Examiners for Professional Psychology, state certification or licensing, or through endorsement by his/her state psychological association.

(iii) Psychologists, consultants and supporting personnel shall be adequate in number and by qualifications to assist in essential diagnostic formulations, and to participate in program development and evaluation of program effectiveness, in training and research activities, in the therapeutic interventions such as milieu, individual or group therapy, and in interdisciplinary conferences and meetings held to establish diagnoses, goals and treatment programs.

(e) Social Services.

(i) Social services shall be under the supervision of a qualified social worker.

The social work staff shall be adequate in numbers and by qualifications to fulfill responsibilities related to the specific needs of individual patients and their families, the development of community resources and consultation to other staff and community agencies.

(ii) Social work staff, including other social workers, consultants, and other assistants or case aides, shall be qualified and numerically adequate to conduct pre-hospitalization studies. They shall provide psychological data for diagnosis and treatment planning, direct therapeutic services to patients, patient groups or families, to develop community resources, including family or foster care programs. They shall conduct appropriate social work research and training activities; and participate in interdisciplinary conferences and meetings concerning diagnostic formulation and treatment planning, including identification and utilization of other facilities and alternative forms of care and treatment.

(f) Qualified Therapists, Consultants, Volunteers, Assistants and Aides.

(i) Qualified therapists, consultants, volunteers, assistants or aides shall be sufficient in number to provide comprehensive therapeutic activities. They shall include occupational, recreational, and physical therapists to assure that appropriate treatment shall be rendered for each patient, and to establish and maintain a therapeutic milieu.

(ii) Occupational therapy services shall be under the supervision of a graduate of an occupational therapy program approved by the Council on Education of the American Medical Association and who has passed or is eligible for the National Registration Examination of the American Occupational Therapy Association. Note: In the absence of a full-time, fully qualified occupational therapist, a certified occupational therapy assistant as defined in W.S. §33-40-102 may function as the director of the activities program with consultation from a fully qualified occupational therapist.

(iii) When physical therapy services are offered, the services are given by or under the supervision of a qualified physical therapist who is a graduate of a physical therapy program approved by the Council on Medical Education of the American Medical Association or its equivalent. In the absence of a full time, fully qualified physical therapist, physical therapy services shall be available by arrangement with a licensed and certified hospital or by consultation or part- time services furnished by a fully qualified physical therapist.

(iv) Recreational or activity therapy services shall be available under the direct supervision of a member of the staff who has demonstrated competence in therapeutic recreation programs.

(v) Other occupational, recreational, activity and physical therapy assistants or aides shall be directly responsible to qualified supervisors and shall be provided special on-the-job training to fulfill assigned functions.

(vi) The total number of occupational, recreational, activity and rehabilitation personnel, including consultants, shall permit adequate representation and participation in the interdisciplinary conference and meetings affecting the planning and implementation of activity and rehabilitation programs, including diagnostic conferences. All daily schedule and prescribed activities including maintenance of appropriate progress records of individual patients shall be maintained.

(vii) Voluntary services workers shall be: under the direction of a paid professional supervisor of volunteers; provided appropriate orientation and training; and available daily in sufficient numbers to be of assistance to patients and their families in support of therapeutic activities.

(g) Physical and Therapeutic Environment.

(i) Areas for private conversations, group activities or therapy sessions, recreational and hobby activities and dining shall be provided commensurate with the number and characteristics of the patient population.

(ii) If staff members do not eat with the patients, dining areas shall be adequately supervised.

(iii) There shall be a written policy regarding any activities involving travel and use of facilities away from the hospital of which the service or unit is a part. This policy shall address the manner in which security of patients and staff will be ensured and shall also include a description of the way in which community law enforcement and other community resources will be informed when patient elopement occurs.

(iv) A minimum of one detention room shall be provided.

(v) Recreational equipment, games, books and magazines shall be provided in accordance with the backgrounds and needs of the patients.

(vi) Therapeutic Environment.

(A) Written policies and procedures shall be in place which govern the use of seclusion, restraints, psycho surgery, electroconvulsive therapy, behavior modification procedures that use painful stimuli, scheduled drugs and experimental treatment activities. These policies shall require specific written justification to be made and entered in the patient's record for the use of such treatment.

(B) The Psychiatric Hospital Administrator, or his/her designee, shall be the authorizing official for the use of mechanical restraints. The order to use the restraints and the reasons why they were used shall be documented in the patient's clinical record and signed by the Psychiatric Hospital Administrator, or his/her designee. The patient's clinical record shall also contain documentation of what restraints were used, and the time they were applied and released. Frequent monitoring of patients in restraints shall ensure that patients are safe and that restraints are used for the minimum amount of time clinically indicated.

(C) Written policies and procedures shall be in place regarding elopement and the use of discipline. Such policies and procedures shall include a detailed description of staff action to be taken when elopement occurs and how community law enforcement shall be informed and involved.

(D) Rehabilitation therapy shall be provided by the facility or by arrangement with other service providers, as appropriate, to meet the needs of the patient population.

Rehabilitation therapy includes:

(I) Activities which shall be provided daily, including evenings and weekends;

(II) Education services;

(III) Speech and hearing services which shall be provided to assess, as well as treat; and

(IV) Vocational services.

(E) Patients shall be encouraged to take responsibility for maintaining their own living quarters.

(I) Except for the responsibilities identified in (vi)(E) above, patients may not be required to work unless it is part of the individual treatment plan and fair compensation is paid. Any such work arrangement shall be documented and included in the patient's record.

(h) Patient's Rights.

(i) Every effort shall be made to insure that the patient or the person responsible for the patient's care or custody understands at the time of admission the policies relating to the patient's rights and responsibilities during hospitalization. This shall include the patient's rights and an explanation of the facility's policies regarding seclusion and restraints, discipline, and elopement. A copy of the written policy concerning patient's rights and responsibilities shall be provided to the patient or person responsible for the patient's care or custody at the time of admission.

(ii) A written policy shall be in place which describes the rights of patients, including a description of the circumstances under which, and to what extent, rights may be limited. Patient's rights include, but are not necessarily limited to:

(A) Communicate by sealed mail or otherwise with persons, including official agencies, inside or outside the hospital;

(B) Receive visitors;

(D) Wear his/her own clothing;

(E) An independent or in-house medical review, upon written request;

(F) Review the proceedings involving his/her commitment; and

(G) An explanation and a written copy of these rights.

(iii) A copy of these rights shall be posted in a prominent location that is available to the patients.

(iv) Any limitation of the patients rights shall be documented in the patient's record by the Psychiatric Hospital Administrator, or his/her designee, and explained to the patient.

(v) The patient's right to communicate with an attorney by sealed mail shall not in any way be subject to limitation.

(i) Grievance Procedure.

(i) The written grievance procedure shall establish a system of reviewing complaints and allegations of patient's right violations to include, but not limited to:

(A) How to voice grievances;

(B) Documentation of the provider's response to verbal and written patient grievances;

(C) List of agencies, with addresses and telephone numbers for patients to contact if grievances are not addressed satisfactorily; and

(D) Written reports of the grievances and resolutions shall be provided to the Licensing Division within ten (10) days after the grievance is filed.

(ii) The written grievance procedure shall be posted in a conspicuous place, and there shall be documentation in each patient's medical record that the resident has read or had such policy for handling grievances explained upon admission.

(j) Complaint Investigations.

(i) Patient complaints and grievances shall be referred in writing to the Licensing Division.

(ii) Written reports of investigations and the status of the resolutions shall be provided to the Licensing Division, within thirty (30) days after the investigation.

(l) Special Administrative Requirements.

(i) Inpatient psychiatric services shall be included in the program evaluation, quality assurance and utilization review policies and procedures of the Psychiatric Hospital.

(ii) Designated inpatient psychiatric services shall have a written policy regarding the contents, filing and distribution of reports required by the Department of Health and those reports required to be filed with the court pursuant to W.S. §25-10-110 et. seq. for involuntarily hospitalized patients.

(iii) At least every six (6) months the Psychiatric Hospital Administrator, or his/her designee, shall reexamine every patient involuntarily hospitalized to determine if the patient should be released, released on convalescent leave or remain hospitalized.

Section 9. Dietary Services. The Psychiatric Hospital shall have an organized dietary services directed by qualified personnel.

(a) The Psychiatric Hospital shall provide dietetary services that meet the nutritional needs of patients according to the science of nutrition.

(i) Dietetary service must operate with safe food handling practices in accordance with the most current edition of FOOD CODE from the U.S. Public Health Service, Food and Drug Administration from receipt through production and service.

(b) Dietary Supervision.

(i) Overall supervisory responsibility for dietary service shall be assigned to a full time qualified dietary supervisor.

(A) If the qualified supervisor is not a registered dietitian, she/he shall be a graduate of a dietetic technician program approved by the American Dietetic Association or a dietary managers educational program approved by the Wyoming Dietary Managers' Association. Training and experience in food service supervision and nutrition equivalent in content to the approved educational programs are acceptable.

(ii) Visits of a consultant dietitian shall be scheduled to assure that the professional dietetic service needs of the facility are met. These visits shall be scheduled for at least eight (8) hours every other week, so that adequate time is allowed for observation of more than one (1) meal per visit. Visits shall not be limited to evenings and weekends only.

(iii) Reports of the consultant dietitian shall be made verbally and in writing to the Psychiatric Hospital Administrator. The reports shall be kept on file with notations made of actions taken by the facility.

(A) The report shall include dates, length of time on-site, functions performed, and recommendations.

(iv) The consultant or staff dietitian shall:

(A) Develop written plans and conduct or supervise inservice programs for dietary personnel on a monthly basis;

(B) Participate in the development of policies and procedures, as well as the development and approval of all menus;

(D) Maintain interdisciplinary communication and to act as the dietetic service's chief liaison to the medical and nursing staffs.

(v) The dietetary supervisor shall be responsible for:

(A) Orientation, training, scheduling, and work assignments for all dietetary service personnel;

(B) Menu planning, ordering or recommending the purchase of supplies, monitoring the dietary service budget, controlling costs, maintaining associated records, etc; and

(C) Development of dietary policies and procedures. These policies shall be maintained in a manual and reviewed at least annually. Reviews and revisions shall be dated and signed by the supervisor and the consultant dietitian.

(vi) If the dietetary supervisor has responsibility for cooking, adequate time shall be allowed for supervisory management.

(i) Food service personnel shall be in good health and shall practice safe food handling techniques in accordance with the current edition of FOOD CODE published by the U.S.

Public Health Service, Food and Drug Administration.

(ii) Personnel having symptoms of a communicable disease that can reasonable be expected to be transmitted through food, a boil, an infected wound, or an acute respiratory infection shall not be permitted to work until medical clearance is received from a physician.

(iii) Personnel returning to work after an absence due to illness shall receive clearance from a physician. Written clearance shall be maintained in the employee's file.

(iv) An up-to-date manual of regimens shall be available for all therapeutic diets, as approved by the medical staff and the dietitian.

(d) Menus shall be planned and written in advance for regular and therapeutic diets. When changes in the menu are necessary, substitutions shall provide equal nutritive value.

Section 10. Laboratory.

(a) The Psychiatric Hospital shall have a well organized CLIA of 1988 (Clinical Laboratory Improvement Act of 1988) certified, supervised clinical laboratory with the necessary space, facilities, equipment and suitable location to perform those services commensurate with the Psychiatric Hospital's needs for its patients. Laboratory service may be provided by a certified, contracting laboratory.

(b) Anatomical and/or clinical pathology services and blood bank services shall be available either in the Psychiatric Hospital or by other arrangements with a CLIA certified laboratory.

Section 11. Radiology Services. The Psychiatric Hospital shall maintain or have radiological services readily available.

(a) Personnel adequate to supervise and conduct radiology services shall be provided; interpretation of radiological examinations shall be made by physicians competent to make such interpretation.

(b) Written policies and procedures concerning the operation of equipment, the use of radium or other radio-active isotopes, safety precautions, and radiation exposure shall be in place.

(c) Yearly inspection of x-ray equipment shall be made by competent personnel trained in radiation physics. Annual documentation must be kept on-site.

Section 12. Pharmacy. The Psychiatric Hospital shall have a pharmacy directed by a registered pharmacist. The pharmacy shall be administered in accordance with accepted professional principles.

(a) The pharmacist shall be responsible to the Psychiatric Hospital Administrator for developing, supervising and coordinating pharmacy activities.

(b) Prescription medications shall be compounded in a proper location by a qualified pharmacist.

(i) Drugs shall be issued to floor units in accordance with approved policies and procedures.

(ii) Drug cabinets on the nursing units shall be routinely checked by the pharmacist and all floor stocks shall be controlled.

(d) Provisions shall be made for emergency pharmaceutical services.

Section 13. Medical Library. The Psychiatric Hospital shall have a medical library.

(a) The medical library shall be located in or adjacent to the Psychiatric Hospital building; its contents shall be organized, easily accessible and available at all times to the medical and nursing staffs.

(b) The library shall contain modern textbooks in basic sciences and other current textbooks, journals and magazines pertinent to the clinical services maintained in the Psychiatric Hospital.

Section 14. Medical Records. Medical records shall stress the psychiatric component, history of findings, and the treatment rendered to patients.

(a) Preferably, a Registered Record Administrator (RRA) or Accredited Record Technician (ART) supervises the medical records function. If such a profes-sionally qualified person is not in charge of Medical Records, a qualified RRA or ART on a consultant or part-time basis shall organize the function, train the personnel, and make periodic visits to evaluate the records and the operation.

(b) Disclosure of psychiatric patient records can be made only when:

(i) The patient or guardian consents in writing; or

(ii) The patient's parent or guardian consents in writing, if the patient is a minor or incompetent; or

(iii) It is necessary to effect treatment; or

(iv) It is necessary for continuing treatment in the event of transfer or referral to another facility or service; or

(v) It is necessary for a pending court disposition or commitment proceeding.

(c) Records of Psychiatric Hospitals shall be preserved, either in the original form or on microfilm, for a period of time determined by the Psychiatric Hospital Administrator and the Archives, Records Management, and centralized Microfilm Division of the State of Wyoming Archives and Historical Department. If any records are to be destroyed, final legal authority must be granted by the State of Wyoming Archives and Historical Department Records Committee.

(d) A system of identification and filing to ensure the prompt location of a patient's medical records shall be maintained.

(i) Indexing shall be current within three (3) months following discharge of the patient.

(e) Medical records shall contain at least the following information:

(i) Identification Data and Legal Status;

(ii) Admitting/Intercurrent Diagnosis;

(iii) Reasons for Admission;

(iv) Social Service Reports;

(v) Neurological Examinations;

(vi) Psychiatric evaluations;

(vii) Medical History;

(viii) Treatment Plans;

(ix) Treatment notes;

(x) Progress notes; and

(xi) Discharge Summary.

Section 15. Infection Control Program. An Infection Control Program shall be established to prevent, identify, and control infections and communicable diseases.

(a) The infection control program shall be coordinated by the Psychiatric Hospital Administrator, the medical staff, and Director of Nursing Services, in conjunction with the Hospital's quality assurance and inservice training programs.

(b) Problems identified shall be reported to the medical staff, nursing and administration, and addressed in the Hospital's quality assurance management and inservice training programs.

Section 16. Sanitary Environment. The Psychiatric Hospital shall provide for housekeeping, maintenance, and laundry services.

(a) There shall be written policies and procedures for each of these services to ensure the use of approved practices, procedures, and products.

(i) A designated person shall be responsible for plant maintenance, laundry and general housekeeping.

(ii) Housekeeping shall be responsible for keeping the Psychiatric Hospital free of offensive odors, accumulations of dirt, rubbish, dust, insects and rodents.

(iii) Laundry facilities shall have physical separation of clean and dirty areas, adequate ventilation and temperature control.

(iv) Oxygen tubing and humidifiers shall be replaced after each usage and the length of continuous usage shall not exceed twenty-four (24) hours.

(v) There shall be written policies and procedures covering the disinfectants used on various types of equipment, surfaces, and instruments.

(vi) There shall be a written policy covering the cleaning and disinfecting of ice machines.

(vii) All garbage and kitchen refuse shall be kept in leakproof, nonabsorbent containers with tight fitting covers. All garbage containers kept within the Hospital buildings shall be washed, inside and out, daily. Other dry waste materials, normally designated "Trash", may be stored in plastic bags.

Section 17. Other Hospital Services. Psychiatric Hospitals which provide one (1) or more of the hospital services listed in W.S. 35-2-901(a)(xiii), in addition to psychiatric care, shall meet the State's Rules and Regulations for Licensure of Hospitals.

Section 18. Physical Environment. The Psychiatric Hospital buildings shall be designed, constructed, arranged, equipped and maintained to ensure the safety of patients, personnel and visitors and to provide adequate and efficient care and treatment to the patients. Fire safety in Psychiatric Hospitals shall be in accordance with the requirements of NFPA Life Safety Code 101, Section 31-4.4.

Section 19. Disaster Plan. Psychiatric Hospitals shall develop and adopt a written disaster preparedness plan in accordance with NFPA 99, Standards for Health Care Facilities, 1996 edition, Chapter 11.

Section 20. Construction and Remodeling. Department of Health, Chapter III Construction Rules for Health Facilities apply.

Section 21. Life Safety and Electrical Safety. Department of Health, Chapter III Construction Rules for Health Facilities apply.

(a) Psychiatric Hospitals operating prior to the effective date of these rules, shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as a Psychiatric Hospital.

History

Effective 1999-06-18

Chapter 16 Licensure of Rehabilitation Facilities

Wyo. Code R. 048.0026.16.08251997 Licensure of Rehabilitation Facilities

RULES AND REGULATIONS FOR LICENSURE OF REHABILITATION FACILITIES

CHAPTER 16

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Licensure Act at W.S. 35-2-901 et seq. and the Wyoming Administrative Proce- dures Act at W.S. 16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the licensure of rehabilitation facili- ties. The purpose of these standards is to provide minimum requirements for services, structure, opera- tion and personnel practices designed to protect the health and safety of patients and employees.

Section 3. Severability. If any portion of this rule is found invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. "Acceptable plan of correction" means an Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) approved plan to correct the deficiencies identified through a survey. The plan of correction shall bea written document and shall contain who is responsible for correction, what was done to correct the problem, who will monitor to ensure that the situation does not develop again, and a timely date for completion of the correction.

"Administrator" is the person in charge of the operation of the facility twenty-four hours per day and is:

A physician, or

A Registered Nurse, or

A rehabilitation counselor, or

An occupational therapist, or

A physical therapist, or

A speech and language pathologist, or

A respiratory therapist, or

An individual with a bachelors degree and one years experience in health service administration preferably in a comprehensive outpatient rehabilitation facility; or

An individual with at least five years of management experience in a comprehensive outpatient rehabilitation facility.

"Central Registry" means the registry operated by the Wyoming Department of Family Ser- vices pursuant to W.S. §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults.

"Certified Occupational Therapy Assistant" is a person who is licensed to practice as a certi- fied occupational therapy assistant by the Wyoming Board of Occupational Therapy.

"Dietitian" means a person who is registered by the American Dietetic Association and provides nutritional and dietary consultation services.

"Facility" -- a "comprehensive outpatient rehabilitation facility", CORF, or "facility" means nonresidential facility that: Is established and operated exclusively for the purpose ofproviding diagnostic, thera- peutic, and restorative services to outpatients for the rehabilitation of injured, disabled, or sick persons, at a single fixed location, by or under the supervision of a physician.

"Fidelity bond" means a contract of fidelity insurance. One agrees to insure another against loss arising from the want of honesty, integrity or fidelity of an employee of the rehabilitation facilities.

"Licensed Practical Nurse" is a graduate of an approved school of practical or vocational nursing who is currently licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing.

"Occupational therapist" is a graduate of an approved school of occupational therapy who is currently licensed to practice as a registered occupational therapist by the Wyoming Board of Occupa- tional Therapy.

"Physician" means a person licensed to practice medicine in Wyoming by the Wyoming Board of Medicine.

"Registered Nurse" is a graduate of an approved school of professional nursing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing.

"Rehabilitation Facility" means an outpatient facility which is operated for the primary pur- pose of assisting the rehabilitation of disabled persons by providing comprehensive medical evaluations and services, psychological and social services, or vocation evaluations and training or any combination of these services and in which the major portion of the services is furnished within the facility.

"Social Worker" is a person who has graduated with a bachelors degree from a school of social work accredited by the Council on Social Work Education.

Section 5. Licensing.

Licensing requirements. The Office of Health Quality has been duly authorized to issue licenses to rehabilitation facilities. The Office of Health Quality has established a system of licensure to comply with minimum requirements for protecting the health, welfare and safety of patients receiving this type of service.

Licensing procedure.

For an initial license to be issued the facility shall submit:

A completed application form. (The blank application form shall be supplied by the Office of Health Quality.)

The required licensure fee outlined in Chapter 1 Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Trea- surer, State of Wyoming.

Demonstrated compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation shall be available through the Office of Health Quality following the on site survey.

The effective date of the initial license shall be:

The date of the survey, if there are no deficiencies, or

If deficiencies exist, the date an acceptable plan of correction is devel- oped.

The length of the license shall be from the effective date of the license until the next June 30th.

For renewal of a full license for one year beginning July 1st, and unless suspended, or revoked, shall expire on June 30th of the following year, the Office of Health Quality shall receive:

A completed application form returned by the date indicated in the cover letter.

The application form shall be mailed by the Office of Health Quality to the facility.

License fee. Each application shall be accompanied by the required licensure fee outlined in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check shall be made payable to the Treasurer, State of Wyoming.

Must demonstrate full compliance with the requirements for licensure as required in paragraph (c) of this section or an acceptable plan of correction for deficiencies from the standards. This documentation is maintained on file at the Office of Health Quality following the on site survey.

Requirements for licensure. The Office of Health Quality shallconsider: The rehabilitation facility shall be in conformity with all laws and standards relating to communicable and reportable diseases as promulgated by the Department of Health, Public Health Division.

Existing deficiencies shall not create a hazard to the health, safety or welfare of the patients.

The rehabilitation facility is making a positive effort to correct all existing deficien- cies.

Adequate policies and procedures are in place to guide operations.

There is adequate and appropriately trained staff.

The rehabilitation facility has an organized and implemented quality improvement plan.

There is an approved plan of correction for all cited deficiencies.

Transfer of, or changes to the license.

No license granted shall be assignable or transferrable. A license shall apply only to the facility location described in the license application.

Whenever ownership of an agency is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The buyer shall notify the Office of Health Quality of the impending transfer and apply for a new license.

Any license granted to the buyer shall be subject to the plan of correc- tion submitted by the previous owner as approved by the Office of Health Quality.

The seller shall notify the Office of Health Quality at least thirty (30) days before the actual date of transfer.

Upon receipt of the licensure application, a new license will be issued to be effective on the date of the change of ownership.

The day after the change of ownership the obsolete license shall be mailed back to the Office of Health Quality.

If the rehabilitation facility's name is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

Conditioning or revoking a license.

Denial of application - suspension or revocation of license.

An application for license may be denied or a previously issued license may be suspended or revoked for noncompliance with minimum standards as herein set forth when noncompli- ance jeopardizes the health, safety or welfare of patients.

Suspension of admissions.

The Office of Health Quality may suspend new admissions or re-admissions to rehabilitation facility when conditions in the facility are such that patient needs cannot safely be met.

Conditions in a rehabilitation facility shall not jeopardize the patient's health and safety.

Hearings.

Any rehabilitation facility aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within ten (10) days of the date of the decision.

Except in matters concerned with the spread of communicable disease as required in Section 5 (c)(i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing if a hearing is requested within ten (10) days.

Hearings requested under the terms of these rules and regulations shall be held by the Office of Health Quality according to the provisions of the Wyoming Administrative Procedures Act at W.S. 16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

Posting of license.

The current license issued by the Office of Health Quality shallbe displayed in a public area within the rehabilitation facility.

Survey of the rehabilitation facility.

The survey of rehabilitation facility programs shall be arranged by the Office of Health Quality. The survey shall be performed periodically. All records of the facility shall be made available to the surveyor.

Requirements of the Office of Health Quality.

The Office of Health Quality shall provide each rehabilitation facility with:

A copy of these standards; and

A copy of any deficiencies found.

Voluntary Closure.

If a rehabilitation facility voluntarily ceases to operate, they shall notify the Office of Health Quality in writing at least five working days prior to the closure.

The first working day after the closure of the rehabilitation facility the license of the rehabilitation facility shall be returned to the Office of Health Quality.

Section 6. Organization and Management.

(a) Governing Body. The rehabilitation program shall have a governing body which has the legal authority and responsibility to operate the rehabilitation program. The governing body shall:

(i) Obtain a fidelity bond for client protection arising from the want of honesty, integrity or fidelity of an employee. The bond shall consist of no less than $2500 and shall be aug- mented in relation to the number of employees.

Central registry information can be obtained by contacting Department of Family Services at 307-777-5366. (This number may be subject to change.)

Adopt, revise, and approve personnel policies; including:

Frequency of evaluations;

Insuring confidentiality of central registry information checks;

Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client care level.

The governing body shall ensure that all services provided are consistent with ac- cepted standards of practice.

The governing body shall ensure adequate staffing to provide quality rehabilitation care.

There must be policies and procedures for services offered, which shall be reviewed annually by the governing body.

Ensure in accordance with the State Statute 25-2-910, there is an effective, ongoing, agency wide written quality improvement program which ensures and evaluates quality of care provided to all clients.

Personnel Records.

There shall be one person designated responsible for maintaining the confiden- tiality.

Employee Health. The rehabilitation program shall:

Develop policies and procedures for employee health, including a policy identifying communicable diseases that could put the client population at risk.

Advanced Directives.

The rehabilitation program shall adopt policies which assure that they provide information on advanced directives to clients. If the client's advanced directives are known they shall be followed by the rehabilitation facility.

Notification. Prior to admission all perspective clients shall be notified if the rehabili- tation program is not Medicare/Medicaid certified.

Section 7. Construction.

At the time of initial licensure the rehabilitation facility shall meet the most current provisions of NFPA 101 Life Safety Code of the National Fire Protection Association.

After initial licensure the rehabilitation facility will continue to be licensed under the same provisions of the NFPA 101 Life Safety Code as when they were initially licensed.

For new construction the facility shall comply with the most current edition of the Guidelines for Construction and Equipment of Hospitals and Medical Facilities Chapter 10 Rehabilitation Facili- ties.

For remodeling a portion of the rehabilitation facility, the facility must comply with the most current edition of the Guidelines for Construction and Equipment of Hospital and Medical Facilities Chapter 10 Rehabilitation Facilities.

Plans must be submitted and approved by the Office of Health Quality.

History

Effective 1997-08-25

Chapter 18 Licensure of Renal Dialysis Centers

Wyo. Code R. 048.0026.18.03111998 Licensure of Renal Dialysis Centers

RULES AND REGULATIONS FOR LICENSURE OF RENAL DIALYSIS CENTERS

CHAPTER 18

Section 2. Purpose. These rules have been adopted for the licensure of renal dialysis centers. The purpose of these standards is to provide minimum requirements for services, structure, operation and personnel practices designed to protect the health and safety of patients and employees.

Section 3. Severability. If any portion of this rule is found invalid or unenforceable, the re- mainder shall continue in effect.

Section 4. Definitions.

(a) "Acceptable plan of correction" means an Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) approved plan to correct the deficiencies identified through a survey.

The plan of correction shall be a written document and must contain who is responsible for correction, what was done to correct the problem, who will monitor to ensure that the situation does not develop again, and must contain a timely date for completion of the correction.

(b) "Administrator" is the person in charge of the operation of the facility twenty-four hours per day and is:

(i) A physician,

(ii) A dialysis nurse, or

(iii) An individual with a bachelors degree and one year experience in health service administration, preferably in a renal dialysis center.

(c) "Central Registry" means the registry operated by the Wyoming Department of Family Ser- vices pursuant to W.S. §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults.

(d) "Clinical Laboratory Improvement Act (CLIA)" means the clinical laboratories approved by the U.S. Department of Health and Human Services, Health Care Financing Administration as required by 42 CFR Part 493, Section 1861 (e) and (j), the sentence following Section 1861 (s)(13), and 1902(a)(9) of the Social Security Act and Section 353 of the Public Health Service Act.

(e) "Dialysis" is a process by which dissolved substances are removed from a patient's body by diffusion from one fluid compartment to another across a semipermeable membrane. The two types of dialysis that are currently in common use are hemodialysis and peritoneal dialysis.

(f) "Dialysis nurse" is a Registered Nurse who has had at least six (6) months of experience working in a renal dialysis center.

(g) "Dialysis technician" is a person who has successfully completed a core curriculum consist- ing of didactic and clinical classes in:

(i) Understanding the person with renal failure,

(ii) Principles of dialysis,

(iii) Hemodialysis devices,

(iv) Hemodialysis procedures,

(v) Dialyzer reprocessing,

(vi) Water treatment, and

(vii) Infection Control

(h) "Dietitian" means a person who is registered by the American Dietetic Association and provides nutritional and dietary consultation services.

(i) "Fidelity bond" means a contract of fidelity insurance. One agrees to insure another against loss arising from the want of honesty, integrity or fidelity of an employee of the renal dialysis center.

(j) "Licensed Practical Nurse" is a graduate of an approved school of practical or vocational nursing who is currently licensed to practice as a licensed practical nurse by the Wyoming Board of Nurs- ing.

(k) "Physician" means a person licensed to practice medicine in Wyoming by the Wyoming Board of Medicine.

(l) "Renal Dialysis Center" means a freestanding facility for the treatment of kidney diseases.

(m) "Registered Nurse" is a graduate of an approved school of professional nursing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing.

(n) "Social Worker" is a person who has graduated with a masters degree from a graduate school of social work accredited by the Council on Social Work Education.

Section 5. Licensing.

(a) Licensing requirements. The Office of Health Quality has been duly authorized to issue licenses to renal dialysis centers. The Office of Health Quality has established a system of licensure to comply with minimum requirements for protecting the health, welfare and safety of patients receiving this type of service.

(b) Licensing procedure.

(i) For an initial license to be issued the facility shall submit:

(A) A completed application form as supplied by the Office of Health Quality.

(B) The required licensure fee outlined in Chapter 1 Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(C) Demonstrated compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation shall be available through the Office of Health Quality following the on site survey.

(D) The effective date of the initial license shall be:

(I) The date of the survey, if there are no deficiencies, or

(II) If deficiencies exist, the date that an acceptable plan of correction is developed.

(E) The length of the license shall be from the effective date of the license until the next June 30th.

(ii) For renewal of a full license for one year beginning July 1st, and unless suspended, or revoked, shall expire on June the of the following year, the Office of Health Quality shall receive:

(A) A completed application form returned by the date indicated in the cover letter.

(I) The application form shall be mailed by the Office of Health Quality to the facility.

(B) License fee. Each application shall be accompanied by the required licen- sure fee outlined in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check shall be made payable to the Treasurer, State of Wyoming.

(C) Must demonstrate full compliance with the requirements for licensure as required in paragraph (c) of this section or an Office of Health Quality accepted plan of correction for deficiencies from the standards. This documentation is maintained on file at the Office of Health Quality following the on site survey.

(i) The renal dialysis center is in conformity with all laws and standards relating to communicable and reportable diseases as promulgated by the Department of Health, Public Health Divi- sion.

(ii) Existing deficiencies shall not create a hazard to the health, safety or welfare of the patients.

(iii) The renal dialysis center is making a positive effort to correct all existing deficien- cies.

(iv) Adequate policies and procedures are in place to guide operations.

(v) There is adequate and appropriately trained staff.

(vi) The renal dialysis center shall have an organized and implemented quality improve- ment plan.

(vii) There is an Office of Health Quality approved plan of correction for all cited defi- ciencies.

(d) Transfer of, or changes to the license.

(i) No license granted shall be assignable or transferrable. A license shall apply only to the agency location described in the license application.

(A) Whenever ownership of an agency is transferred from the individual or en- tity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The buyer shall notify the Office of Health Quality of the impending transfer and apply for a new license.

(I) Any license granted to the buyer shall be subject to the plan of cor- rection submitted by the previous owner as approved by the Office of Health Quality.

(B) The seller shall notify the Office of Health Quality at least thirty (30) days before the actual date of transfer.

(C) Within the week prior to the effective date of the change of ownership a new license will be mailed to the agency provided that the Office of Health Quality is in receipt of the licensure application, and the licensure fee.

(I) The day after the change of ownership the obsolete license must be mailed back to the Office of Health Quality.

(ii) If the renal dialysis center's name is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(iii) If the renal dialysis center increases or decreases the number of stations, the Office of Health Quality shall be advised in writing and a new license application requested.

(A) Upon receipt of the licensure application and licensure fee the following actions will be taken:

(I) For additional stations to be added an on site review shall be con- ducted to determine adequacy of space, equipment, and appropriateness of staff and services. The addi- tional stations will be licensed for service on the day of the on site inspection if all the requirements are met.

(II) If the renal dialysis center is decreasing stations then the new license will be made effective the date the application is received or the date the owner specifies in the licensure application, whichever date is later.

(e) Conditioning or revoking a license.

(i) Denial of application - suspension or revocation of license.

(A) An application for license may be denied or a previously issued license may be suspended or revoked for noncompliance with minimum standards as herein set forth when noncompli- ance jeopardizes the health, safety or welfare of patients.

(ii) Suspension of admissions.

(A) The Office of Health Quality may suspend new admissions or re-admissions to a renal dialysis center when conditions in the facility are such that patient needs cannot safely be met.

Conditions in a renal dialysis center shall not jeopardize the patients' health and safety.

(iii) Hearings.

(A) Any renal dialysis center aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within ten (10) days of the receipt date of the notice of adverse action.

(B) Except in matters concerned with the spread of communicable disease as required in Section 5 (c)(i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing, if hearing is requested, within ten (10) days.

(C) Hearings requested under the terms of these rules and regulations shall be held by the Office of Health Quality according to the provisions of the Wyoming Administrative Proce- dures Act at W.S. 16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

(f) Posting of license.

(i) The current license issued by the Office of Health Quality shall be displayed in a public area within the renal dialysis center.

(g) Survey of the renal dialysis center.

(i) The survey of renal dialysis center programs shall be arranged by the Office of Health Quality. The survey shall be made periodically. All records of the facility shall be made available to the surveyor.

(h) Requirements of the Office of Health Quality.

(i) The Office of Health Quality shall provide each renal dialysis center with:

(A) A copy of these standards; and

(B) A copy of any deficiencies found.

(i) Voluntary Closure.

(i) If a renal dialysis center voluntarily ceases to operate, they shall notify the Office of Health Quality in writing at least five working days prior to the closure.

(ii) The first working day after the closure of the renal dialysis center, the license shall be returned to the Office of Health Quality.

Section 6. Organization and Management.

(a) Governing Body. The renal dialysis program shall have a governing body which has the legal authority and responsibility to operate the renal dialysis program. The governing body shall:

(i) Obtain a fidelity bond for client protection arising from the want of honesty, integ- rity or fidelity of an employee. The bond shall consist of no less than $2500 and shall be augmented in relation to the number of employees.

(ii) Provide verification of a central registry information check on all employees hired at the time of or after the filing of these rules. The individual agencies or corporations are responsible to initiate and follow this process to completion.

Central registry information can be obtained by contacting The Department of Fam- ily Services at 307-777-5366. (This number is subject to change.)

(iii) Adopt, revise, and approve personnel policies; including:

(A) Frequency of evaluations;

(B) Insuring confidentiality of a central registry information checks.

(iv) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client care level.

(v) The governing body shall ensure that all services provided are consistent with ac- cepted standards of practice.

(vi) The governing body shall ensure adequate staffing to provide quality care.

(vii) There shall be policies and procedures for services offered, which shall be reviewed annually by the governing body.

(viii) Ensure in accordance with the State Statute 35-2-910, there is an effective, ongoing, agency wide written quality improvement program which ensures and evaluates quality of care provided to all clients.

(ix) Personnel Records.

(A) There shall be one person designated responsible for maintaining the confi- dentiality.

(x) Employee Health. The renal dialysis program shall:

(A) Develop policies and procedures for employee health including a policy iden- tifying communicable diseases that could put the client population at risk.

(xi) Advanced Directives.

(A) The renal dialysis program shall adopt policies which assure they provide information on advanced directives to clients. If the client's advanced directives are known they shall be followed by the center.

(xii) Notification. Prior to admission all prospective clients shall be notified if the renal dialysis program is not Medicare/Medicaid certified.

Section 7. Construction.

(a) At the time of initial licensure the renal dialysis center shall meet the most current provi- sions of NFPA 101 Life Safety Code of the National Fire Protection Association.

(b) ab For new construction or remodeling the following regulations shall apply, but not be limited to:

(i) There shall be a grade level access or ramp, and in multi-story structure where the unit is above grade level, ready access to an elevator.

(ii) Each treatment area shall provide a minimum of 80 square feet with 4 feet between beds and/or lounge chairs for each station.

(iii) Floor space shall be provided for a central nurses' station which has direct visual observation of all patients.

(iv) Each unit shall be designed to provide visual privacy for patients by the use of cu- bicle curtains.

(v) Handwashing facilities shall be located in the treatment area. Handwashing sinks shall have faucets that discharge at least five inches above the spill level of the sink. Soap dispensers and hand drying apparatus shall be provided. All sinks must be provided with spray heads or equivalent. Aerators are not allowed.

(vi) Space shall be provided in the work area for an emergency "crash" cart.

(vii) A janitor's closet shall be provided either within or immediately next to the unit.

(viii) Work areas shall be designed and maintained to separate clean areas from soiled areas.

(ix) A toilet room with a water closet and handwashing lavatory shall be provided for patient use convenient to the unit. The toilet room and lavatory shall be accessible from a wheel chair.

(x) Adequate space shall be provided for instrument maintenance and storage of equip- ment, and for disassembling, preparation and testing of dialyzers.

(xi) A conference room shall be conveniently located in or near the unit.

(xii) There shall be space for record storage that can be locked.

(xiii) Adequate lighting shall be provided for the unit with a minimum of one hundred (100) footcandles appropriately placed to illuminate the patient's connection and equipment area.

(xiv) Suction and oxygen equipment shall be available to the unit.

(xv) Mechanical ventilation with air conditioning shall be provided throughout the unit. Mechanical exhaust shall be provided for the reuse equipment area.

History

Effective 1998-03-11

Chapter 19 Licensure of Nursing Care Facilities

Wyo. Code R. 048.0026.19.06262000 Licensure of Nursing Care Facilities

RULES AND REGULATIONS FOR LICENSURE OF NURSING CARE FACILITIES

CHAPTER 19

Section 2. Purpose. These rules have been adopted to protect the health, safety and welfare of residents and employees in Nursing Care Facilities.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules gender pronouns are used interchangeable. 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 purpose of these regulations, the following shall apply:

(a) "Acceptable Plan of Correction" means the Licensing Division approved the Nursing Care Facility's plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division or its designated representative. The plan of correction shall be a written document and shall provide, but not be limited to, the following information.

(i) Who is responsible for the correction.

(ii) What was done or will be done to correct the problem.

(iii) Who will monitor to ensure that the situation does not reoccur.

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) "Chief Administrative Officer" means the Director, Department of Health per W.S. §9- 2-101(e), or the designated licensure representative.

(c) "Complaint Investigations" means those investigations required to be performed by the Long Term Care Ombudsman as established in W.S. §9-2-1301 through 1309 or by the State Survey Agency as per the agreement between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

(d) "License" means the authority granted by the Licensing Division to operate a Nursing Care Facility.

(e) "Licensee" means any person, association, partnership, or corporation holding a Nursing Care Facility license.

(f) "Licensing Division" means the Department of Health, Office of Health Quality.

(g) "LSC" means NFPA 101 Life Safety Code cited in the Department of Health, Chapter III Construction Rules for Health Facilities.

(h) "NEC" means the National Electrical Code.

(i) "NFPA" means the National Fire Protection Association.

(j) "Nursing Care Facility" means an institution which is a skilled nursing facility (SNF) or a nursing facility (NF) which is currently licensed and meets the requirements of these rules and regulations.

(k) "Ombudsman" means the Long Term Care Ombudsman as established in W.S. §9-2-1301 through 9-2-1309.

(l) "Program Administration" means the rules and regulations promulgated by the Department of Health as developed by the Program Division for the day-to-day operation of a Nursing Care Facility.

(m) "Program Division" means the Department of Health, Aging Division.

(n) "Quality Management Program" means a program developed and implemented by the Nursing Care Facility to evaluate and improve resident care and services.

(o) "State Survey Agency" means the Department of Health, Office of Health Quality which has the primary responsibility to determine whether health care providers/suppliers do or do not meet federal certification standards to participate in the Medicaid or Medicare programs as per the agreements between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

(p) "Survey" means an on-site evaluation conducted by the Survey Division or its designated representative to determine compliance with State rules and regulations for Nursing Care Facilities.

(q) "Survey Division" means the Department of Health, Office of Health Quality or its designated representative.

Section 5. Licensure. Applicants must demonstrate full compliance with paragraphs (a) and (b) of this section.

(a) Licensing Procedure.

(i) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division.

(B) Each completed application shall be accompanied by the required licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one year beginning July 1st, and unless suspended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The Licensing Division shall consider:

(i) Initial and annual renewal licensure survey deficiencies cited by the Survey Division;

(ii) Life Safety Code deficiencies cited by the Survey Division;

(iii) Complaint investigations and resolutions;

(iv) Compliance with all laws and standards relating to communicable and reportable diseases as required by the Department of Health State Health Officer and Public Health Division; and

(v) The effectiveness of the quality management program.

(i) No license granted shall be assigned or transferred by the licensee without prior approval of the Licensing Division.

(A) Requests to assign or transfer a Nursing Care Facility license shall be submitted in writing by the licensee to the Licensing Division at least thirty (30) days prior to the planned date of assignment or transfer.

(B) Any license approved for assignment or transfer by the Licensing Division shall be subject to the plan of correction for licensure submitted by the previous owner.

(ii) If the Nursing Care Facility's name is changed, the Licensing Division shall be advised in writing, before the name is changed, by the current licensee and a new license will be issued upon the receipt of an application and licensure fee.

(d) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(e) Suspension of Admissions.

(i) The Licensing Division may suspend new admissions or re-admissions to the Nursing Care Facility when conditions are such that resident needs cannot be met. Conditions in a Nursing Care Facility shall not jeopardize the resident's health or safety.

(f) Monitor.

(i) The Licensing Division may place a Department of Health approved monitor at the owner's expense when conditions are such that residents' needs are not being met by the Nursing Care Facility. The monitor shall insure that neither the health nor the safety of the resident is jeopardized.

(g) Hearings.

(i) Any Nursing Care Facility aggrieved by a decision of the Licensing Division may request a hearing by submitting a written request to the Licensing Division within ten (10) days of receipt of the adverse action.

(ii) Except in matters concerned with the spread of communicable disease, the Licensure Division (Nurse Administrator or designated representative) shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for hearing shall adhere to the time frames of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for a hearing shall adhere to the time frames in (i) above.

(iv) Hearings requested under the terms of these licensure rules shall be held in accordance with the provisions of the Wyoming Administrative Procedures Act.

(h) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Nursing Care Facility.

(i) Surveys for Licensure.

(i) The Survey Division or its designated representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Licensure and Program Administration Rules and Regulations for Nursing Care Facilities as promulgated by the Wyoming Department of Health. If there are conflicts between the Licensure and Program Administration Rules, the Licensure Rules take precedence.

(B) The Survey Division shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the Nursing Care Facility and Program Division.

(C) The Nursing Care Facility shall provide an acceptable plan of correction for all cited deficiencies, within ten (10) working days after receipt of the deficiencies, to the Licensing Division.

(ii) At the time of survey, all records, including resident medical records, pertaining to matters involved in the survey shall be made available to members of the survey team in their assigned disciplines.

(j) Voluntary Closure.

(i) If a Nursing Care Facility voluntarily ceases to operate, it shall notify the Licensing Division in writing at least thirty (30) working days prior to the closure.

(ii) The first working day after closure, the Nursing Care Facility's license shall be hand carried to or sent by certified mail to the Office of Health Quality; 2020 Carey Avenue, Eighth Floor; Cheyenne, WY 82002.

(iii) Personnel, financial and client medical records shall be maintained by the licensee for a minimum of six (6) years after the month of closure.

Section 6. Disaster Plan.

(a) All Nursing Care Facilities shall develop and adopt a written disaster preparedness plan in accordance with the Chapter 11, "Health Care Emergency Preparedness", of NFPA 99, Standard for Health Care Facilities.

Section 7. Construction/Remodeling. Department of Health Chapter III, Construction Rules for Health Facilities apply.

Section 8. Life Safety and Electrical Safety. Department of Health Chapter III, Construction Rules for Health Facilities apply.

(i) Nursing Care Facilities operating prior to the effective date of these rules, shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as a Nursing Care Facility.

History

Effective 2000-06-26

Chapter 24 Health Care Cooperative Arrangements for Anti-Trust Exceptions

Wyo. Code R. 048.0026.24.11121996 Health Care Cooperative Arrangements for Anti-Trust Exceptions

Chapter 24

HEALTH CARE COOPERATIVE ARRANGEMENTS FOR ANTI-TRUST EXCEPTIONS

Section 1. Purpose. These rules are implemented to amplify procedures for regulations of health care cooperative arrangements permitted under W.S. § 35-24-101 through W.S. § 35-24-116. These rules are implemented to further Wyoming's policy of promoting quality and access to health care for all citizens, to contain health care costs, and to promote a comprehensive health care system. These rules are to be read in conjunction with the Wyoming Administrative Procedures Act, appli- cable Wyoming Rules of Civil Procedure, and, addressing Contested Hearings, any rules pertaining to the conduct of hearings before the Office of Administrative Hearings.

Section 2. Definitions.

(a) As used within the rules:

(i) "Aggrieved Party" means any provider, purchaser or third-party payor including but not limited to any hospital, physician, allied health professional, health care provider or other person fur- nishing goods or services to or in competition with hospitals, insurers, hospital service corporations, medi- cal service corporations, preferred provider organizations, health maintenance organizations or any em- ployer or association that directly or indirectly provides health care benefits to its employees or members.

(ii) "Anniversary Month" means the month a health care cooperative arrangement is approved.

(iii) "Arrangement Already in Effect" means all substantiating elements included in the health care cooperative arrangement application have been working together in the State of Wyoming as proposed in the application for one (1) year prior to the filing of the application.

(iv) "Certified Mail" means uninsured first class mail whose delivery is recorded by having the addressee sign for it.

(v) "Comment" means a written document offering explanation, illustration, criticism, or personal opinion.

(vi) "Contested Case" means a proceeding including but not restricted to the review of applications for health care cooperative arrangements and the administration of approved applications for health care cooperative arrangements in accordance with WSS § 16-3-101.

(vii) "Days" means consecutive calendar days.

(viii) "Department" means the Wyoming Department of Health.

(ix) "Director" means the Director of the Wyoming Department of Health.

(x) "Objection" means a written document offered by an aggrieved party in opposition to a health care cooperative arrangement which states the reason, grounds, or cause for expressing opposi- tion.

(xi) "Persons on Record" means persons submitting written documentation to the Direc- tor, by certified mail, stating objections, comments, or requests for notification of a specific health care cooperative arrangement. Persons on record status must be renewed by written request, sent by certified mail to the Director, prior to December 31 of each calendar year.

(xii) "Revenue" means income received during the preceding fiscal year under the cash basis of accounting.

(xiii) "Trade Secret Information" means proprietary data including a formula, pattern, compilation, program, device, method, technique or process that:

A. Is supplied by the affected individual or organization to the State;

B. Is the subject of efforts by the individual or organization that are reason- able under the circumstances to maintain secrecy; and

C. Derives independent economic value, actual or potential, from not being generally known and not being readily ascertainable by proper means by other persons who can obtain economic value from its disclosure or use.

Section 3. Application.

(a) Application content shall be in accord with W.S. § 35-24-104 and W.S. § 35-24-111.

(i) Application information is to be provided in the sequence in accord with the stat- utes.

(ii) If information requested by the statutes is not applicable, a statement indicating such and providing a reason therefore shall be provided in lieu of such information.

(b) Application format

(i) Applications must be in the following format:

(A) Application pages shall be numbered and printed on paper measuring 8 1/2 by 11 inches. The margins shall not be less than one (1) inch on all sides. Unless otherwise required, all applications shall be printed on white paper.

(B) Applications shall be in courier type at ten (10) characters per inch and double spaced.

(D) Trade secret information shall be printed on goldenrod colored paper to as- sist in identifying material exempt from Wyoming's Public Record Act.

(E) The Department shall develop procedures to protect trade secret informa- tion.

(F) Applications shall be bound in a three ring notebook; and, if the application consists of multiple volumes, be numbered.

(G) Applications which do not comply with these rules shall not be accepted for filing and returned to the applicant.

Section 4. Filing of Applications and Related Documents.

(a) Filing of applications

(i) Applications shall be filed by presenting an original and three (3) copies to the Di- rector.

(ii) The filing date of a conforming application shall be the date stamped received by the Department.

(iii) No application shall be filed by facsimile machine.

(iv) Applications filed with the Department become property of the State.

(v) Applications shall be accompanied by the filing fee as determined by Section 5 of these rules in accord with W.S. § 35-24-104 (d).

(b) Filing of related documents

(i) Format required for filing of related documents shall be in accord with Section 3 (b) of these rules.

(ii) Documents relating to an application shall be filed by presenting an original and three (3) copies to the Director.

(iii) The filing date of a document shall be the date stamped received by the Department.

(iv) Documents relating to an application may be accepted by facsimile machine pro- vided an original and three (3) copies are received by the Director no later than seven (7) days after trans- mission of the facsimile.

(v) Documents relating to an application shall be incorporated in the original applica- tion file.

Section 5. Filing Fees.

(a) Remittance of filing fees

(i) In accord with W.S. § 35-24-104 (d), filing fees shall be remitted along with the application.

(ii) Filing fees must be remitted by cashiers check made payable to the Department.

(iii) The filing fee shall be in the amount of one-fourth (1/4) of one (1) percent of total gross revenue during the last complete fiscal year for all practitioners, health care facilities, and health insurers included in the application up to a maximum amount of one hundred thousand ($100,000.00) dollars. The minimum filing fee shall be twenty-five thousand ($25,000.00) dollars.

(iv) If the calculated fee in (iii) is greater than twenty-five thousand ($25,000.00) dol- lars, the applicant may submit the minimum filing fee amount of twenty-five thousand ($25,000.00) dol- lars.

(v) The Director may request additional financing in increments of twenty-five thou- sand ($25,000.00) dollars with the last increment being twenty-five thousand ($25,000.00) dollars or less.

(vi) The filing fee submitted with the application and additional financing increments shall not exceed the filing fee established in (iii).

(vii) Additional filing fee increments must be submitted to the Department within thirty

(30) days of the request.

(viii) Failure to submit additional filing fee increments within thirty (30) days of the re- quest places the application on hold until such time the additional filing fee is forthcoming.

(ix) In lieu of disclosure of actual gross revenues for individual physicians, an applicant may elect to have the portion of the fee attributable to individual physicians based upon a standard imputed amount for each physician which would be set by the Department.

(x) The filing fee associated with submitting a modification to an approved application shall be in the amount of twenty-five thousand ($25,000.00) dollars.

(b) Utilization of filing fees

(i) In accord with W.S. § 35-24-104 (d) and W.S. § 35-24-112 (d), all fees collected by the Department under these subsections shall be deposited into a separate account within a special revenue fund. These funds shall be expended for the activities specified in W.S. § 35-24-104 (d). The Director shall have discretion to allocate start-up costs among all applicants who submit applications.

(i) Remaining balance of the filing fee shall be refunded within thirty (30) days from the date of the Director's final determination. The Director may extend the thirty (30) day period for good cause.

Section 6. Notification of Pending Application.

(a) In accord with W.S. § 35-24-104 (b):

(i) The applicant shall, at the time of filing, provide notice to the public and all persons on record.

(ii) The notice of a pending application shall be approved by the Director.

(iii) The public notice of a pending application shall conform to the notice criteria and shall be published for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.

(iv) The notice of a pending application shall conform to the notice criteria and shall be mailed to all persons on record.

Section 7. Initial Review of Application.

(a) In accord with W.S. § 35-24-105 (a):

(i) If the Director determines that an application is unclear, incomplete, or contains an insufficient basis on which to provide a decision, the application shall be returned with a written descrip- tion of the deficiencies to the applicant.

(ii) The initial review by the Director shall be completed within thirty (30) days of the date the application is filed with the Department. The Director may extend the thirty (30) day period to a maximum of sixty (60) days, for good cause.

(iii) If an application is returned to the applicant, the initial review period ceases. If an application is returned for review, a new initial review period begins.

(iv) If an application is returned to the applicant and the applicant will be resubmitting the application for further review, the filing fee shall remain deposited.

(v) If an application is returned and the applicant elects not to resubmit an amended application, the Director shall return the filing fee submitted with the application less costs associated with the initial review process.

(vi) A determination by the Director that an application is unclear, incomplete, or pro- vides an insufficient basis to make a determination, is not subject to administrative or judicial review.

(b) Applications regarding arrangements already in effect in accord with W.S. § 35-24-105 (b):

(i) If an application relates to an arrangement already in effect before the submission of the application, the Director may decline to review the application and return the filing fee submitted with the application less costs associated with any review conducted.

(ii) A determination by the Director that an application relates to an arrangement al- ready in effect is not subject to administrative or judicial review.

(iii) If the Director declines to review the application, the applicant may appeal the deci- sion within thirty (30) days of the denial to review.

Section 8. Notice of Application by the Director.

(a) When an application is in accord with W.S. § 35-24-104, the Director shall provide the following notifications:

(i) General Notice: Within ten (10) days of completion of the initial review of the application, the notice required shall be published for a minimum of seven (7) days in a Wyoming newspa- per of general circulation in the area.

(ii) Requested Notice: The Director shall provide one (1) copy of the notice to all per- sons on record.

(iii) Special Notice: The Director may notify and request comments from persons. Cop- ies of any request for comments shall be provided to the applicant.

Section 9. Comment Period by Persons.

(a) In accord with W.S. § 35-24-106:

(i) Within twenty (20) days after the publication period for notice of the proposed ap- plication, any person may submit typed comments with respect to the application.

(ii) Comments shall, to the extent applicable, conform to the application format.

(iii) Any comment regarding a specific provision of the application shall designate the specific page number(s) of the application.

(iv) Comments must be filed with the Director by delivering or mailing an original and three (3) copies. The filing date of comments shall be the date stamped received by the Department.

(v) Comments may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.

(vi) Comments on file with the Department become property of the State.

(vii) Persons submitting comments shall provide a copy of the comments to the applicant by certified mail.

Section 10. Applicant Response to Comments.

(a) The applicant shall have ten (10) days after the close of the comment period to file a re- sponse with the Director by delivering or mailing an original and three (3) copies of the response to the Department.

(i) Responses to comments shall, to the extent applicable, conform to the application format.

(ii) Responses may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.

(iii) The filing date of a comment shall be the date stamped received by the Department.

(iv) The applicant shall provide a copy of any response to the person submitting the comment.

Section 11. Objections by Aggrieved Parties.

(a) In accord with W.S. § 35-24-106:

(i) Within thirty (30) days after the publication period for notice of the proposed appli- cation, any aggrieved party may submit written objections with respect to the application.

(ii) Objections shall, to the extent applicable, conform to the application format.

(iii) Objections regarding a specific provision of the application shall designate the spe- cific page number(s) of the application.

(iv) Objections shall be filed by presenting or mailing an original and three (3) copies to the Director.

(v) The filing date of an objection shall be the date stamped received by the Depart- ment.

(vi) Objections may be filed by facsimile machine provided an original is sent to the Director within seven (7) days of transmission of the facsimile.

(vii) Objections on file with the Department become property of the State.

(viii) The aggrieved party submitting an objection shall provide a copy of the objection to the applicant by certified mail.

Section 12. Determination of Review Procedures.

(a) In accord with W.S. § 35-24-107, the Director shall determine the review procedure to be used.

(i) The Director shall provide the applicant and aggrieved parties written notification, sent by certified mail, of the method of review to be used within fifteen (15) days of the close of the objection period.

(ii) The criteria to be used in determining the method of review shall consider the fac- tual record, size, complexity, novelty, substance, and quantity of comments.

(iii) A contested hearing shall be held upon the request of an applicant, the timely filing of an objection by an aggrieved party, or at the determination of the Director.

Section 13. Decision Based Upon the Written Record.

(a) In accord with W.S. § 35-24-108, the Director may issue a decision based upon the record.

(i) A written decision shall be provided to the applicant and all persons on record.

Section 14. Limited Hearings.

(a) In accord with W.S. § 35-24-109, the Director may, prior to making a final decision on any application, order a limited hearing.

(i) A limited hearing shall be held within sixty (60) days of the close of the notice of determination of review.

(ii) The order for a limited hearing shall be sent by certified mail to the applicant, and to all persons on record.

(iii) The limited hearing shall be conducted in accord with W.S. § 35-24-109 and the Wyoming Administrative Procedures Act.

Section 15. Contested Case Application Hearings.

(a) In accord with W.S. § 35-24-107, a contested hearing shall be conducted when requested by the applicant, upon filing of an objection, or at the determination of the Director.

(i) The Director shall order a contested hearing no later than thirty (30) days after the conclusion of the objection period for an application under W.S. § 35-24-110. The Director may extend the thirty (30) day period for good cause.

(ii) The order for a contested hearing shall be sent, by certified mail, to the applicant, and all persons on record.

(b) The Director shall provide the public with notice of a contested hearing. The notice shall detail the purpose, date, time, and location of the hearing and be published at least seven (7) days prior to the hearing for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.

(c) Contested hearings shall be conducted pursuant to the Wyoming Administrative Procedures Act, applicable provisions of the Wyoming Rules of Civil Procedure, and applicable rules of the Office of Administrative Hearings.

(d) The final decision shall be mailed by the Director to the applicant and all persons on record.

Section 16. Final Decision.

(a) The final decision regarding an application shall be made by the Director in accord with Wyoming statutes and rules regarding health care cooperative agreements.

(i) The final decision shall be in writing and include specific findings of fact concern- ing cost, access, and quality criteria and shall identify one or more of these criteria as the basis of the decision.

(ii) An approval may be conditioned on modification(s) of all or part of the proposed agreement.

(iii) A decision based upon the written record shall be made thirty (30) days after the date of notice of determination.

(iv) A decision based upon a limited hearing shall be made thirty (30) days after the conclusion of the hearing.

(v) A decision based upon a contested hearing shall be made by the Director within thirty (30) days after written recommendations are received from the hearing officer.

(vi) A copy of the final decision shall be sent, by certified mail, to the applicant and aggrieved parties. All persons on record shall be provided notice of the decision.

(b) Immunity granted by an approved application shall be limited to the activities approved by the Director in the final written decision.

Section 17. Judicial Review of Final Decisions, Conditions for Approval, Findings, Ongoing Supervision and Reporting.

(a) After the Director has rendered a decision in accord with W.S. § 35-24-112, the applicant, or any other aggrieved party, may request judicial review of the Director's decision by filing a petition for review within thirty (30) days in accord with Wyoming's Administrative Procedures Act. A determination under W.S. § 35-24-107 (a) shall not be raised on appeal.

Section 18. Ongoing Supervision and Renewal of Health Care Cooperative Arrangements.

(a) The decision to approve an application shall specify a time schedule for the submission of data required to supervise, monitor, and regulate the arrangement.

(i) Requested data shall be in the following format:

(A) The pages shall be numbered and printed on paper measuring 8 1/2 by 11 inches. The margins shall not be less than one (1) inch on all sides. Unless otherwise required, all data shall be printed on white paper.

(B) The required data shall be in courier type at ten (10) characters per inch and double spaced.

(D) Trade secret information shall be designated and printed on goldenrod col- ored paper to assist in identifying material exempt from Wyoming's Public Record Act.

(E) The Department shall develop procedures to protect trade secret informa- tion.

(ii) The Director may, at any time, require the submission of additional data or alter the time schedule for submission of information.

(A) The applicant shall be notified, by certified mail, of any requirement for the submission of additional information or any alteration of the time for submission of materials.

(b) The Director shall notify the applicant of any nonconformity by certified mail.

(i) The Director's notice of nonconformity shall state with particularity any deficiency.

(ii) The applicant shall respond, by certified mail, within thirty (30) days from the date of the notice of nonconformity, with a written response supported by additional data which either negates the nonconformity or provides a proposal to correct any nonconformity.

(iii) Within forty (40) days of the date from the notice of nonconformity, the Director and the applicant shall meet informally for the purpose of resolving any nonconformity by agreement.

(iv) If any nonconformity cannot be resolved informally, a contested hearing shall be conducted.

(A) The hearing shall be conducted in accord with W.S. § 35-24-110.

(B) A decision shall be made by the Director within thirty (30) days after written recommendations are received from the hearing officer.

(D) A final decision from the Director is subject to judicial review in accord with W.S. § 16-3-114.

(d) and provide the Director with supporting documentation in accord with W.S. § 35-24-112 (d).

(i) The applicant shall submit notice of intent to renew accompanied by the renewal fee and supporting documentation to the Director no later than thirty (30) days prior to the anniversary month.

(ii) The Director shall evaluate whether the existing arrangement promotes the quality and access to health care for all citizens and whether it promotes the development of a comprehensive health care system.

(iii) If the Director determines the arrangement promotes the quality and access to health care for all citizens and promotes the development of a comprehensive health care system, a renewal shall be granted.

(d) Public comments regarding the impact of existing arrangements.

(i) Two (2) years after the date the initial application is approved, and at two year inter- vals thereafter, the Director shall solicit public comment. The purpose of such comments is to evaluate the arrangement's impact on the cost, access, and quality of health care.

(A) The notice is to be published for a minimum of seven (7) days in a Wyoming newspaper of general circulation in the area.

(B) Any comments will be incorporated in files relating to the application.

(C) The applicant shall review public comments and provide a written response to the Director. The applicant shall send the person(s) making the comment(s) a copy of any response.

Section 19. Revocation of Approval.

(a) Health care cooperative arrangements are subject to the revocation in accord with W.S. § 35-24-115.

(i) Prior to initiating an action to revoke approval, the Director shall comply with the provisions of W.S. § 35-24-114.

(ii) A proceeding to revoke approval is initiated by the Director providing notice, by certified mail, to the applicant of the proposed action.

(iii) The notice shall be in writing and specify, with particularity, the grounds for the proposed action.

(iv) Upon request of the applicant, by certified mail to the Director, a proceeding to revoke will be conducted as a contested hearing. The hearing shall be conducted in accord with W.S. § 35-24-110.

(v) Notice of a revocation proceeding shall be as follows:

(A) The notice of the time, date, and location of the revocation proceeding shall be sent, by certified mail, to the applicant and all persons on record.

(B) The Director shall publish notice of the purpose, time, date, and location of the revocation proceeding for a minimum of seven (7) days prior to the date of the hearing in a Wyoming newspaper of general circulation in the area.

(C) A contested hearing shall be conducted pursuant to the Wyoming Adminis- trative Procedures Act, applicable provisions of the Wyoming Rules of Civil Procedure, and any rules adopted by the Office of Administrative Hearings.

(D) The Director shall issue a final decision, by certified mail, within thirty (30) days following receipt of the written recommendations from the hearing officer.

(b) An entity whose approved application has been revoked shall be required to submit a new application in accord with appropriate sections of these rules.

History

Effective 1996-11-12

Chapter 26 Birthing Centers

Wyo. Code R. 048.0026.26.06272019 § 1 Authority

The Wyoming Department of Health (Department) promulgates this Chapter under Wyoming Statutes 35-2-904, -907, and -908.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 2 Purpose and Applicability

(a) This Chapter applies to the operation of a birthing center.

(b) This Chapter does not apply to the operation of a birthing center that is exempt from licensure under Section 4(b) of this Chapter.

(c) The Department may issue a provider manual, provider bulletin, or other guidance materials to interpret the provisions of this Chapter. Such guidance must be consistent with and reflect the policies contained in this rule.

(d) If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 3 Definitions

(a) The following definitions apply to this Chapter:

(i) "Administration of Drugs" means the act in which a single dose of a prescribed drug or biological is given to a patient by a licensed person in accordance with all laws and regulations governing such acts.

(ii) "Activity, Pulse, Grimace, Appearance, and Respiration" or "APGAR" means the overall assessment of the newborn.

(iii) "Bathing Facility" means a bathtub or shower.

(iv) "Birthing Center" means a facility which operates for the primary purpose of performing deliveries and is not part of a hospital.

(v) "Birthing Room" means a room and environment designed, equipped and arranged to provide for the care of a woman and newborn and to accommodate her support person(s) during the process of vaginal delivery.

(vi) "Certified Nurse Midwife" or "CNM" means a midwife who is licensed as an Advanced Practice Registered Nurse by the Wyoming State Board of Nursing and is certified by the American Midwifery Certification Board.

(vii) "Central Registry" means the registry operated by the Wyoming Department of Family Services to index individuals who have been substantiated for:

(A) Abuse or neglect of children under W.S. 14-3-213; or

(B) Abuse, neglect, exploitation, or abandonment of vulnerable adults under W.S. 35-20-115.

(viii) "Certified Professional Midwife" or "CPM" means a midwife who is certified by the North American Registry of Midwives (NARM) and currently licensed by the Wyoming Board of Midwifery.

(ix) "Clinical Staff" means the physicians, CNMs, or CPM's hired to practice within the birthing center and licensed by the state of Wyoming.

(x) "Governing Body" means an individual or group which is legally responsible for the operation, control and maintenance of the birthing center.

(xi) "Immediate jeopardy" means a situation in which a center's noncompliance with one or more requirements of these Rules has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient.

(xii) "Low Risk" means normal, uncomplicated prenatal course as determined by adequate prenatal care and prospects for a normal, uncomplicated delivery as defined by reasonable and generally accepted criteria of maternal and fetal health. These services shall be limited to mothers not falling in the categories of conditions and needs listed in Section 11 of this Chapter.

(xiii) "Patient" means a pregnant woman or the newborn receiving care in a birthing center.

(xiv) "Personnel" mean individuals employed by the birthing center.

(xv) "Physician" means a person authorized by the Wyoming Board of Medicine to practice medicine pursuant to W.S. 33-26-301.

(xvi) "Plan of correction" means a center's plan to correct the deficiencies identified during a survey conducted by the State Survey Agency.

(xvii) "Recovery" means that period or duration of time starting at birth and ending with the discharge of a patient from the birthing center.

(xviii) "State Survey Agency" means the Department of Health, Aging Division, Healthcare Licensing and Surveys, including its staff and designees.

(xix) "Support Person" means the individual(s) selected or chosen by a mother to provide emotional support and to assist her during the process of labor and childbirth.

(xx) "Survey" means an onsite or offsite inspection conducted by the State Survey Agency to determine compliance with these Rules. The term includes activities commonly referred to in the field as surveys, revisits, complaint investigations, periodic surveys, and other inspections deemed necessary by the State Survey Agency.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 4 Licensing

(a) A birthing center may not operate in Wyoming unless the center is licensed by the State Survey Agency under this Chapter.

(b) Despite the licensure requirement under Subsection (a) of this Section, a center may operate without a license if the center:

(i) Consists of no more than one (1) birthing room; and

(ii) Is located within thirty (30) road miles of an acute care hospital.

(d) The State Survey Agency may issue a center a provisional license according to the following conditions:

(i) A provisional license provides a center with temporary authorization to operate while the center pursues compliance with these Rules. A provisional license is effective for no more than three (3) months. The State Survey Agency may extend the term of a provisional license for an additional three (3) months, as deemed necessary by the State Survey Agency.

(ii) To apply for a provisional license, a center shall submit the following to the State Survey Agency:

(A) A complete and accurate application form, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls;

(B) A complete and accurate Birthing Centers Required Licensure Documentation Checklist, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls; and

(C) The required licensure fee, in the form of a check or money order made payable to "Treasurer, State of Wyoming," identified in Rules, Wyoming Department of Health, Health Quality, Chapter 1 (1998).

(iii) Upon receipt and review of the required application, checklist, and fee, the State Survey Agency may issue the center a provisional license if the State Survey Agency finds the center has demonstrated a good faith effort to comply with these Rules. The State Survey Agency may also issue a provisional license to the center as the State Survey Agency deems necessary to allow the center to become compliant with these Rules.

(e) After the State Survey Agency completes a survey under Section 5(b)(i) of this Chapter, the State Survey Agency may issue a license to a provisionally-licensed center if the State Survey Agency determines the center has submitted an acceptable plan of correction, or corrected any deficiencies cited by the State Survey Agency.

(f) The renewal of a license is subject to the following:

(i) To apply for licensure renewal, a center shall submit the following to the State Survey Agency:

(A) A complete and accurate application form, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls; and

(B) The required licensure fee, in the form of a check or money order made payable to "Treasurer, State of Wyoming," identified in Rules, Wyoming Department of Health, Health Quality, Chapter 1 (1998).

(ii) Upon receipt of the required application and fee, the State Survey Agency may renew the center's license if the State Survey Agency finds the center has demonstrated a good faith effort to comply with the regulatory requirements.

(g) A center may not transfer a license, even if the center changes ownership.

(i) If a center undergoes a change of ownership, the center shall:

(A) Provide written notice no later than sixty (60) days prior to the effective date of the change of ownership to the State Survey Agency that outlines the specific details of the change, parties involved, and proposed effective date;

(B) Within twenty-four (24) hours of the effective change of ownership date, submit a copy of the signed bill of sale and any lease agreements that reflects the effective date of the sale or lease; and

(ii) A change of ownership occurs when there is a change in the legal entity responsible for the operation of the center, whether by lease or by ownership.

(h) If a center changes the center's name or address, the center shall submit the appropriate form and fee established by the State Survey Agency no later than sixty (60) days before the change in center name or address is effective.

(i) If a center voluntarily terminates operations, the center shall notify the State Survey Agency in writing within sixty (60) days before the voluntary termination of operations.

(i) A center voluntarily terminating operations shall provide for the continued storage of medical, financial, and personnel records for a period of six (6) years.

(ii) The notice provided to the State Survey Agency must include the name, address, email, and other contact information of the custodian of the center's medical, financial, and personnel records.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 5 Surveys

(a) A center shall submit to and comply with a survey performed by the State Survey Agency.

(b) The State Survey Agency shall perform:

(i) A survey before the State Survey Agency may issue a license under Section 4(e) of this Chapter;

(ii) A survey as necessary to monitor or resolve previously-identified deficiencies;

(iii) A survey as necessary to periodically monitor compliance with these Rules;

(iv) A survey upon receipt of a complaint against a center for the alleged violation of these Rules or other applicable laws; and

(v) Any other surveys the State Survey Agency deems necessary to enforce the provisions of these Rules, to enforce other applicable law, or to protect the public health, safety, or welfare.

(d) While under survey, a center shall provide the State Survey Agency with immediate access to all center records.

(e) If immediate jeopardy is identified during a survey, the State Survey Agency shall verbally notify the administrator or the administrator's designee. The center shall:

(i) Immediately develop a written action plan to remove the immediate risk to the patient(s);

(ii) Provide the written action plan to the State Survey Agency for review and approval; and

(iii) Upon approval, implement the action plan.

(f) The State Survey Agency shall notify the administrator or administrator's designee when an immediate jeopardy situation has been removed.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 6 Deficiencies and Actions Against a License

(a) If the State Survey Agency determines during a survey that a center is out of compliance with any provision of these Rules or other applicable law, the following conditions apply:

(i) The State Survey Agency shall provide the center a statement of deficiencies within ten (10) business days of the survey exit date.

(ii) If a center receives a statement of deficiencies, the center shall comply with the following provisions.

(A) The center shall submit an acceptable plan of correction to the State Survey Agency within ten (10) business days.

(B) The plan of correction must be a written document that provides the following information:

(I) Who will be charged with the responsibility to correct each deficiency;

(II) What will be done to correct each deficiency;

(III) How the plan of correction will be incorporated into the center's quality management program;

(IV) Who will be charged with monitoring the center to ensure each deficiency does not occur or develop again; and

(V) The date the center expects to correct all deficiencies, which may not exceed sixty (60) calendar days after the survey exit date.

(iii) If the State Survey Agency determines it will take the center longer than the sixty (60) days to implement the plan of correction and there is no threat to the health or safety of patients, the State Survey Agency may extend the sixty (60) day deadline.

(b) Pursuant to W.S. 35-2-905, the State Survey Agency may take action against a center according to the following conditions:

(i) The State Survey Agency may take action against a center if the State Survey Agency finds that the center:

(A) Violated a provision of these Rules or other applicable laws;

(B) Permitted, aided, or abetted the commission of any illegal act by a facility licensed by the State Survey Agency; or

(ii) Action against a center may include:

(A) Placing conditions upon the center's license;

(B) Installing a monitor or manager, at the center's expense, that has been approved by the State Survey Agency;

(D) Denying, suspending, or revoking a center's license.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 7 Governing Body

(a) The governing body of a center shall:

(i) Adopt and maintain bylaws that define, identify, and establish responsibilities for the operation and performance of the center,

(ii) Establish administrative policies including qualifications and responsibilities of the center administrator;

(iii) Provide the appropriate personnel, equipment, supplies and special services necessary to provide safe and effective care; and

(iv) Meet at least annually and keep minutes or other records necessary for the orderly conduct of the center. Meetings held by the center's governing body shall be separate meetings with separate minutes.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 8 Center Administrator

(a) Prior to licensure, a center shall employ and designate a center administrator.

(b) The center administrator shall:

(i) Oversee management and operation for the center;

(ii) Comply with policies, rules and regulations and statutory provisions pertaining to the health and safety of patients;

(iii) Serve as the liaison between the governing body and the staff;

(iv) Plan, organize and direct activities that may be delegated by the governing body;

(v) Control the purchase, maintenance, and distribution of the equipment, materials, and facilities of the center;

(vi) Establish lines of authority, accountability, and supervision of staff;

(vii) Establish controls related to the custody of the official documents of the center and to maintaining the confidentiality, security, and physical safety of data on patients and staff; and

(viii) Ensure personnel policies are adopted, implemented, and enforced to facilitate attainment of the mission, goals, and objectives of the center.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 9 Duties and Powers of a Birthing Center

(a) A center shall provide:

(i) Anesthetic agents according to Section 10 of this Chapter;

(ii) Provision of services according to Section 11 of this Chapter; and

(iii) Pharmaceutical services according to Section 12 of this Chapter.

(b) A center shall adopt, implement, and enforce:

(i) An emergency preparedness plan according to Section 13 of this Chapter;

(ii) A patient rights policy according to Section 14 of this Chapter;

(iii) A quality management program according to Section 15 of this Chapter;

(iv) A records policy according to Section 16 of this Chapter; and

(v) A staffing policy according to Section 17 of this Chapter.

(d) A center shall maintain a physical environment according to the following conditions:

(i) A facility must be designed, constructed, arranged, equipped and maintained, including the provision of fire safety, in accordance with Chapter 3 of these Rules.

(ii) If a facility constructs, remodels, or changes the use of facility space, the facility shall comply with Chapter 3 of these Rules.

(e) A center shall provide, disclose, or otherwise make available medical records, personnel records, incident reports, and other documents related to compliance with these Rules upon the written request of the State Survey Agency.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 10 Anesthetic Agents

(a) A center may not administer general or conduction anesthesia.

(b) A center may administer:

(i) Systemic analgesia for pain control; and

(ii) Local anesthesia for perineal repair if indicated.

(c) A center shall adopt, implement, and enforce policies and procedures for the proper use of anesthetic agents, including relevant techniques, at the center.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 11 Provision of Services

(a) A center may not accept a pregnant woman under sixteen (16) years of age for care.

(b) A center may not perform a delivery if the pregnant woman exhibits medical evidence of the following conditions:

(i) Hypertension, pre-eclampsia, or eclampsia;

(ii) Multiple gestation (i.e. twins);

(iii) Placental abnormalities, including previa or abruptio, which may threaten the neonate;

(iv) Premature labor, post-maturity labor, or medically-induced labor;

(v) More than one (1) prior cesarean section with no history of a vaginal delivery; a cesarean section within eighteen (18) months of the current delivery; or, any cesarean section that was surgically closed with a classical or vertical uterine incision; or

(vi) Known breech or other abnormal, non-vertex, presentation.

(i) A physician, CNM, or CPM shall attend each delivery at the center. A second staff member shall also attend the delivery.

(ii) If more than one patient is in labor at a center, a minimum of one staff member per a patient must be present at the center.

(iii) After a delivery, a CNM, CPM, or RN shall be present in the center at all times until the mother and newborn are stable and discharged from care.

(d) A center shall develop, implement, and enforce written operational policies for:

(i) Informed consent that is obtained prior to the onset of labor and shall include evidence of an explanation by personnel of the services offered and potential risks;

(ii) Orientation and education of patients, family, and support persons regarding childbirth and newborn care;

(iii) Consultation, back-up services, transfer, and transport of the patient(s) to the hospital where appropriate care is available;

(iv) Emergency transport of the patient(s) if indicated, including method of providing pertinent medical information to the receiving hospital;

(v) Discharge of the mothers and newborns within 24 hours after delivery;

(vi) A program for prompt follow-up care and postpartum evaluation after discharge; and

(vii) Registration of birth and reporting of complications, anomalies, and stillbirths.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 12 Pharmaceutical Services

(a) A center shall provide pharmaceutical services necessary to meet the needs of patients and to adequately support the center's clinical capabilities.

(b) A center shall:

(i) Maintain the pharmacy or drug storage area according to relevant federal and state law;

(ii) Package and dispense drugs and biologicals according to relevant federal and state law;

(iii) Keep drugs and biologicals in a locked storage area; and

(iv) Destroy drugs and biologicals as necessary according to accepted medical practices. If the drug is a controlled substance, a RN shall destroy the drug in the presence of another qualified professional and shall document the destruction in the patient's medical record.

(c) A staff member shall immediately report a drug administration error, adverse drug reaction, or incompatibility to the clinical staff.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 13 Emergency Preparedness

(a) A center shall develop and maintain an emergency preparedness plan according to Chapter 3 of these Rules.

(b) A center shall:

(i) Ensure the plan includes ongoing coordination with community agencies and other local health care facilities;

(ii) Review the plan annually; and

(iii) Update the plan as necessary.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 14 Patient Rights

(a) A center shall promote and protect patient rights.

(b) A center shall:

(i) Treat a patient with respect, consideration, and dignity;

(ii) Provide a patient appropriate privacy;

(iii) Provide a patient, to the degree known by the center, appropriate information concerning the patient's diagnosis, treatment, and prognosis. When it is medically inadvisable to give such information to a patient, the center shall provide the information to a person designated by the patient or to a legally authorized person;

(iv) Provide a patient the opportunity to participate in decisions involving the patient's health care, except when the patient's participation is contraindicated for medical reasons; and

(v) Provide the patient written information regarding the patient's rights including the following subjects:

(A) Patient conduct and responsibilities;

(B) Services available at the center;

(D) Fees for services provided at the center;

(E) The center's payment policies; and

(F) The center's procedure for filing and pursuing a grievance, including all relevant steps from filing the initial grievance to achieving a resolution.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 15 Quality Management

(a) A center shall implement a quality management function under W.S. 35-2-910.

(b) A center's quality management program must:

(i) Ensure and evaluate the quality of patient care provided at the center; and

(ii) Provide for the annual review of:

(A) The utilization of the center's services, including the number of patients served and volume of services;

(B) The center's health care policies;

(D) The initiation and documentation of appropriate remedial action to address deficiencies found through the quality management program, as well as documentation of the outcome of remedial action.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 16 Records

(a) If a patient receives services at a center, the center shall maintain a patient medical record. As applicable, a patient medical record must include:

(i) Regarding a pregnant woman or mother:

(A) Documentation of prenatal care, including:

(I) A complete blood count;

(II) Urinalysis;

(III) Prenatal blood serology;

(IV) Rhesus factor (Rh) determination and evidence of a plan for the appropriate use of Rh immune globulin;

(V) Past obstetrical history;

(VI) Physical examination;

(VII) Rubella titer;

(VIII) Identification data including patient history and physical examination;

(IX) Signed consent;

(X) Medication orders signed by licensed provider (Physician, CNM or CPM); and

(XI) Other laboratory test results.

(ii) Regarding the labor and delivery:

(A) Documentation of the labor and delivery:

(I) Anesthesia and analgesia and medication given in the course of labor, delivery, and postpartum;

(II) Administration of rhesus (Rh) immune globulin, if any;

(III) Recovery and other progress notes;

(IV) Medications administered;

(V) Condition and referral on discharge; and

(VI) Home visits following discharge.

(iii) Regarding a newborn:

(A) Documentation of newborn care, including:

(I) Date and hour of birth;

(II) Birth weight:

(III) Length;

(IV) Estimation of gestational age;

(V) Gender;

(VI) Condition of infant on delivery including APGAR;

(VII) Record of ophthalmic prophylaxis and Vitamin K, or refusal thereof;

(VIII) Appropriate physical examination at birth and at discharge by physician or midwife;

(IX) Genetic screening, phenylketonuria (PKU) or other metabolic disorders report or refusal thereof; and

(X) Fetal monitoring record.

(b) A center shall register a birth according to W.S. 35-1-410 and Rules, Wyoming Department of Health, Vital Records Services, Chapter 3 (2008). A center shall include the birth registration information as part of the medical record.

(c) A center shall comply with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the implementing regulations of HIPAA, and any other applicable law relating to the maintenance or disclosure of health information.

(d) A center shall maintain all records according to professional standards of practice, including storage of records in a secure and designated area.

(e) A center's medical records policy must:

(i) Ensure the confidentiality of medical records and safeguard against loss, destruction, or unauthorized use, in accordance with applicable law;

(ii) Govern the use and removal of records from the record storage area;

(iii) Specify the conditions under which record information may be released and to whom;

(iv) Specify when the patient's written consent is required for release of information;

(v) Ensure all entries are dated, signed, and legible;

(vi) Ensure all information to a patient's care and stay is documented in the patient's medical record; and

(vii) Ensure that medical records are preserved in physical or electronic form.

(f) A center shall maintain personnel records for each individual employed at the center that include:

(i) An employment application;

(ii) Verification of criminal background check and Central Registry check;

(iii) Licensure verification;

(iv) Copies of certifications required under Section 17;

(v) Immunizations and other medical tests; and

(vi) Results of medical examinations required as a part of employment.

(g) A center shall maintain equipment records per the manufacturer's recommendations.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 17 Staff

(a) A center may not permit a staff member to provide a service unless:

(i) The staff member possesses the necessary education, training, experience, licensure, and certifications; and

(ii) The staff member is certified in Basic Life Support (BLS) and has required training in bloodborne pathogens.

(b) A center shall employ sufficient staff to allow for:

(i) A practitioner, CNM or CPM to be on-site at the center when patients are present;

(ii) A practitioner to be on-call and immediately available by telephone or radio if there is no practitioner on-site at the center; and

(iii) An adequate number of practitioners, RNs or CPMs to be available on-call to meet the emergency needs of patients in a timely manner.

(c) A center shall require all direct care center staff to submit to a Child & Adult Abuse/Neglect Central Registry Screen, through the Wyoming Department of Family Services, and a full fingerprint-based national criminal background check.

(i) If a direct care staff member is found to have previously committed abuse/neglect or a criminal offence, the center must not allow the staff member to work independently and unsupervised unless the center:

(A) Investigates the conduct at issue in a thorough manner;

(B) Determines, based on the findings of its investigation, that the direct care staff member may be allowed to have unsupervised access to patients and the center's operational systems; and

(C) Maintains documentation of its investigation and determination in the direct care staff member's subsequent personnel file.

History

Effective 2019-06-27

Wyo. Code R. 048.0026.26.06272019 § 18 Equipment and Supplies

(a) A center shall maintain appropriate equipment and supplies, including:

(i) A bed suitable for labor, delivery, and recovery;

(ii) Oxygen with flow meters and masks or equivalent;

(iii) Mechanical suction or bulb suction;

(iv) Endotracheal tubes;

(v) Oral airways;

(vi) Needles;

(vii) Syringes;

(viii) Emergency drugs;

(ix) A laryngoscope;

(x) An automated external defibrillator;

(xi) Emergency medications, intravenous fluids, and related supplies and equipment for both mother and newborn;

(xii) Equipment for monitoring fetal heartrate;

(xiii) Equipment specifically designed for thermal regulation and transport of newborns, and regular training and review in proper use of equipment;

(xiv) An infant scale;

(xv) A clock;

(xvi) Sterile suturing equipment and supplies;

(xvii) Adjustable lighting that is adequate for examinations;

(xviii) Containers for soiled linen which shall be closed or covered;

(xix) Infection control supplies for the sanitary disposal of all wastes;

(xx) An emergency communication system;

(xxi) A sphygmomanometer, stethoscope and fetoscope;

(xxii) Supplies for routine laboratory testing; and

(xxiii) Any other equipment necessary to ensure the safety of pregnant women, mothers, and children.

History

Effective 2019-06-27

185 Healthcare Licensing and Surveys

Chapter 1 Assessment of Licensure Fees

Wyo. Code R. 048.0061.1.10111994 Assessment of Licensure Fees

health/hlthfacil/01_Assessment_of_Licensure_Fees Agency HEALTH Health, Dept. of

Program HLTHFACIL Health Facilities

Chapter Name Assessment of Licensure Fees Chapter No.1

Date Filed 10/22/94 Expr Date Supr Date Repeal Date

Document Type RULES

LICENSURE FEES HEALTH FACILITIES

CHAPTER 1

Assessment of Fees to Wyoming Health Care Facilities

Section 1. Authority. The Department of Health, pursuant to W.S. 35-2-904(a)(ii) of the Hospitals, Health Care Facilities, and Health Services Act and the Wyoming Administrative Procedure Act (W.S. 16-3-101 through 16-3-115) is authorized to establish reasonable fees to recover administrative and operational expenses of the department in conducting its licensure program under this article.

Section 2. Definitions.

(a) "Accrediting Agency" means an inspecting body nationally recognized and approved by federal regulations and having facility standards that meet or exceed the state standards for licensure;

(b) "Acute Care" means short term inpatient care provided in a hospital;

(c) "Ambulatory Surgical Center" means a facility which provides surgical treatment to patients not requiring hospitalization and is not part of a hospital or office of private physicians, dentists or podiatrists;

(d) "Assisted Living Facility" means a dwelling operated by any person, firm or corporation engaged in providing limited nursing care, personal care and boarding home care but not habilitative care, for persons not related to the owner of the facility;

(e) "Bed Capacity" means the number of beds the facility is requesting a license for;

(f) "Birthing Center" means a facility which operates for the primary purpose of performing deliveries and is not part of a hospital;

(g) "Boarding Home" means a dwelling or rooming house operated by any person, firm, or corporation engaged in the business of operating a home for the purpose of letting rooms for rent and providing meals and personal daily living care, but not habilitative or nursing care, for persons not related to the owner. Boarding home does not include a lodging facility or an apartment in which only room and board is provided;

(h) "Department" means the department of health;

(i) "Freestanding Diagnostic Testing Center" means a mobile or permanent facility which provides diagnostic testing but not treatment and is not part of the private offices of health care professionals operating within the scope of their licenses;

(j) "Freestanding Emergency Center" means a clinic built to provide emergency or routine treatment but does not include the private offices of health care professionals operating within the scope of their licenses;

(k) "Health Care Facility" means any ambulatory surgical center, assisted living facility, birthing center, boarding home, freestanding diagnostic testing center, freestanding emergency center, home health agency, hospice, hospital, intermediate care facility for the mentally retarded, medical assistance facility, nursing care facility, rehabilitation facility or renal dialysis center;

(l) "Home Health Agency" means an agency primarily engaged in arranging and directly providing nursing or other health care services to persons at their residence;

(m) "Hospice" means a program of care for the terminally ill and their families given in a home or health facility which provides medical, palliative, psychological, spiritual and supportive care and treatment;

(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;

(i) Diagnostic and therapeutic services for medical diagnosis, treatment and care of injured, disabled or sick persons;

(ii) Rehabilitation services for the rehabilitation of injured, disabled or sick persons;

(iii) Acute care;

(iv) Psychiatric care;

(v) Swing beds.

(o) "Intermediate Care Facility For The Mentally Retarded" means a facility which provides on a regular basis health related care and training to mentally retarded individuals or persons with related conditions, who do not require the degree of care and treatment of a hospital or nursing facility but who do require services in excess of those provided by a boarding home;

(p) "Medical Assistance Facility" means a facility which provides inpatient care to ill or injured persons prior to their transportation to a hospital or provides inpatient care to persons needing that care for a period of no longer than sixty (60) hours and is located more than thirty (30) miles from the nearest Wyoming hospital;

(q) "Nursing Care Facility" means a facility providing nursing care, rehabilitative and other related services;

(r) "Physician" means a doctor of medicine or osteopathy licensed to practice medicine or surgery under state law;

(s) "Psychiatric Care" means the inpatient care and treatment of persons with a mental diagnosis;

(t) "Rehabilitation Facility" means an outpatient facility which is operated for the primary purpose of assisting the rehabilitation of disabled persons by providing comprehensive medical evaluations and services, psychological and social services, or vocational evaluations and training or any combination of these services and in which the major portion of the services is furnished within the facility;

(u) "Renal Dialysis Center" means a freestanding facility for treatment of kidney diseases;

(v) "Revised License" means a new license issued to a facility because of changes incurred in the facility's name, location, or number of beds;

(w) "This Act" means W.S. 35-2-901 through 35-2-910.

Section 3. License Fees.

(a) Revised License fees shall be assessed at $50 per health care facility.

Section 5. Fee for License of an Accredited Hospital. A hospital shall be issued a license after notification of approval of accreditation from an accrediting agency.

(a) Except for accredited hospitals with swing bed programs, license fees shall be $100 per accredited hospital.

(b) License fees for Accredited Hospitals with swing bed programs shall be $200.

Section 6. Fee Schedule Amounts for Health Care Facilities with Beds. Other than Accredited Hospitals.

(a) There are five (5) schedules of health care facilities for the purpose of determining the fee amount a health care facility is assessed. Each health care facility is placed into one of the five following schedules based on the health care facility's bed capacity:

(i) Schedule A. The health care facility has a bed capacity of at least one (1) but not more than fifty

(50) ;

(ii) Schedule B. The health care facility has a bed capacity of more than fifty (50) but not more than one hundred (100);

(iii) Schedule C. The health care facility has a bed capacity of more than one hundred (100) but not more than one hundred fifty (150);

(iv) Schedule D. The health care facility has a bed capacity of more than one hundred fifty (150) but not more than two hundred (200);

(v) Schedule E. The health care facility has a bed capacity of more than two hundred (200).

(b) License fees for health care facilities in this section shall be:

(i) Schedule A facility - $100;

(ii) Schedule B facility - $200;

(iii) Schedule C facility - $300;

(iv) Schedule D facility - $400;

(v) Schedule E facility - $500.

Section 7. Fee Schedule Amounts for Health Care Facilities with Services.

(a) The following types of health care facilities shall be assessed a license fee of $100:

(i) Ambulatory Surgical Center;

(ii) Birthing Center;

(iii) Freestanding Diagnostic Testing Center;

(iv) Freestanding Emergency Center;

(v) Home Health Agency;

(vi) Hospice;

(vii) Intermediate Care Facility For The Mentally Retarded;

(viii) Medical Assistance Facility;

(ix) Rehabilitation Facility;

(x) Renal Dialysis Center.

History

Effective 1994-10-11

Chapter 3 Construction Rules and Regulation for Healthcare Facilities

Wyo. Code R. 048.0061.3.04032008 Construction Rules and Regulation for Healthcare Facilities

CHAPTER 3

CONSTRUCTION RULES AND REGULATIONS FOR HEALTHCARE FACILITILES

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to W.S. 35-2-901, et seq., W.S. 35-9-121.1, and the Wyoming Administrative Procedure Act at W.S. 16-3-101, et seq.

Section 2. Applicability.

(a) These rules shall apply to and govern the construction, remodel, or expansion of healthcare facilities, on and after the effective date of these rules.

(b) The Office of Healthcare Licensing and Surveys may issue manuals, bulletins, or both, to interpret the provisions of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

(c) The incorporation by reference of any external standard intended to be the incorporation of that standards as it is in effect on the effective date of these rules and regulations.

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.

(a) ADepartment@ means the State of Wyoming Department of Health, which is the authority having jurisdiction over all aspects of construction and remodeling, except electrical installation, of any state-licensed healthcare facility as defined in W.S. 35-2-901.

(b) ACouncil@ means the council on fire prevention and electrical safety in buildings per W.S. 35-9-102 (a) (iv).

(c) AHealthcare facility@ means any adult day care facility, ambulatory surgical center, assisted living facility, birthing center, boarding home, freestanding diagnostic testing center, home health agency, hospice, hospital, intermediate care facility for the mentally retarded, medical assistance facility, nursing care facility, rehabilitation facility and renal dialysis center, or as defined by W.S. 35-2-901, et seq.

(d) ANFPA@ means the National Fire Protection Association.

(e) APreliminary plans@ means schematic design documents consisting of drawings and other documents illustrating the scale and relationship of project components that have been approved by the owner.

Section 4. Department of Health Jurisdiction.

(a) W.S. 35-9-121.1. Healthcare facilities; jurisdiction; delegation; rules.

(i) The Department has jurisdiction over all aspects of construction and remodeling, except electrical installation, of any state-licensed healthcare facility, as defined in W.S.35-2-901.

(ii) The fire safety code requirements for the construction and remodeling of any state-licensed healthcare facility shall meet the minimum requirements established in the National Fire Protection Association 101 Life Safety Code or any other code required to meet federal fire and life safety certification. If any code requirements for federal certification conflict with the code of any other state or local governmental entity, the code required for federal certification shall prevail.

(iii) Upon written request from any county or municipality, the Department shall delegate plan review and inspection responsibilities to the county or municipality that has personnel who are certified pursuant to the applicable code. The Department shall transfer jurisdiction and authority by letter. The Department shall notify the governing body of the municipality or county of the minimum standards and requirements under this section, W.S. 16-6-501, and W.S. 16-6-502. The following shall apply:

(A) Any municipality or county may issue a certificate of occupancy for

a healthcare facility. The certificate shall reference any code applied to the construction or remodeling of the facility;

(B) A municipality or county which has enforcement authority under this subsection may create its own appeals board to determine the suitability of alternate materials and types of construction. If a municipality or county has not created an appeals board, the Department shall establish an appeals board which includes representation from the Department and the Council.

(iv) After construction or remodeling of any healthcare facility, the Department shall have jurisdiction over the fire and life safety inspections required for federal certification.

Section 5. Construction Design Requirements for Healthcare Facilities.

(a) Wyoming Fire and Life Safety Minimum Standards for Healthcare Facilities.

(i) The 2006 Edition of "NFPA 101: Life Safety Code," and all codes and standards referenced therein, are adopted by reference.

(ii) The 2005 Edition of "NFPA 99: Standard for Health Care Facilities," and all codes and standards referenced therein, are adopted by reference.

(iii) NFPA 13, NFPA 70, NFPA 99, NFPA 101, and NFPA 110, referenced in these rules, are publications of the: National Fire Protection Association 1 Batterymarch Park P.O. Box 9101 Quincy, MA 02169-7471 Telephone: (617) 770-3000 URL: www.nfpa.org

(iv) Exceptions.

(A) Healthcare facilities that are excepted from "NFPA 101: Life Safety Code" are home health agencies and hospice facilities that do not provide inpatient care.

(B) Healthcare facilities that are excepted from "NFPA 99: Standard for Health Care Facilities" are adult day care facilities, home health agencies, and hospice facilities that do not provide inpatient care.

(C) Any healthcare facility for which the license has lapsed for not more than ten (10) years from the last date of operation and has continuously maintained the building to the 2000 Edition of the "NFPA 101: Life Safety Code" is exempt. Any construction, remodel, or expansion during the period of licensure lapse shall meet the requirements of these rules for new construction.

(b) Wyoming Design and Construction Minimum Standards for Healthcare Facilities.

(i) The "Guidelines for Design and Construction of Health Care Facilities – 2006 Edition," and all codes and standards referenced therein, are adopted by reference.

(ii) This is a publication of: The American Institute of Architects 1735 New York Ave., NW Washington, DC 20006-5292 Telephone: 1-800-242-3837 URL: www.aia.org AIA Store Telephone: 1-800-242-3837, option 4 Facsimile: (202) 626-7519 E-Mail address: bookstore@aia.org

(iii) Exceptions.

(A) Healthcare facilities that are excepted from the "Guidelines for Design and Construction of Health Care Facilities – 2006 Edition" are adult day care facilities, assisted living facilities, boarding homes, hospice facilities that do not provide inpatient care, home health agencies, and intermediate care facilities for the mentally retarded.

(B) Any healthcare facility for which the license has lapsed for not more than ten (10) years from the last date of operation and has continuously maintained the physical environment to the licensure standards in effect on the date of last licensure is exempt. Any construction, remodel, or expansion during the period of licensure lapse shall meet the requirements of these rules for new construction.

(iv) Requirements in addition to the "Guidelines for Design and Construction of Health Care Facilities – 2006 Edition" are as follows:

(A) In hospitals and nursing care facilities, the laundry shall have a

soiled linen holding room equipped with handwashing facilities and a sink for soaking soiled items.

(B) In ambulatory surgical centers, birthing centers, hospices providing inpatient care, hospitals, and nursing care facilities, continuous mechanical exhaust ventilation shall be provided in all bathing rooms, toilet rooms, and soiled and wet areas.

(C) In hospitals and nursing care facilities, nurse call systems and equipment shall be tested against the provisions of IHS UL Standard 1069.

(D) In ambulatory surgical centers, birthing centers, hospices providing inpatient care, hospitals, and nursing care facilities, the air ducts that penetrate floors shall be provided with fire-rated dampers which are activated by smoke and heat.

(E) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, all sinks shall be provided with spray heads or equivalent. Aerators shall not be used.

(F) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, all handwash sinks shall have faucets which discharge at least five (5) inches above the spill level of the sink. Soap dispensers and hand drying apparatus shall be provided at each handwash sink.

(G) In nursing care facilities, bathing facilities shall include one (1) circulating type fixture for each nurses' station.

(H) In nursing care facilities, each resident shall have within his or her bedroom, minimum storage space to include a wardrobe, locker or closet, separated from other resident-shared spaces by a solid divider with a minimum dimension of 2' 4" x 1' 8", with a shelf and rod to permit hanging of full-length garments. In addition, a built-in or freestanding drawer unit which contains at least three (3) drawers, with a minimum inside drawer width of 24", shall be provided for each resident. Nightstand furniture is not considered storage space.

(I) Engineering Services and Equipment.

(I) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, the boiler room or other rooms containing storage of combustible material shall not contain ventilation equipment, the main electrical switch board, or emergency electrical equipment.

(II) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, building water system designs shall be in accordance with "Guideline 12-2000 - Minimizing the Risk of Legionellosis Associated with Building Water Systems," published by the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE).

(III) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, all electrical receptacles located adjacent to sinks or other potentially wet areas shall be provided with ground fault circuit interrupter protection.

(IV) In ambulatory surgical centers, birthing centers, hospitals, medical assistance facilities, and nursing care facilities, a standby electrical generator shall be installed in all facilities to provide emergency lighting and power per the 2008 Edition of "NFPA 70: National Electrical Code," the 2005 Edition of "NFPA 99: Standard for Health Care Facilities," and the 2005 Edition of "NFPA 110: Standard for Emergency and Standby Power Systems."

(V) In ambulatory surgical centers, birthing centers, freestanding diagnostic testing centers, hospices providing inpatient care, hospitals, medical assistance facilities, nursing care facilities, rehabilitation facilities, and renal dialysis centers, exposed light bulb fixtures and heat lamps shall not be allowed. Globes, guards, lenses, and speciality coated bulbs shall be provided.

(VI) In ambulatory surgical centers, birthing centers, hospitals, medical assistance facilities, and nursing care facilities, supply and return air systems for patient and resident care areas shall be within a duct. Common returns using corridor, ceiling cavities, and attic spaces as return plenums are prohibited.

(1.) Exception: Remodeling of existing buildings where the remodeling causes no change of space use that previously existed and where the ventilation of the existing building complies with Section 7 (b) of these Rules.

(VII) In assisted living facilities where there are sleeping accommodations for more than sixteen (16) residents, the automatic sprinkler system shall be installed in accordance with "NFPA 13: Standard for the Installation of Sprinkler Systems."

(i) The 2006 Edition of the "International Building Code," and all codes and standards referenced therein, are adopted by reference.

(A) Modifications to the 2006 Edition of the "International Building Code" applicable to these rules and regulations are as follows:

(I) Sections 103, 104, 105, 108, 110, 111, 112, 113, 114, and 115 are not applicable.

(II) Subsection 101.4.1, Electrical, is modified by deleting AICC Electrical Code@ and replacing with ANational Electrical Code."

(III) The Department is the building official where the phrase "building official" is used in the applicable Sections of the code.

(IV) Subsection 1805.2.1, "Frost protection," is amended in all areas of the state outside the local government jurisdictions, the minimum depth from finished grade to the bottom of footings shall be three (3) feet for single-story wood or metal frame buildings, and four (4) feet for multistory or masonry buildings.

(ii) The 2006 Edition of the "International Fuel Gas Code," and all codes and standards referenced therein, are adopted by reference.

(A) Modifications to the 2006 "International Fuel Gas Code" applicable to these rules and regulations are as follows:

(I) Sections 103, 104, 106 (other than 106.3.1), 108, and 109 are not applicable.

(II) Subsection 2702.1, "Installation"; Subsection 309.2, "Electrical"; Subsection 1003.2.11.2, "Illumination emergency power"; and Subsection 1003.2.10.5 "Power source"; are modified by deleting AICC Electrical Code@ and replacing with ANational Electrical Code."

(III) The Department is the code official where the phrase "code official" is used in the applicable Sections of the code.

(iii) The 2006 Edition of the "International Mechanical Code," and all codes and standards referenced therein, are adopted by reference.

(A) Modifications to the 2006 "International Mechanical Code" applicable to these rules and regulations are as follows:

(I) Sections 103, 104, 106 (other than 106.3.1), 108, and 109 are not applicable.

(II) Subsection 301.7, "Electrical," is modified by deleting AICC Electrical Code@ and replacing with ANational Electrical Code."

(III) The Department is the code official where the phrase "code official" is used in the applicable Sections of the code.

(iv) The 2006 edition of the "International Plumbing Code," and all codes and standards referenced therein, are adopted by reference.

(A) Modifications to the 2006 "International Plumbing Code" applicable to these rules and regulations are as follows:

(I) Sections 103, 104, 106 (other than 106.3.1), 108, and 109 are not applicable.

(II) The Department is the code official where the phrase "code official" is used in the applicable Sections of the code.

(v) The 2006 edition of the "International Fire Code," and all codes and standards referenced therein, are adopted by reference.

(A) Modifications to the 2006 "International Fire Code" applicable to these rules and regulations are as follows:

(I) Sections 103, 104,105 (other than 105.4), 108, 109, 110, and 111 are not applicable.

(II) Subsection 604.1, "Installation," and Section 605, "Electrical Equipment, Wiring and Hazards," are modified by deleting AICC Electrical Code@ and replacing with ANational Electrical Code.@

(III) The Department is the code official where the phrase "code official" is used in the applicable Sections of the code.

(vi) The codes referenced above are publications of: The International Code Council 500 New Jersey Avenue, NW, 6th Floor Washington, DC 20001 Telephone: 1-888-422-7233 Facsimile: (202) 783-2348 URL: http://www.iccsafe.org

Section 6. Approvals, Inspections, Technical Assistance, Interpretations, and Plan Review.

(a) Plan Review.

(i) Submission of Plans and Specifications.

(A) Plans and specifications for new construction must be submitted to the Department for evaluation and approval. No construction shall begin prior to approval of the plans by the Department.

(B) Plans and specifications shall be submitted whenever:

(I) New construction of a healthcare facility is planned;

(II) An existing structure is being converted for use as a healthcare facility;

(III) There are changes to the functional operation and space usage of an existing healthcare facility;

(IV) Remodeling of an existing healthcare facility is planned.

(C) Based on a preliminary plan review, the final plan review may be waived at the discretion of the Department, based on the scope and nature of the project.

(D) Routine maintenance does not require the submission of plans and specifications. For the purpose of this subsection, Aroutine maintenance@ means repair or replacement of existing equipment, room finishes and furnishings, and similar activities. Such repairs shall not include the cutting away of any wall, partition or portion thereof; the removal or cutting of any structural beam or load-bearing support; or the removal or change of any required means of egress, or rearrangement of parts of the structure affecting the egress requirements; nor shall ordinary repairs include addition to, alteration of, replacement or relocation of any standpipe, water supply, sewer, drainage, drain leader, gas, soil, waste, vent or similar piping, electrical wiring or mechanical or other work affecting health or general safety.

(E) Where equipment replacement and construction are to be performed in an emergency situation, the Department shall be notified within the next working business day. The approval for any work requiring plan approval shall be obtained for the work done for the emergency situation.

(ii) Preliminary Plans.

(A) One (1) set of preliminary plans, the functional program, and the Infection Control Risk Assessment, as required by the AGuidelines for Design and Construction of Healthcare Facilities – 2006 Edition," approved by the owner, shall be submitted to the Department for review and approval by the Department or by the Department=s authorized representative prior to submitting final plans.

Effective: 04/03/2008

(B) After preliminary plans are approved, the final plans shall be submitted to the Department, or the owner may choose to retain an outside plan reviewer, at the expense of the facility, who has been qualified and approved by the department.

(C) The requirement for preliminary plans may be waived at the sole discretion of the Department, based on the nature of the project.

(D) Approval of preliminary plans expires twelve (12) months after the date of the Department=s approval letter if the final drawings have not been submitted and approved.

Preliminary plans shall be resubmitted to obtain a new letter of approval.

(iii) Final Plans.

(A) Prior to beginning work, the owner or owner=s representative shall submit two (2) complete sets of plans and specifications to the Department for evaluation and approval. Alternately, the facility owner may choose to retain an outside plan reviewer, at the expense of the facility, who has been qualified and approved by the department. Sufficient stamps or metered postage to provide for the return of one (1) set of plans and specifications shall be included at the time of plan submission and attached to a label bearing the return address of the owner or owner=s representative.

(B) When plans and specifications are submitted for review, they shall be drawn to scale on substantial paper and shall be of sufficient clarity to indicate the nature and extent of the work proposed, and shall show in sufficient detail to indicate they conform to the provision of the statutes and the rules and regulations of the Department.

(C) If the plans and specifications are prepared by an architect or engineer, that professional must be licensed in the State of Wyoming.

(D) When the Department issues its final acceptance, the plans and specifications shall be stamped AREVIEWED AND ACCEPTED.@ The accepted plans and specifications shall not be changed, modified, or altered without authorization of the Department, and all work shall be done in accordance with the accepted plans. A set of the plans and specifications shall be returned to the owner or owner=s representative, stamped AREVIEWED AND ACCEPTED,@ and shall be kept at the site of work, and shall be open to inspection.

(E) Any construction on a project prior to the Department's approval of the final plans shall only be permitted by written authorization from the Department. This type of approval shall be limited to foundation construction only.

(F) Stamped plans and specifications marked "REVIEWED AND ACCEPTED@ do not authorize, allow, or approve the violation of any applicable code, law, or rules and regulations.

(G) All plan approvals issued for a project shall become invalid unless the construction commences within 180 days from the date on the approval letter issued by the Department. In addition, plan approvals shall become invalid if construction on a project is suspended or abandoned for a period of 180 consecutive days. The Department may authorize, in response to a written request by the owner, one or more extensions of time for periods not to exceed 180 days each.

(H) The Department may suspend or revoke the approval/acceptance issued under the provisions of these rules and regulations if the Department believes the approval/acceptance was issued on the basis of incomplete or inaccurate information.

(I) Construction documents shall be submitted in accordance with Section 106 of the "International Building Code," Section 106.3.1 of the "International Fuel Gas Code," Section 106.3.1 of the "International Mechanical Code," Section 106.3.1 of the "International Plumbing Code," and Section 105.4 of the "International Fire Code." Separate drawings shall be prepared for each of the following branches of work: architectural, structural, mechanical, and electrical. The working drawings and specifications, in addition and as appropriate to the project, shall include or contain the following:

(I) Architectural Drawings.

(1.) Site plan showing all new topography: newly established levels and grades, existing structures on the site (if any), new buildings and structures, roadways, walks, and the extent of areas to be landscaped. All structures and improvements that are to be removed under the construction contract shall be shown.

(2.) Plan of each floor and roof.

(3.) Elevations of each facade.

(4.) Sections through the building.

(5.) Elevators and dumbwaiters. Drawings delineating shaft details and dimensions; sizes of cab platform and doors; travel distances, including elevation of landings; pit sizes; and machine rooms.

(6.) Kitchen, laundry, laboratories, special care areas, and similar areas shall be detailed at a scale to show the location, type, size, and connection of all fixed and movable equipment.

(7.) Scale details as necessary; scale details to one and one-half inches (1-1/2") to the foot may be necessary to properly indicate portions of the work.

(8.) Schedule of finishes.

(9.) List of applicable building codes.

(10.) A separate plan for each floor, including smoke compartmentation, exit signage, fire extinguishers, fire alarm devices, pull stations, sprinklered areas, fire barriers, and corridor protection reflecting "NFPA 101: Life Safety Code."

(II) Structural Drawings.

(1.) Plan of foundation, floors, roofs, and intermediate levels shall show a complete design with sizes, section, and the relative location of the various members, schedule of beams, girders, and columns.

(2.) Floor levels, column centers, and offsets shall be dimensioned.

(3.) Special openings and pipe sleeves shall be dimensioned or otherwise noted for easy reference.

(4.) Details of all special connection, assemblies, and expansion joints shall be given.

(5.) Notes on design data shall include the name of the governing building code, values of allowable unit stresses, assumed live loads, wind loads, earthquake load, and soil-bearing pressures.

(6.) For special structures, a stress sheet shall be incorporated in the drawings showing: a. Outline of structure;

b. All load assumptions used;

c. Stresses and bending moments separately for each kind of loading;

d. Maximum stress and/or bending moment for which each member is designed, when not readily apparent from the mechanical drawings; and

e. Horizontal and vertical reaction at column bases.

(III) Mechanical Drawings.

(1.) Heating, cooling, and ventilation plans, including:

a. Radiators, coils, and steam-heated equipment, such as sterilizers, warmers, and steam tables;

b. Heating and steam mains and branches with pipe sizes;

c. Diagram of heating and steam riser with pipe sizes;

d. Sizes, types, and heating surface of boiler furnaces with stokers and oil burners, if any;

e. Pumps, tanks, boiler breeching and piping, and boiler room accessories;

f. Air conditioning systems with required equipment, water and refrigerant piping, and ducts;

g. Supply and exhaust ventilating systems with connection and piping; and

h. Air quantities for all room supply and exhaust ventilating duct openings.

(2.) Plumbing, drainage, and stand pipe systems plans including:

a. Size and elevation of street sewer, house sewer, house drains, street water main, and water service into the building;

b. Location and size of soil, waste, and vent stacks with connection to house drain, clean outs, fixtures, and equipment;

c. Size and location of hot, cold, and circulating mains, branches, and risers for the service entrance and fixture connections;

d. Gas, oxygen, and similar piped system;

e. Standpipe and sprinkler system; and

f. All fixtures and equipment that require water and drain connections.

(IV) Electrical Drawings.

(1.) Electrical service entrance with switches and feeders to the public service feeders, characteristics for the light and power current, transformers and their connection if located in the building.

(2.) Location of main switchboard, power panels, light panels, and equipment. Feeder and conduit sizes shall be shown with schedule of feeder breaker or switches.

(3.) Light outlets, receptacles, switches, power outlets, and circuits.

(4.) Telephone layout showing service entrance, telephone switchboard, strip boxes, telephone outlets, branch conduits, and public telephones.

(5.) Nurse call systems with outlets for beds, duty stations, corridor signal lights, annunciators, and wiring diagrams.

(6.) Fire alarm system with stations, signal devices, control board, and wiring diagrams.

(7.) Emergency electrical system with outlets, transfer switch, source of supply, feeders, and circuits.

(8.) All other electrically operated systems and equipment.

(iv) Special submittals.

(A) Automatic sprinkler systems. At least two (2) sets of the sprinkler system shop drawings, specifications, and calculations prepared by the installer shall be submitted for review and approval prior to the installation.

(B) Radiation Protection. Any project that includes radiology or special imaging equipment used in medical diagnosis, treatment, and therapy of patients, shall include plans, specifications, and shielding criteria, prepared by a qualified medical physicist. The plans shall be submitted and approved prior to the installation of the equipment.

(v) Plans and specifications shall be reviewed by personnel who are certified pursuant to the applicable code. Personnel who perform plan reviews shall, as a minimum, be certified as follows:

(A) Building Plans Examiner - certified by the International Code Council.

(B) Mechanical Plans Examiner - certified by the International Code Council.

(D) Fire Plans Examiner - certified by the National Fire Protection Association.

(b) Inspections.

(i) The construction specifications shall require the contractor to perform tests to ensure all systems conform to the approved plans and specifications.

(A) It shall be the owner=s responsibility to ensure qualified inspectors are retained to perform all required construction inspections throughout the course of the construction project. The owner may request inspection(s) by Department inspectors or may choose to retain outside inspectors, at the expense of the facility, who have been qualified and approved by the Department. Inspections shall be conducted in accordance with the following codes and shall be completed by personnel certified pursuant to the applicable code:

(I) Section 109 of the 2006 Edition of the "International Building Code."

(II) Section 107 of the 2006 Edition of the "International Fuel Gas Code."

(III) Section 107 of the 2006 Edition of the "International Mechanical Code."

(IV) Section 107 of the 2006 Edition of the "International Plumbing Code."

(V) Section 106 of the 2006 Edition of the "International Fire Code."

(B) Records of inspections shall be retained by the owner and shall be available for inspection by the Department. An inspection sign-off card shall be provided by the Department to be maintained at the construction site. A representative of the Department may periodically visit the site and conduct random inspections of construction elements to ensure conformance with approved plans and specifications.

(ii) Licensure Construction Survey.

(A) Requests for final inspection for licensure on a mutually agreed upon date between the owner and the Department shall be made in writing by the owner to the Department.

(B) Building System Certifications and Tests.

(I) The owner, as requested, shall submit to the Department test reports and certifications as determined by the Department, based on the scope and nature of the project.

(C) If deficiencies are found as a result of the licensure construction survey, the healthcare facility, as requested, shall submit a plan of correction for review and acceptance by the Department.

(D) Healthcare facilities shall not provide patient services in the construction, remodel, or expanded areas until written authorization to provide such services is provided by the Department.

(c) Technical Assistance. The owner or owner=s representative may request technical assistance from the Department concerning the application of the codes, standards, and regulations in these Rules.

(i) Design and Professional Services. Project design and professional architect services requirements, including consultants, are provided in the Rules and Regulations of the Wyoming State Board of Architects and Landscape Architects.

(d) Interpretations. Requests for interpretations of Section 5. Construction Design Requirements for Healthcare Facilities, may be submitted to the Department. The following resources will be used by the Department to provide a formal interpretation: Centers for Medicare & Medicaid Services, National Fire Protection Association, International Code Council, and The American Institute of Architects Academy of Architecture for Health.

Section 7. Existing Building Licensure.

(a) Existing buildings, currently licensed, shall conform to Department construction rules in effect at the time of original facility licensure.

(i) Existing buildings which were previously licensed in the same licensure category, but for which the license has lapsed, shall be brought into compliance with the Department=s construction rules in effect at the time of application for new license.

(b) Ventilation for Existing Buildings.

(i) Existing buildings licensed as a nursing care facility or a hospital before May 29, 1991, shall be designed, constructed, equipped, maintained, and operated in compliance with the ventilation requirements that were in effect at the time the facility was licensed.

(ii) An existing building, not previously licensed as a nursing care facility or hospital, shall comply with the ventilation requirements for new construction.

(iii) Additions, remodels, or changes of space use and service, shall comply with the ventilation requirements for new construction.

(A) If changes of space use and service or the remodeling of a wing or building exceeds fifty percent (50%) of the total square foot area of the nursing care facility or hospital, the entire nursing care facility or hospital shall be brought into compliance with the adopted codes and rules governing new construction in effect on the date the plans were approved by the Department. This provision is not intended to apply to minor or cosmetic renovations, such as paint, wall covering, or floor covering.

Section 8. Electrical Safety.

(a) Electrical installations shall be in accordance with W.S. 35-9-119, including plan reviews and inspections.

Contact: Wyoming Department of Fire Prevention and Electrical Safety Herschler Building, 1W, 122 West 25th Street Cheyenne, WY 82002 Telephone: (307) 777-7288

Section 9. Variances.

(a) A healthcare facility may submit a request to the Department to obtain a variance from the above rules and regulations at any time.

(i) An applicant requesting a variance shall file a Request for Agency Action/Variance Application with the Department on the form furnished by the Department.

(ii) The Department may require additional information from the facility before acting on the request.

(iii) The Department shall act upon each request for a variance in writing within sixty (60) days of receipt of a completed request.

(b) If the Department grants a variance, it shall amend the license in writing to indicate that the facility has been granted a variance. The variance may be renewable or non-renewable. The healthcare facility shall maintain a copy of the approved variance on file in the facility and make the copy available to all interested parties upon request.

(i) The Department shall file the request and variance with the license application.

(ii) The terms of a requested variance may be modified upon agreement between the Department and the facility.

(iii) The Department may impose conditions on the granting of a variance as it determines necessary to protect the health and safety of the facility residents or patients.

(iv) The Department may limit the duration of any variance.

(c) The Department shall issue a written notice of agency decision denying a variance upon a determination that the variance is not justified. This decision shall be final and may not be appealed.

(d) The Department may revoke a variance if:

(i) The variance adversely affects the health, safety, or welfare of the facility residents or patients.

(ii) The facility fails to comply with the conditions of the variance, as granted.

(iii) The licensee notifies the Department in writing that it wishes to relinquish the variance and be subject to the rule previously varied.

(iv) There is a change in the statute, regulations, or rules.

Section 10. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2008-04-03

Chapter 12 Licensure of Hospitals

Wyo. Code R. 048.0061.12.03012023 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter pursuant to Wyoming Statute 35-2-908.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 2 Purpose

This rule has been adopted to protect the health, safety, and welfare of patients and employees in hospitals. This rule does not apply to critical access hospitals.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 3 Severability

If any portion of this rule is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 4 Definitions

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 number shall include the plural and vice-versa. Throughout this rule gender pronouns are used interchangeably. 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 purpose of this rule, the following shall apply:

(a) "Acceptable Plan of Correction" means the State Survey Agency approved the Hospital's plan to correct the deficiencies identified during a survey conducted by the State Survey Agency or its designated representative. The plan of correction shall be a written document and shall provide, but not be limited to, the following information:

(i) Who is responsible for the correction.

(ii) What was done or will be done to correct the problem.

(iii) Who will monitor to ensure that the situation does not again develop.

(iv) An appropriate date, not to exceed forty-five (45) calendar days after the last day of survey, for the correction of deficiencies.

(b) "Anesthesiologist" means a physician who is certified by the American Board of Anesthesiology, the American College of Anesthesiology, or their equivalents.

(c) "Certified Dietary Manager" means a person with education, training, and experience to competently perform the responsibilities of a dietary manager with consultation from or supervision of a Registered Dietitian. The Certified Dietary Manager has passed a nationally-recognized credentialing exam and participates in continuing education as needed to maintain certification status.

(d) "Certified Occupational Therapy Assistant" means a person licensed to assist in the practice of occupational therapy, and who works under the supervision of a registered occupational therapist pursuant to W.S. 33-40-102.

(e) "Certified Registered Nurse Anesthetist (CRNA)" means an advanced practice registered nurse (APRN) authorized by the Wyoming State Board of Nursing to practice as a Certified Registered Nurse Anesthetist pursuant to W.S. 33-21-119 et seq.

(f) "Certified Respiratory Therapy Technician" means a person who has successfully completed a one (1) year respiratory care training program, and who has been certified by the American Association for Respiratory Care (AARC).

(g) "Clinical Laboratory" means a facility for the microbiological, serological, chemical, hematological, biophysical, cytological, or pathological examination of materials derived from a human body for the purpose of obtaining information for the diagnosis, prevention, or treatment of disease or assessment of medical conditions.

(h) "Complaint Investigations" means those investigations required to be performed by the State Survey Agency.

(i) "Critical Access Hospital" means a hospital which meets the criteria required by the Wyoming State Rural Health Plan and rules for designation of critical access hospitals.

(j) "Dietetic Technician Registered" means an individual who has completed at least a two (2) year associate's degree, a dietetic technician program accredited by the Commission on Accreditation for Dietetics Education, has passed a national examination, and maintains registration through the completion of continuing education.

(k) "Dietitian" means a person who is registered by the Commission on Dietetic Registration and provides nutritional and dietary services.

(l) "Drug Administration" means an act in which a single dose of an identified drug is given to a patient.

(m) "Drug Dispensing" means the issuance of one (1) or more doses of a prescribed medication in containers that are correctly labeled to indicate the name of the patient, the contents of the containers, and all other vital information needed to facilitate correct patient usage and drug administration.

(n) "Governing Body" means the individual(s), group, or corporation that is legally responsible for the hospital.

(o) "Health Care Services" includes, but is not limited to, nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, social worker, nurse assistant, and dietary services. Staff shall be licensed or registered in accordance with Wyoming State Statutes.

(p) "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:

(i) Diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons;

(ii) Rehabilitation services for the rehabilitation of injured, disabled, or sick persons;

(iii) Acute care;

(iv) Psychiatric care;

(v) Swing beds.

(q) "Laboratory Director" means a person who is a pathologist, staff physician, or has an MT (ASCP) certification.

(r) "License" means the authority granted by the State Survey Agency to operate a hospital.

(s) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(t) "Licensee" means any association, partnership, or corporation holding a hospital license.

(u) "Life Safety Code" means NFPA 101 Life Safety Code cited in the Wyoming Department of Health, Chapter 3, Construction Rules and Regulations for Healthcare Facilities.

(v) "NEC" means the National Electrical Code.

(w) "NFPA" means the National Fire Protection Association.

(x) "Nursing Care Unit" means an organized jurisdiction of nursing service in which nursing services are provided on a continuous basis.

(y) "Nursing Service" means patient care services pertaining to the curative, restorative, and preventive aspects of nursing that are performed and/or supervised by a registered nurse pursuant to the medical care plan of the practitioner and the nursing care plan.

(z) "Nutrition Care Process" means the standardized process for providing nutritional care to patients as established by the American Dietetic Association. The four steps in the process include: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.

(aa) "Occupational Therapist" means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Registered Occupational Therapist pursuant to W.S. 33-40-102.

(bb) "Pharmacist" means a person licensed as a Pharmacist in Wyoming pursuant to W.S. 33-24-116.

(cc) "Physical Therapist" means a person who is licensed to practice physical therapy in Wyoming pursuant to W.S. 33-25-101.

(dd) "Physical Therapy Assistant" means a person who is licensed by the Wyoming Board of Physical Therapy to practice as a physical therapy assistant under the supervision of a registered Physical Therapist pursuant to W.S. 33-25-101.

(ee) "Physical Therapy Services" means services provided by a physical therapist or a physical therapy assistant licensed pursuant to W.S. 33-25-101.

(ff) "Physician" means a person who is licensed by the Wyoming Board of Medicine to practice medicine in Wyoming pursuant to W.S. 33-26-102.

(gg) "Quality Assessment and Performance Improvement (QAPI) Program" means a program developed and implemented by the hospital to evaluate and improve patient care and services.

(hh) "Registered Nurse" means a person who is a graduate of an approved school of professional nursing, and who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(ii) "Respiratory Care" means the health specialty responsible for the treatment, management, diagnostic testing, control, and care of patients with deficiencies and abnormalities associated with the cardiopulmonary system.

(jj) "Speech Language Pathologist" means a person who is licensed in Wyoming to practice speech language pathology pursuant to W.S. 33-33-105.

(kk) "Speech Pathology" means the application of principles, methods, and procedures for the evaluation, monitoring, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language for preventing, identifying, evaluating, and reducing the effects of such disorders and conditions.

(ll) "State Survey Agency" means the Wyoming Department of Health, Healthcare Licensing and Surveys.

(mm) "Survey" means a periodic evaluation conducted by the State Survey Agency or its designated representative to determine compliance with State Rules and Regulations for Licensure of Hospitals. A survey may be conducted on site or off site.

(nn) "Therapy Service" means physical therapy, occupational therapy, and speech language therapy.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 5 Licensure

(a) Licensing Procedure.

(i) For an initial license to be issued, the State Survey Agency shall receive:

(A) A completed application form supplied by the State Survey Agency, including the completed items identified on the Hospital Licensure Checklist supplied by the State Survey Agency.

(B) Each completed application shall be accompanied by the required licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one (1) year beginning July 1, and unless suspended or revoked, expiring on June 30 of the following year, the State Survey Agency shall receive:

(A) A completed application form submitted no later than the date indicated in the renewal notice posted on the State Survey Agency website at: http://health.wyo.gov/aging/hls; and

(B) The licensure fee required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The State Survey Agency shall consider:

(i) Initial re-licensure and complaint survey deficiencies cited by the State Survey Agency;

(ii) Life Safety Code deficiencies cited by the State Survey Agency;

(iii) Complaint investigations and resolutions;

(iv) Compliance with all laws and standards relating to communicable and reportable diseases, as required by the Wyoming Department of Health, State Health Officer, and Public Health Division; and

(v) The effectiveness of the quality management program to evaluate and improve patient care and services.

(i) Transfer or assignment of a hospital license is prohibited. The hospital shall comply with licensure requirements in paragraph (d) of this section in the event of a change in the ownership of a hospital.

(d) Change of Ownership.

(i) A change in ownership of a hospital occurs when there is a change in the legal entity responsible for the operation of the hospital, whether by lease or by ownership.

(ii) For a Medicare and/or Medicaid certified hospital, the change of ownership determination by the Centers for Medicare and Medicaid Services will also be used to determine the licensure change in ownership.

(iii) The new owner shall submit no later than sixty (60) calendar days prior to the event the following items:

(A) A change in ownership application for licensure with the appropriate fee, as required in paragraph (a)(i)(B) of this section.

(B) The checklist items required for an initial applicant.

(iv) Within twenty-four (24) hours of the event, the new owner shall submit a copy of the signed bill of sale or lease agreement that reflects the effective date of the sale or lease.

(e) Other changes. A licensure application and appropriate fee, as required in paragraph (a)(i)(B) of this section, shall be required for any of the following changes to be processed:

(i) Name change of hospital.

(ii) The number of licensed beds increased or decreased.

(iii) Change in the main hospital address or ancillary locations.

(f) Provisional Licenses.

(i) A provisional license is a temporary license that may be issued in the following instances:

(A) For a new licensed provider.

(B) For a change in ownership, if deemed appropriate by the State Survey Agency.

(C) Following a successful licensure construction inspection for space that has not previously been occupied by patients, residents, or clients. During the aforementioned inspection, there can be no deficiencies cited that could potentially result in harm to the patients, residents, or clients.

(E) Whenever deficiencies are cited that are serious and have resulted in harm or potential harm to patients, residents, or clients.

(F) Whenever the facility fails to satisfactorily correct cited deficient practice.

(G) Whenever the facility fails to comply with any requirement of these rules.

(ii) The state Medicaid office will be notified by the State Survey Agency whenever a provisional license is issued or re-issued.

(iii) A provisional license will be issued with an expiration date to be determined by the State Survey Agency at the time of issuance.

(iv) A provisional license may be re-issued for additional extended time, if deemed appropriate by the State Survey Agency.

(vi) The provisional license must be posted in a public place in the facility just as for any regular operating license.

(g) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(h) Suspension of Admissions.

(i) The State Survey Agency may suspend new admissions or re-admissions to the hospital when conditions are such that patient needs cannot be met. Conditions in a hospital shall not jeopardize the patient's health or safety.

(i) Monitor.

(i) The State Survey Agency shall place a Wyoming Department of Health approved monitor, at the hospital's expense, when conditions are such that patients' needs are not being met by the hospital. The monitor shall insure that neither the health nor the safety of the patients is jeopardized.

(j) Hearings.

(i) Any hospital aggrieved by a decision of the State Survey Agency may request a hearing by submitting a written request to the State Survey Agency within ten (10) calendar days of receipt of the notice of adverse action.

(ii) The State Survey Agency (State Survey Agent or designee) shall provide an opportunity for a hearing, if requested, and shall present the evidence supporting any preliminary licensure decision(s) and reason(s) to the parties concerned.

(iv) Hearings requested under the terms of this rule shall be held in accordance with the provisions of the Wyoming Administrative Procedure Act.

(k) Posting of License.

(i) The current license issued by the State Survey Agency shall be displayed in a public area within the hospital.

(l) Surveys for Licensure.

(i) The State Survey Agency or its designated representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Rules and Regulations for Licensure of Hospitals as promulgated by the Wyoming Department of Health.

(B) The State Survey Agency shall provide, within ten (10) working days after the last day of survey, copies of its cited deficiencies to the hospital.

(C) The hospital shall provide an acceptable plan of correction to the State Survey Agency for all cited deficiencies within ten (10) calendar days after receipt of the deficiencies.

(m) Voluntary Closure.

(i) If a hospital voluntarily ceases to operate, it shall notify the State Survey Agency in writing at least sixty (60) working days prior to closure.

(ii) The first working day after closure, the hospital's license shall be hand carried or sent by certified mail to Healthcare Licensing and Surveys, 6101 Yellowstone Rd., Suite 186C, Cheyenne, WY 82002.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 6 Governing Body

There shall be a governing body legally responsible for the management and operation of the hospital.

(a) Bylaws shall be adopted by the governing body in accordance with legal requirements.

(i) The bylaws shall:

(A) Stipulate the basis upon which members are selected, term of office, and duties.

(B) Specify to whom responsibilities for the operation and maintenance of the hospital, including evaluation of hospital practices, shall be delegated.

(b) Medical staff members shall be appointed by the governing body.

(i) There shall be a formal procedure established, governed by written rules and regulations, covering the application for medical staff membership and the method of processing applications.

(c) The hospital administrator, appointed by the governing body, shall be the executive officer of the hospital and shall be an individual qualified in hospital administration either by sufficient education or experience. She shall be responsible directly to such governing entities and shall execute all policies established by the governing body.

(i) The administrator shall:

(A) Keep the governing body fully informed on the operation of the hospital through annual or monthly written or oral reports and by attendance at meetings of the governing body.

(B) Be responsible for developing current written personnel policies and for establishing continuing in-service programs as indicated by personnel needs.

(C) Maintain current employee records containing evidence of adequate health examinations and absence of active communicable disease.

(D) Insure that all unusual accidents and deaths are immediately reported verbally and in writing to the State Survey Agency and other authorities as required by city, county, state, and federal laws.

(d) The governing body shall be responsible to ensure the facility has an ongoing, facility-wide Quality Assessment and Performance Improvement (QAPI) plan.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 7 Medical Staff

The hospital shall have a medical staff organized under bylaws approved by the governing body and responsible to the governing body for the quality of all medical care provided patients and for the ethical and professional practices of its members.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 8 Emergency Services

The hospital shall meet the emergency needs of patients in accordance with acceptable standards of practice.

(a) Diagnostic and treatment equipment, drug and supply space, and treatment rooms shall be adequate in number and size.

(b) The following equipment, as a minimum, shall be available to the emergency suites: cardiac monitor, resuscitator, defibrillator, aspirator, thoracotomy set, and tracheotomy set.

(c) Services shall be available twenty-four (24) hours a day, seven (7) days a week, and emergency room staff coverage shall be adequate to ensure that a patient for treatment will be seen within a reasonable length of time relative to his illness or injury.

(d) Adequate medical records shall be kept on every patient.

(i) The emergency room record shall contain:

(A) Patient identification.

(B) Time and date of service.

(D) Physical findings.

(E) Laboratory and x-ray reports (if any).

(F) Diagnosis.

(G) Record of treatment.

(H) Medications prescribed.

(I) Discharge instructions.

(J) Signature of physician.

(e) Medical records for each patient treated shall be organized in accordance with policies and procedures developed by the facility's health information and management system.

(f) All hospitals must receive and maintain formal designation through the Wyoming Department of Health Trauma System Enhancement Program (W.S. 35-1-801). The level of designation shall be at the discretion of the hospital.

(g) Pursuant to 42 CFR 482.55, hospitals dedicated primarily to the care of patients in need of comprehensive rehabilitative therapy, psychiatric services, or surgical services, may opt to not have an emergency department and will not be required to function as an acute care hospital with all services needed to support a full-staffed emergency department. If the hospital opts to not have an emergency department, signage designating such shall be posted in a prominent location to ensure the public does not perceive that the hospital has an emergency room. The hospital shall have the ability to provide basic life saving measures to patients, staff, and visitors, and shall have written policies for appraisal of emergencies, initial treatment, and referral when appropriate.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 9 Surgical Services

If the hospital provides surgical services, the services shall be well organized and provided in accordance with acceptable standards of practice. If outpatient surgical services are offered, the services shall be consistent in quality with inpatient care in accordance with the complexity of services offered.

(a) There shall be written policies and procedures covering staffing, records consultation, cleaning procedures, supplies, dress attire, emergency situations, legal procedures, specimens, and recovery of patients.

(b) Traffic shall be controlled to avoid any through traffic.

(d) There shall be adequate and appropriate equipment and supplies maintained relating to the nature of the needs and services offered.

(e) All equipment and supplies shall be protected from contamination.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 10 Anesthesia Services

If the hospital furnishes anesthesia services, they shall be provided under the direction of a qualified doctor of medicine or osteopathy.

(a) Policies and procedures for the administration of all anesthetics shall be in place.

In hospitals where there is no department of anesthesia, the department of surgery and/or medical

staff shall assume the responsibility for establishing general policies regarding the administration of anesthetics.

(b) For hospitals with (twenty-five) 25 licensed beds or less, a CRNA may administer anesthetics without physician supervision if the CRNA's practice is otherwise consistent with the medical staff bylaws.

(c) The medical staff shall designate those individuals qualified to administer anesthetics and shall delineate what each individual is qualified and approved to do.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 11 Radiology Services

The hospital shall maintain or have radiological services readily available.

(a) Personnel adequate to supervise and conduct radiology services shall be provided and interpretations of radiological examinations shall be made by physicians competent to make such interpretations.

(b) Written policies and procedures shall be in place for the operation of equipment, the use of radium or other radioactive isotopes, safety precautions, and radiation exposure.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 12 Laboratories

(a) The hospital shall have a well organized CLIA of 1988 (Clinical Laboratory Improvement Act of 1988) certified, supervised clinical laboratory with the necessary space, facilities, equipment, and suitable location to perform those services commensurate with the hospital's needs for its patients.

(b) Anatomical and/or clinical pathology services and blood bank services shall be available either in the hospital or by other arrangements with a CLIA-certified laboratory.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 13 Special Care Unit

A separate unit designed for intensive treatment of seriously ill patients who require extraordinary care on a concentrated and continuous basis may be provided. The unit may be multipurpose for a variety of diagnoses or for special diagnostic categories. If this service is provided, the following requirements must be met:

(a) The unit shall have a defined organization and shall be integrated with other departments and services of the hospital.

(i) The unit shall be under the direction of a Wyoming-licensed

physician.

(ii) Services shall be governed by written policies and procedures.

(b) There shall be a qualified registered nurse in charge and on duty twenty-four (24) hours a day when the unit is occupied.

(i) Staffing ratio of nurses to patients shall depend on the number of patients in the unit and the type of care required.

(ii) Registered nurses and other healthcare personnel assigned to the unit shall receive special instructions in procedures, monitoring, observation, and other techniques for lifesaving measures.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 14 Obstetric Services

. Hospitals that choose to provide obstetric services shall have policies and procedures to ensure adequate and comprehensive care to mothers and their newborn infants in an environment which provides protection from infection.

(a) The obstetrical suite and accessory services shall be so located that traffic in and out can be controlled and there is no through traffic.

(b) Policies and procedures shall be in writing to ensure safety to patients and personnel.

(d) A registered nurse shall be present in the delivery room at the time of delivery.

(i) The registered nurse shall be responsible for maintaining a complete register of delivery, which shall contain the name and hospital number of each patient admitted, date and time of admission, date and time of birth, sex, Apgar score of infant at birth, type of delivery, all operative procedures, names of physicians, assistants, and anesthetists and/or anesthesiologists.

(e) Provide for availability and adequacy of equipment such as resuscitator, aspirator, isolette or incubator, oxygen analyzer, and supplies.

(f) Facilities shall be available and policies and procedures established for isolation and infection control.

(g) Written policies and procedures shall be established for routine cleaning and cleaning following each delivery.

(h) Surgical attire with scuffs or conductive shoes shall be worn in critical areas. Re-gowning shall be required if surgical attire is worn outside of the critical area.

(i) Nursery.

(i) Competent nursing personnel shall be available in the nursery, when it is occupied.

(ii) Routine admission of a baby to the nursery shall include weight, length, head and chest circumferences, temperature, respiratory rate, pulse rate, presence or absence of jaundice, and abnormalities or other noteworthy manifestations of appearance or reactions.

(j) A postpartum program of education for the mother, concerning the care of the baby, shall be provided.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 15 Outpatient Services

If the hospital provides outpatient services, there shall be policies and procedures relating to the staff, functions of the service, outpatient medical records, and necessary facilities in order to assure the health and safety of the patients.

(a) Outpatient services shall be organized into sections (clinics); the number will depend on the size of the medical staff, available facilities, and patient needs.

(i) Outpatient services shall have arrangements and communications with community agencies such as other outpatient agencies, public health nursing, and health and welfare agencies.

(b) Patients, on their initial visit to outpatient services, shall receive a general medical evaluation; patients under continuous care shall receive periodic re-evaluation.

(c) There shall be a physician responsible for professional services. A physician or a qualified administrator shall be responsible for administrative services.

(d) Medical records shall be maintained and correlated with other hospital medical records.

(i) Information contained in the medical record shall be complete and sufficiently detailed relative to the patient's history, examination, laboratory and other diagnostic tests, and diagnosis and treatment to facilitate continuity of care.

(e) Conferences shall be conducted to maintain close liaison between the various sections within outpatient services and with other hospital services.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 16 Nursing Services

The hospital shall provide nursing services twenty-four (24) hours per day, seven (7) days a week. These services shall be supervised by a registered nurse.

(a) Job descriptions delineating the qualifications, responsibilities, and duties for each category of nursing personnel shall be in writing and approved by the hospital administrator or her designee.

(b) Personnel records, including the application and verification of credentials, shall be maintained for each member of the nursing staff. Documentation shall be maintained which verifies the current Wyoming licensure status for those persons requiring licenses. Electronic verification must be evidenced in the personnel file by hard copy.

(c) Medications shall be administered by a registered nurse, LPN, a certified medication aide (MA-C) if allowed by the hospital's policy, or a student nurse in an approved school of nursing under the direct supervision of a registered nurse. In all instances, this activity shall be in accordance with the Wyoming Nurse Practice Act.

(d) All medication orders shall be in writing and signed by the practitioner. Telephone orders shall be used sparingly, and shall be signed or initialed by the practitioner within forty-eight (48) hours.

(e) Blood transfusions and intravenous medications shall be administered in accordance with state law. If administered by a registered nurse and/or LPN, they shall be administered only by those who have been specially trained.

(f) There shall be monthly meetings of the nursing staff. Minutes of these meetings shall be recorded.

(i) The minutes, when appropriate, shall reflect:

(A) The purpose of the staff meeting;

(B) Review and evaluation of nursing care, ways of improving nursing services, discussion of nursing care, and plans for individual patients;

(D) Establishment and/or interpretation of nursing services policies;

(E) Interpretation of administrative and medical staff policies, reports of meetings, etc.; and

(F) The names of individuals attending the meeting.

(g) New employees shall be oriented to the hospital, nursing services, and their jobs.

(i) Planned in-service programs shall be conducted at regular intervals for all nursing personnel. Records which document the date, time, topic, outline of content, and individuals present shall be maintained.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 17 Dietary Services

The hospital shall have an organized dietary service function directed by qualified personnel.

(a) The hospital shall provide dietary services that meet the nutritional needs of patients according to the science of nutrition.

(i) Dietary services must operate with safe food handling practices in accordance with the current edition of the Food Code, published by the U.S. Public Health Service, Food and Drug Administration, from receipt through production and service.

(b) Dietary Supervision.

(i) Overall supervisory responsibility for dietary services shall be assigned to a full-time qualified dietary supervisor.

(A) If the qualified dietary supervisor is not a registered dietitian, he shall be a Dietetic Technician Registered or a Certified Dietary Manager.

(ii) Visits of a consultant dietitian shall be scheduled to ensure the professional dietary service needs of the facility are met. These visits shall be scheduled for at least eight (8) hours every other week, so that adequate time is allowed for observation of more than one (1) meal per visit. Visits shall not be limited to evenings and weekends only.

(iii) The registered dietitian shall practice in accordance with current standards of professional practice utilizing a nationally recognized, standardized assessment and evaluation process, such as the Nutrition Care Process, a model established by the American Dietetic Association.

(iv) Reports of the consultant dietitian shall be made verbally and in writing to the hospital administrator. The reports shall be kept on file with notations made of actions taken by the facility.

(A) The reports shall include dates, length of time on-site, functions performed, and recommendations.

(v) The consultant or staff dietitian shall:

(A) Develop written plans and conduct or supervise in-service programs for dietary personnel on a monthly basis;

(B) Participate in the development of policies and procedures, as well as the development and approval of all menus;

(D) Maintain interdisciplinary communication and act as the liaison to the medical and nursing staffs.

(vi) The dietary supervisor shall be responsible for:

(A) Orientation, training, scheduling, and work assignments for all dietary service personnel;

(B) Menu planning, ordering or recommending the purchase of supplies, monitoring the dietary budget, controlling costs, maintaining associated records, etc.; and

(C) Dietary policies and procedures shall be maintained in a manual and reviewed at least annually. Reviews and revisions shall be dated and signed by the dietary supervisor and the consultant dietitian.

(vii) If the dietary supervisor has responsibility for cooking, adequate time shall be allowed for supervisory management.

(i) Food service personnel shall be in good health and shall practice safe food handling techniques in accordance with the current edition of the Food Code published by the U.S. Public Health Service, Food and Drug Administration.

(A) Personnel having symptoms of a communicable disease that can reasonably be expected to be transmitted through food, a boil, an infected wound, or an acute respiratory infection shall not be permitted to work until medical clearance is received from a physician.

(B) Personnel returning to work after an absence due to having been diagnosed with a communicable disease shall receive clearance from a physician. Written clearance shall be maintained in the employee's file. The hospital may also require physician's approval in the event of an infectious outbreak or upon the advice of the infection control coordinator or the State Epidemiologist.

(ii) There shall be available an up-to-date manual of regimens for all therapeutic diets, approved by the medical staff and the dietitian.

(d) Menus shall be planned and written in advance for regular and therapeutic diets. When changes in the menu are necessary, substitutions shall provide equal nutritive value.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 18 Social Services

There shall be policies and procedures for the social services' staff and its functions.

(a) Social services shall be under the direction of a qualified social worker.

(b) Social services and other hospital services shall perform as an integrated unit.

(i) Social services shall participate in appropriate in-service training programs and conferences.

(c) Records of social services' activity related to individual patients shall be kept and be available to the appropriate professional personnel concerned.

(i) Functions and activities recorded shall include, as appropriate:

(A) Medical social study of referred patients;

(B) Evaluation of financial status of the patients;

(D) Social therapy and rehabilitation of patients;

(E) Environmental investigations for the attending physicians;

(F) Participation on care transitions team; and

(G) Cooperative activities with community agencies.

(ii) Significant social services' summaries shall be entered promptly in the patient's central medical record for the benefit of all staff involved in the care of the patient.

(d) Adequate work areas shall be provided for social services' staff which is easily accessible to patients and to the medical staff, and shall assure privacy for interviews.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 19 Rehabilitation, Physical Therapy, Speech Therapy, Audiology, and Occupational Therapy Services

If the facility provides rehabilitation/therapy services, the following requirements must be met:

(a) Written policies and procedures shall be in place to address the scope of services provided.

(b) Therapy personnel shall have the necessary knowledge, training, experience, and capabilities to properly supervise and administer the applicable therapy services. The rehabilitation/therapy services program shall be under the direction of an individual qualified by education and experience as appropriate to the scope of the rehabilitation/therapy services provided.

(c) Facilities and equipment for physical therapy, speech therapy, audiology, and occupational therapy shall be in good condition and adequate to meet patient needs.

(d) All therapies shall be given in accordance with a physician's orders and such orders shall be incorporated in the patient's record.

(e) Complete records shall be maintained for each patient who receives rehabilitation/therapy services and shall be part of the patient's permanent medical record.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 20 Dental Services

If the hospital provides dental services, the department shall be organized comparable to other hospital services or departments. The appointment of dentists shall be in accordance with the hospital's medical staff bylaws and rules and regulations.

(a) The following requirements shall be met:

(i) Members of the dental staff shall be licensed in Wyoming pursuant to W.S. 33-15-120.

(ii) There shall be a physician in attendance who is responsible for the medical care of the patient throughout the hospital stay;

(iii) Patients admitted for dental services shall be admitted in compliance with hospital regulations;

(iv) There shall be specific bylaws concerning the dental staff written as combined medical-dental staff bylaws or as separate or adjunct dental bylaws;

(v) Bylaws and rules and regulations shall specifically delineate the rights and privileges of the dentists; and

(vi) Complete records, both medical and dental, shall be required for each dental patient and shall be part of the hospital records.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 21 Pharmacy

The hospital shall have a pharmacy directed by a registered pharmacist. The pharmacy shall be administered in accordance with accepted professional principles.

(a) The pharmacist shall be responsible to the hospital administrator for developing, supervising, and coordinating all the activities of the pharmacy.

(b) Prescription medications shall be compounded in a proper location by a qualified pharmacist.

(i) Drugs shall be issued to floor units in accordance with approved policies and procedures.

(ii) Drug cabinets on the nursing units shall be routinely checked by the pharmacist and all floor stocks shall be controlled.

(d) Provisions shall be made for emergency pharmaceutical services.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 22 Inpatient Psychiatric Services

Hospitals which provide inpatient psychiatric services shall also meet the State's Rules and Regulations for Licensure of Psychiatric Hospitals.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 23 Health Information and Management System

. The health information and management system shall be maintained in accordance with accepted professional principles, for every patient evaluated or treated in the hospital.

(a) There shall be qualified personnel adequate to supervise, maintain, and conduct the health information and management system function. Preferably, a Registered Health Information Administrator (RHIA) or Medical Records/Health Information Technician (MRHIT) will be in charge. If such a professional is not in charge, a qualified RHIA or MRHIT on a consultant or part-time basis shall organize the function, train the personnel, and make periodic on-site visits to evaluate the medical records function.

(b) All medical records and health information shall be maintained in accordance with the Health Insurance Portability and Accountability Act (HIPAA) of 1996, 42 CFR Part 2, and any other relevant state or federal laws relating to the maintenance of protected health information.

(c) Records of public hospitals shall be preserved, either in the original form or by other permanent means, for a period of time determined by the hospital administrator, based upon the legally approved retention schedules for publically-funded hospitals established by the Wyoming State Archives and the State Records Committee.

(d) A system of identification and filing to ensure the prompt location of a patient's medical records shall be maintained.

(e) Indexing shall be current within three (3) months following discharge of the patient.

(f) Medical records shall contain sufficient information to justify the diagnosis and warrant the treatment and end results.

(i) The medical records shall contain the following information:

(A) Identification data;

(B) Chief complaint;

(D) Past history;

(E) Family history;

(F) Physical examination;

(G) Provisional diagnosis;

(H) Clinical laboratory reports;

(I) X-ray reports;

(J) Consultations;

(K) Treatment, medical and surgical;

(L) Tissue report;

(M) Progress notes;

(N) Final diagnosis;

(O) Discharge summary; and

(P) Autopsy findings.

(g) In hospitals with house staff, the attending physician countersigns at least the history, physical examination, and summary written by the house staff.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 24 Infection Control Program

An infection control program shall be established based on nationally recognized standards of practice. The program shall prevent, identify, and control infections and communicable diseases.

(a) The infection control program is coordinated by the hospital administrator, the medical staff, and director of nursing services in conjunction with the hospital's quality assurance and performance improvement programs.

(b) Problems identified are reported to the medical staff, nursing, administration, and addressed in the hospital's quality assurance and in-service training programs.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 25 Sanitary Environment

The hospital shall provide for housekeeping, maintenance, and laundry services.

(a) There shall be written policies and procedures for each of these functions to ensure the use of approved practices, procedures, and products.

(i) A designated person shall be responsible for plant maintenance, laundry, and general housekeeping. These responsibilities may be assigned to a single person in small hospitals.

(ii) Housekeeping shall be responsible for keeping the hospital free of offensive odors, accumulations of dirt, rubbish, dust, insects, and rodents.

(iii) Laundry facilities shall have physical separation of clean and dirty areas, adequate ventilation, and temperature control.

(iv) There shall be written policies and procedures covering the sterilization process used on various types of equipment, surfaces, supplies, and instruments.

(A) There shall be a procedure for quality control in relation to the sterilization process.

(B) Humidifiers and any associated tubing shall be replaced after each usage and the length of continuous usage shall not exceed twenty-four (24) hours.

(v) There shall be written policies and procedures covering the disinfectants used on various types of equipment, surfaces, and instruments.

(vi) There shall be a written policy covering the cleaning and disinfecting of ice machines.

(vii) All garbage and kitchen refuse shall be kept in leak proof, nonabsorbent containers with tight fitting covers. All garbage containers kept within the hospital buildings shall be washed, inside and out, daily. Other dry waste materials, normally designated "trash," may be stored in plastic bags.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 26 Physical Environment

The hospital buildings shall be designed, constructed, arranged, equipped, and maintained to ensure the safety of patients, personnel, and visitors, and to provide adequate and efficient care and treatment to the patients.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 27 Disaster Plan

All hospitals shall develop and adopt a written disaster preparedness plan. For hospitals that are federally certified, the disaster preparedness plan shall be in accordance with, at a minimum, the edition of the NFPA 99, Standards for Health Care Facilities, required by the federal government.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 28 Construction and Remodeling

Wyoming Department of Health Chapter 3, Construction Rules and Regulations for Healthcare Facilities, shall apply to all construction and remodeling of hospitals.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.12.03012023 § 29 Life Safety and Electrical Safety

. Existing life safety and electrical safety in hospitals shall be maintained in accordance with the requirements of the edition of the NFPA 101 Life Safety Code that was in effect at the time the facility was licensed as a hospital.

(a) Where portions of a hospital have been licensed at different times, the existing life safety and electrical safety in each portion shall be maintained in accordance with the requirements of the NFPA 101 Life Safety Code that was in effect at the time that portion was added to the license.

(b) Hospitals that are federally certified shall meet, at a minimum, the edition of the NFPA 101 Life Safety Code required by the federal government.

History

Effective 2023-03-01

Chapter 17 Licensure of Critical Access Hospitals

Wyo. Code R. 048.0061.17.03012023 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter pursuant to Wyoming Statute 35-2-908.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 2 Purpose and Applicability

(a) These rules have been adopted to protect the health, safety and welfare of patients and employees in Critical Access Hospitals.

(b) The Department may issue manuals, bulletins, or both, to interpret the provisions of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

(c) 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 these rules and regulations.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 3 Severability

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 4 Definitions

The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and visa versa. Throughout these rules gender pronouns are used interchangeably. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender include individuals of the other gender.

For the purpose of these rules, the following shall apply:

(a) "Acceptable Plan of Correction" means the Licensing Division approved the Critical Access Hospital's plan to correct the deficiencies identified during an on-site survey conducted by the Survey Division or its designated representative. The plan of correction shall be a written document and shall provide, but not be limited to, the following information:

(i) Who is responsible for the correction;

(ii) What was done to correct the problem;

(iii) Who will monitor to ensure that the situation does not develop again; and

(iv) An appropriate date, not to exceed sixty (60) days after the last day of survey, for the correction of deficiencies.

(b) "Administrator" is the person in charge of the facility twenty-four (24) hours per day and is:

(i) A physician;

(ii) A mid-level practitioner;

(iii) A registered nurse; or

(iv) An individual with training and experience in health service administration.

(c) "Advanced Practice Registered Nurse (APRN)" means a person who is licensed by the Wyoming Board of Nursing to practice as an Advanced Practice Registered Nurse.

(d) "Central Registry" means the registry operated by the Wyoming Department of Family Services pursuant to W.S.14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults. The registry information is available by calling 307-777-5366, such number may be subject to change.

(e) "Certified Registered Nurse Anesthetist (CRNA)" means an advanced practice registered nurse (APRN) authorized by the Wyoming State Board of Nursing to practice as a Certified Nurse Anesthetist pursuant to W.S. 33-21-119 et seq.

(f) "Clinical Laboratory Improvement Act (CLIA)" means the clinical laboratories approved by the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services as required by 42 CFR Part 493, Section 1861 (e) and (j), the sentence following section 1861 (s)(13), and 1902(a)(9) of the Social Security Act and Section 353 of the Public Health Service Act.

(g) "Collaborative Practice" means the implementation of a formal written agreement that outlines procedures for consultation and collaboration with other health care professionals, e.g., licensed physicians and mid-level practitioners.

(h) "Complaint Investigations" means those facility investigations required to be performed by the Licensing Division.

(i) "Critical Access Hospital" means a hospital which meets the criteria required by the Wyoming State Rural Health Plan and rules for designation of critical access hospitals.

(j) "Designation" means an official finding and recognition by the Director, Department of Health that a health clinic or health center meets Wyoming State Rural Health Care Plan requirements to be a Critical Access Hospital.

(k) "Dietitian" means a person who is registered by the American Dietetic Association and provides nutritional dietary services.

(l) "Facility" means a Critical Access Hospital.

(m) "Governing Body" means the individual(s), group or corporation that is legally responsible for the Critical Access Hospital.

(n) "Hospital" means an institution licensed pursuant to W.S. 35-2-901 et seq.

(o) "License" means the authority granted by the Licensing Division to operate a Critical Access Hospital.

(p) "Licensed Practical Nurse (LPN)" means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(q) "Licensee" means any person, association, partnership, or corporation holding a Critical Access Hospital license.

(r) "Licensing Division" means the Department of Health, Healthcare Licensing and Surveys.

(s) "LSC" means NFPA 101 Life Safety Code cited in the Department of Health, Chapter III Construction Rules for Health Facilities.

(t) "Mid-level Practitioner" means either an advanced practitioner of nursing or a physician assistant.

(u) "NFPA" means the National Fire Protection Association.

(v) Registered Nurse" means a person who is a graduate of an approved school of professional nursing and is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(w) "Physician" means a person licensed to practice medicine in Wyoming by the Wyoming Board of Medicine.

(x) "Physician Assistant" means a person who is licensed by the Wyoming Board of Medicine to practice as a physician assistant.

(y) "Practitioner" means a person licensed in Wyoming as a physician, advanced practitioner of nursing, or physician assistant.

(z) "Survey" means a periodic on-site evaluation conducted by the Survey Division or its designated representative to determine compliance with State rules and regulations for licensure of Critical Access Hospitals.

(aa) "Survey Division" means the Department of Health, Healthcare Licensing and Surveys.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 5 Licensure

(a) Licensing Procedure.

(i) For an initial license to be issued, the Licensing Division shall receive:

(A) A completed application form as supplied by the Licensing Division;

(B) A copy of the Director, Department of Health's written notice of designation to become a Critical Access Hospital;

(C) The required licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(D) Applicant shall demonstrate full compliance with the licensure requirements in paragraph (b) of this section.

(ii) For renewal of a full license for one (1) year beginning July 1st, and unless suspended or revoked, expiring on June 30th of the following year, the Licensing Division shall receive:

(A) A completed application form by the date stated in the application cover letter supplied by the Licensing Division; and

(B) The license fee as required in paragraph (a)(i)(C) of this section.

(b) Requirements for Licensure.

(i) Meet the criteria required by the Wyoming State Rural Health Plan for designation as a Critical Access Hospital by the Director, Department of Health.

(ii) The Critical Access Hospital shall be in compliance with all laws and standards relating to communicable and reportable diseases as required by the Department of Health, State Health Officer and Public Health Division.

(iii) Cited survey and complaint investigation deficiencies shall not create a hazard to the health, safety or welfare of the patients.

(iv) The Critical Access Hospital shall make a positive effort to correct all survey and complaint investigation deficiencies.

(v) Policies and procedures shall be in place to guide operations.

(vi) An adequate number of appropriately trained staff shall be maintained.

(vii) An organized quality improvement plan shall be in place and implemented.

(viii) There shall be an approved plan of correction for all survey and complaint investigation deficiencies.

(i) For initial licensure, the date of license shall be:

(A) The date of the survey, if there are no deficiencies; or

(B) If deficiencies exist, the date that an acceptable plan of correction is developed.

(C) The period of license shall be one year beginning on July 1st, and unless suspended or revoked, shall expire on June 30th of the following year.

(d) Transfer of License.

(i) A license shall apply only to the geographical location described in the license application.

(A) Whenever ownership of a Critical Access Hospital is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Licensing Division. The transferee shall notify the Licensing Division of the transfer and apply for a new license.

(I) Any license granted to the transferee shall be subject to the plan of correction submitted by the previous owner as approved by the Survey Division.

(B) The transferor shall notify the Licensing Division at least thirty (30) days before the transfer.

(ii) If the Critical Access Hospital's name is changed, the Licensing Division shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

(e) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules.

(f) Suspension of Admissions.

(i) The Licensing Division may suspend new admissions or re-admissions to a Critical Access Hospital when conditions are such that patient needs cannot be met. Conditions in a Critical Access Hospital shall not jeopardize the patient's health and/or safety.

(g) Monitor.

(i) When conditions are such that patient needs are not being met, the Licensing Division shall install a Department of Health approved monitor at the expense of the Critical Access Hospital.

(h) Hearings.

(i) Any Critical Access Hospital aggrieved by a decision of the Licensing Division may request a hearing by submitting a written request within ten (10) days of the date of receipt of the notice of adverse action.

(ii) Except in matters concerned with the spread of communicable disease, the Licensing Division shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for a hearing shall adhere to the time frame of (i) above.

(iii) In matters concerned with the spread of communicable disease, the Wyoming State Health Officer or designated representative shall present the preliminary decisions and reasons for the decision to the parties concerned and shall provide an opportunity for a hearing. Any request for a hearing shall adhere to the time frame in (i) above.

(iv) Hearings requested under the terms of these licensure rules shall be held in accordance with the provisions of the Wyoming Administrative Procedures Act.

(i) Posting of License.

(i) The current license issued by the Licensing Division shall be displayed in a public area within the Critical Access Hospital.

(j) Surveys for Licensure.

(i) The Survey Division or designed representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Licensure Rules and Regulations for Critical Access Hospitals as promulgated by the Wyoming Department of Health.

(B) The Survey Division shall provide, within ten (10) working days after the last day of survey, copies of the cited deficiencies to the Critical Access Hospital.

(C) The Critical Access Hospital shall provide an acceptable plan of correction for all cited deficiencies, within ten (10) working days after receipt of the deficiencies to the Survey Division.

(k) Voluntary Closure.

(i) If a Critical Access Hospital voluntarily ceases to operate, it shall notify the Licensing Division in writing at least fifteen (15) working days prior to closure.

(ii) The first working day after closure, the Critical Access Hospital's license shall be hand carried to or sent by certified mail to Wyoming Department of Health, Healthcare Licensing and Surveys; 2300 Capitol Avenue, Hathaway Building, Suite 510; Cheyenne, WY 82002.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 6 Organization and Management

(a) Governing Body. The Critical Access Hospital shall have a governing body which:

(i) Has the legal authority and responsibility to operate the facility.

(ii) Appoints an administrator who is responsible for managing the facility.

(iii) Provides verification of a central registry information check on all employees hired at the time of or after the filing of these rules. The individual agencies or corporations are responsible to initiate and follow this process to completion.

Central registry information can be obtained by contacting the Department of Family Services at 307-777-5366. (This number is subject to change.)

(iv) Adopts, revises, and approves personnel policies, including; but not limited to:

(A) Frequency of evaluations;

(B) Insuring confidentiality of central registry information checks.

(v) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client care level.

(vi) The governing body shall ensure that all services provided are consistent with accepted standards of practice.

(vii) The governing body shall be accountable for the quality of care provided to the patient.

(viii) There shall be policies and procedures for services offered, which shall be reviewed annually by the governing body. Policies required, but not limited to:

(A) Every patient shall be under the care of a physician or under the care of a mid-level practitioner consistent with the mid-level practitioner's scope of practice and as otherwise authorized by law.

(B) A CRNA may administer anesthetics without physician supervision if the CRNA's practice is otherwise consistent with the medical staff bylaws.

(C) A physician, a mid-level practitioner or a registered nurse shall be on duty and physically available in the facility when there are inpatients;

(D) When there are no inpatients, the facility may close (i.e. be unstaffed) provided an effective system is in place to ensure that a practitioner with training and experience in emergency care is on call and available by telephone or radio twenty-four (24) hours a day; and

(E) Patient care shall meet the provisions in Section 4.(h).

(ix) Personnel Records.

(A) There shall be one person designated responsible for maintaining confidentiality.

(x) Employee Health.

(A) Policies and procedures shall be developed for employee health, including a policy identifying communicable diseases that could put the patient population at risk.

(xi) Services.

(A) Furnished services, including contracted services, shall comply with all applicable licensure standards;

(B) Medical and nursing staff shall be licensed, certified, or registered according to Wyoming laws and rules; and

(C) Staff members shall provide health services only within the scope of his or her license, certification or registration.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 7 Medical Staff

(a) The facility shall have a medical staff that includes at least one (1) physician, and may also include one (1) or more mid-level practitioners, who:

(i) Examines the credentials of candidates for medical staff membership and makes recommendations to the governing body on the appointment of candidates; and

(ii) Adopts a collaborative plan containing the following, and enforces the collaborative plan after approval by the governing body:

(A) A statement of the duties and privileges of each category of medical staff (e.g., physician and mid-level practitioner); and

(B) A requirement that a physical examination be made and medical history taken of a patient by a member of the medical staff no more than twenty-four (24) hours after the patient's admission to the facility.

(b) A physician on staff shall:

(i) Provide medical direction to the facility's health care activities and consultation for non-physician health care providers;

(ii) In conjunction with the mid-level practitioner staff members, participate in developing, executing, and periodically reviewing the facility's written policies and the services provided to patients.

(iii) Review and sign the records of each patient admitted and treated by a mid- level practitioner no later than fifteen (15) days after the patient's discharge from the facility;

(iv) Provide health care services to the patients in the facility, whenever needed and requested;

(v) Prepare guidelines for the medical management of health problems, including conditions requiring medical consultation and/or patient referral; and

(vi) At intervals no more than two (2) weeks apart, be physically present in the facility for a sufficient time to provide medical direction, medical care services, and staff consultation required by the collaborative agreement;

(A) When not present, either be available through direct telecommunication for consultation and assistance with medical emergencies, and patient referral, or ensure that another physician is available for this purpose.

(B) However, the physical site visit for a given two (2) week period is not required if, during that period, no inpatients have been treated in the facility.

(i) Participate in the development, execution, and periodic review of the guidelines and written policies governing the services furnished by the facility;

(ii) Participate in a review of each patient's health records in accordance with facility policy;

(iii) Provide health care services to patients according to the facility's policies;

(iv) Arrange for, or refer patients to needed services that are not provided at the facility; and

(v) Assure that adequate patient health records are maintained and transferred as necessary.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 8 Emergency Services

(a) The Critical Access Hospital shall meet the emergency needs of patients in accordance with acceptable standards of practice.

(i) Diagnostic and treatment equipment, drugs, supplies, and space, including space for a sufficient number of treatment rooms, shall be adequate in terms of the size and scope of service.

(ii) The following equipment shall be available to the emergency suites: cardiac monitor, resuscitator, defibrillator, aspirator, thoracotomy set and tracheotomy set.

(iii) Service shall be available twenty-four (24) hours a day, and emergency room staff shall be adequate to ensure that an applicant for treatment will be seen within a reasonable length of time relative to his/her illness.

(iv) Medical records for patients receiving emergency services shall be in accordance with Section 15.

(v) Critical Access Hospitals must receive, and maintain, formal designation through the Department of Health's trauma system enhancement program W.S. 35-1-801). The level of designation shall be at the discretion of the hospital.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 9 Nursing Services

(a) A Critical Access Hospital shall have a nursing service program that provides twenty-four (24) hour services, whenever a patient is in the facility, and meets the following requirements:

(i) The director of nursing services shall:

(A) Be a Wyoming licensed registered nurse;

(B) Determine the type and number of nursing personnel and staff necessary to provide nursing care; and

(C) Schedule adequate numbers of licensed registered nurses, licensed practical nurses, certified nursing assistants and other personnel to provide nursing care as needed.

(ii) A registered nurse shall be on duty at least eight (8) hours per day, and the director of nursing or another registered nursed designated as the director's alternate shall be on call and available within twenty (20) minutes at all times.

(iii) All drugs and biologicals shall be administered by a nurse, a physician, or a mid-level practitioner according to Federal and state laws and regulations, including applicable licensing requirements.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 10 Pharmaceutical Services

(a) The facility shall have pharmaceutical services that meet the needs of the patients and comply with the following:

(i) A drug storage area under the supervision of the Director of Nursing who shall develop, supervise, and coordinate all of the pharmacy services;

(ii) The pharmacy or drug storage area shall be administered according to accepted professional standards;

(iii) All compounding, packaging, and dispensing of drugs and biologicals shall be consistent with federal and state laws;

(iv) Drugs and biologicals shall be kept in a locked storage area;

(v) Outdated, mislabeled, or otherwise unusable drugs and biologicals shall be destroyed by grinding in a garbage disposal or incineration; and

(vi) Drug administration errors, adverse drug reactions, and incompatibilities shall be immediately reported to the attending practitioner.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 11 Radiologic Services

(a) The facility shall maintain, or have available, diagnostic radiologic services, which shall meet the following:

(i) The radiologic services shall be free from radiation hazards for patients and personnel;

(ii) Annual inspection of equipment shall be made and hazards identified are promptly corrected;

(iii) Radiation workers shall continuously wear monitoring badges that are to be checked quarterly to determine the amount of radiation to which they are routinely exposed;

(iv) A qualified full-time, part-time, or consulting radiologist shall be utilized to interpret those radiographic tests that are determined by the medical staff to require a radiologist's specialized knowledge;

(A) The radiologist or other practitioner who provides radiology services shall sign each report containing his/her interpretations.

(v) Only personnel designated as qualified by the medical staff, and meeting the requirements of state law, may use the radiographic equipment and administer procedures; and

(vi) The facility shall maintain any radiographic studies and their interpretations for at least six (6) years.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 12 Laboratory Services

(a) The facility shall maintain, or have available, clinical laboratory services adequate to fulfill the needs of its patients and meets the following:

(i) The facility, at a minimum, shall provide basic laboratory services essential to the immediate diagnosis and treatment of patients, including:

(A) Chemical examinations of urine by stick or tablet methods, or both (including urine ketones);

(B) Microscopic examinations of urine sediment;

(D) Blood sugar;

(E) Gram stain;

(F) Examination of stool specimens for occult blood;

(G) Pregnancy test;

(H) Primary culturing for transmittal to a CLIA certified laboratory;

(I) Sediment rate;

(J) CBC; and

(K) Chemistry Panel.

(ii) The facility shall have a contractual agreement with a CLIA approved hospital or independent laboratory for any additional laboratory services that are needed by a patient.

(iii) Emergency provision of basic laboratory services shall be available twenty-four (24) hours a day.

(iv) Only personnel designated as qualified by the medical staff by virtue of education, experience, and training may perform and report laboratory results.

(v) The laboratory shall be a CLIA certified laboratory.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 13 Dietary Services

(a) The facility shall provide dietary services that are directed and staffed by adequate personnel and meet the following:

(i) The facility shall assign an employee, or contract with a consultant, to direct dietetic services and be responsible for the daily management of dietary services. The individual shall be qualified by experience and training as a food service supervisor.

(ii) The facility shall utilize a qualified dietitian, full-time, part-time, or on a consultant basis; and

(iii) The facility shall provide dietetic services that meet the nutritional needs of patients according to the science of nutrition:

(A) The dietetic service must operate from receipt through production and service with safe food handling practices in accordance with the most current edition of FOOD CODE from the U.S. Public Health Service, Food and Drug Administration; and

(B) Therapeutic diets shall be prescribed by the practitioner responsible for the care of the patients.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 14 Required Contracted Services

(a) The facility shall enter into agreements with one or more hospitals participating in the Medicare/Medicaid programs to provide services which the Critical Access Hospital is unable to provide.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 15 Medical Records

(a) The facility shall maintain a medical records system in accordance with written policies and procedures.

(i) Professional standards of practice for medical records shall be met.

(ii) A medical record shall be created and maintained for each patient receiving health care services that includes, if applicable:

(A) Identification and social data;

(B) Admitting diagnosis;

(D) Properly executed consent forms;

(E) Reports of physical examinations, diagnostic and laboratory test results, and consultation findings;

(F) All physicians' orders, nurses' notes, and reports of treatment and medications;

(G) Final diagnosis;

(H) Discharge summary; and

(I) Any other pertinent information necessary to monitor the patient's prognosis.

(iii) Each record shall include the signatures of the physician and the health care professional's documentation.

(iv) Records of a discharged patient shall be completed within fifteen (15) days of the discharge date.

(A) Govern the use and removal of records from the record storage area;

(B) Specify the conditions under which record information may be released and to whom; and

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 16 Quality Improvement

(a) The governing body, in accordance with W.S. 35-2-910, shall ensure there is an effective, on-going, facility-wide, written quality improvement program which ensures and evaluates the quality of patient care provided and includes an annual review of the following:

(i) The utilization of facility services, including at least the number of patients served and volume of services; and

(ii) The facility's health care policies.

(b) The initiation and documentation of appropriate remedial action to address deficiencies found through the quality improvement program, as well as documentation of the outcome of remedial action.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 17 Infection Control

(a) The facility shall:

(i) Maintain a sanitary environment which prevents the transmission and sources of infections and communicable diseases;

(ii) Develop and implement policies governing control of infections and communicable diseases; and

(iii) Maintain a log of incidents related to infections and communicable diseases.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 18 Disaster Plan

(a) All Critical Access Hospitals shall develop and adopt a written disaster preparedness plan in accordance with the Health Care Emergency Preparedness chapter of the applicable Life Safety Code (Ref: Page 17, Section 21(a)(i)).

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 19 Physical Environment

(a) The Critical Access Hospital building(s) shall be designed, constructed, arranged, equipped and maintained to ensure the safety of patients, personnel and visitors and to provide adequate and efficient care and treatment of patients.

Fire safety shall be in accordance with the requirements of the applicable NFPA Life Safety Code 101 (Ref: Page 17, Section 21(a)(i)).

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 20 Construction/Remodeling/Changes in Space Use

(a) Department of Health Chapter III, Construction Rules for Health Facilities apply.

History

Effective 2023-03-01

Wyo. Code R. 048.0061.17.03012023 § 21 Life Safety and Electrical Safety

(a) Department of Health Chapter III, Construction Rules for Health Facilities apply.

(i) Designated Critical Access Hospitals shall meet the Life Safety Code of the National Fire Protection Association that was in effect at the time the facility was licensed as a hospital, health clinic or health center.

History

Effective 2023-03-01

Chapter 20 Health Care Facilities Jurisdiction and Delegation

Wyo. Code R. 048.0061.20.07152004 Health Care Facilities Jurisdiction and Delegation

CHAPTER 20

RULES AND REGULATIONS FOR HEALTH CARE FACILITIES JURISDICTION AND DELEGATION

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to W.S. 35-2-906, W.S. 35-9-121.1 et seq., and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.

Section 2. Applicability.

(a) These rules shall apply to and govern Health Care Facilities jurisdiction and delegation, on and after the effective date of these rules.

(b) The Office of Health Facilities may issue manuals, bulletins, or both, to interpret the provisions of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

(c) 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 these rules.

Section 3. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, 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.

(a) "Approved" means acceptable to the Authority Having Jurisdiction.

(b) _ "Authority Having Jurisdiction" means the Director, Wyoming Department of Health.

(c) "Certified" means those individuals who have been recognized by the International Code Council or National Fire Protection Association as being qualified in their plan examiner and inspection practice specialties: Building Plans Examiner, International Code Council; Fire Plans Examiner, National Fire Protection Association; Mechanical Plans Examiner, International Code Council; Commercial Building Inspector, International Code Council; Fire Inspector I, National Fire Protection Association; Commercial Mechanical Inspector, International Code Council; Commercial Plumbing Inspector, International Code Council; and Fire Inspector I, International Code Council.

(d) "Certification" means those Health Care Fac ilities that meet the standards to participate in the federal Medicare and/or Medicaid programs.

(e) "Construction rules" means the Wyoming Department of Health's Chapter 3 Construction Rules and Regulations for Health Care Facilities.

(f) "Council" means the council on fire prevention and electrical safety in buildings per W.S. 35- 9-102(a)(iv).

(g) "Department" means the State of Wyoming Department of Health which is the Authority Having Jurisdiction.

(h) "Director" means the Director, Wyoming Department of Health.

(i) "Health Care Facilities" means any adult day care facility, ambulatory surgical center, assisted living facility, birthing center, boarding home, freestanding diagnostic testing center, home health agency, hospice, hospital, intermediate care facility for the mentally retarded, medical assistance facilities, nursing care facilities, rehabilitation facilities and renal dialysis center, or as defined by W.S. 35-2-901 et seq.

(j) "International Building Code" establishes the minimum requirements to safeguard the public health, safety and general welfare through structural strength, means of egress facilities, stability, sanitation, adequate light and ventilation, energy conservation, and safety to life and property from fire and other hazards attributed to the built environment.

(k) "International Mechanical Code" provides minimum standards to safeguard life or limb, health, property and public welfare by regulating and controlling the design, construction, installation, quality of materials, location, operation and maintenance or use of mechanical systems.

(l) "International Plumbing Code" provides comprehensive regulation of plumbing systems by setting minimum regulations for plumbing facilities in terms of both performance and prescriptive objectives.

(m) " International Fire Code" establishes the minimum requirements consistent with nationally recognized good practice for providing a reasonable level of life safety and property protection from hazards of fire, explosion or dangerous conditions in new and existing buildings, structures and premises.

(n) "Licensed" means those Health Care Facilities that meet the licensing standards cited in W.S.35-2-901 et seq.

(o) "State Survey Agency" means the Office of Health Facilities which is a component within the Wyoming State government that has the primary responsibility for performing the functions under the agreements between the Secretary of the U.S. Department of Health and Human Services and the State of Wyoming dated June 18, 1985.

Section 4. Department of Health Jurisdiction.

(a) W.S. 35-9-121.1. Health care facilities; jurisdiction; delegation; rules.

(i) The Department of Health has jurisdiction over all aspects of construction and remodeling, except electrical installation, of any state licensed health care facility as defined in W.S. 35-2-901.

(ii) The fire safety code requirements for the construction and remodeling of any state licensed health care facility shall meet the minimum requirements established in the National Fire Protection Association 101 Life Safety Code or any other code required to meet federal fire and life safety certification. If any code requirements for federal certification conflict with the code of any other state or local governmental entity, the code required for federal certification shall prevail.

(iii) The Department of Health shall promulgate rules and regulations for all aspects of construction and remodeling of Health Care Facilities except electrical installation. For aspects of construction and remodeling included in codes adopted by the Council pursuant to W.S. 35-9-106, the rules and regulations shall be based on and not exceed the standards of these codes except where federal certification requirements dictate otherwise.

(iv) Upon written request from any county or municipality, the Department of Health shall delegate plan review and inspection responsibilities to the county or municipality that has personnel who are certified pursuant to the applicable code. The Department of Health shall transfer jurisdiction and authority by letter. The Department of Health shall notify the governing body of the municipality or county of the minimum standards and requirements under this section and W.S. 16-6-501 and 16-6-502. The following shall apply:

(A) Any municipality or county may issue a certificate of occupancy for a health care facility. The certificate shall reference any code applied to the construction or remodeling of the facility;

(B) A municipality or county which has enforcement authority under this subsection may create its own appeals board to determine the suitability of alternate materials and types of construction. If a municipality or county has not created an appeals board, the Department of Health shall establish an appeals board which includes representation from the Department of Health and the Council.

(v) After construction or remodeling of any health care facility, the Department of Health shall have jurisdiction over the fire and life safety inspections required for federal certification.

Section 5. Delegation.

(a) Per W.S. 35-9-121.1(d), upon written request from any county or municipality, the Department shall delegate plan review and inspection responsibilities to the county or municipality that has personnel who are certified to the pursuant to the applicable code.

(b) County or municipality personnel who perform plan review and inspection functions for the purpose of health care facility licensing shall, as a minimum, be certified as follows:

(i) Building Plans Examiner - certified by the International Code Council.

(ii) Fire Plans Examiner - certified by the National Fire Protection Association.

(iii) Mechanical Plans Examiner - certified by the International Code Council.

(iv) Plumbing Plans Examiner - certified by the International Code Council.

(v) Commercial Building Inspector - certified by the International Code Council.

(vi) Fire Inspector I - certified by the National Fire Protection Association.

(vii) Commercial Mechanical Inspector - certified by the International Code Council.

(viii) Commercial Plumbing Inspector - certified by the International Code Council.

(ix) Fire inspector I - certified by the International Code Council

(c) Relinquishing Delegation. Upon written request from any county or municipality, the county or municipality may at any time relinquish the plan review and inspection responsibilities delegated per W.S.35-9-121.1(d).

(d) When any delegated county or municipality personnel are no longer certified as required in Section 6 (b), written notice must be given to the Department concerning the certification status.

Section 6. Appeals Board.

(a) The Department's Health Care Facilities construction appeals board shall serve as the appeals board for a municipality or county that has not created an appeals board per W.S. 35-9-121.1(d)(ii).

The board shall consist of five (5) members:

(i) State Health Officer shall serve as chairman;

(ii) Two members from the State Survey Agency;

(iii) Two members from the Council as determined by the Council Chairman.

(b) The board shall hear appeals to determine the suitability of alternate materials and type of construction and to interpret and recommend deviations from health care facility construction rules and regulations to the Director.

(d) Appeals requested under the terms of these rules shall be held in accordance with the provisions of the Wyoming Administrative Procedures Act.

Section 7. Construction Rules and Regulations.

(a) The Department's Chapter 3 Construction Rules for Health Care Facilities shall apply to and govern the construction, remodel, or expansion of Health Care Facilities.

Section 8. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2004-07-15

Chapter 21 Procedure for Informal Conference on Appeal of Agency Decision & Procedures for Formal Administrative Hearings on Appeal of Agency Decision

Wyo. Code R. 048.0061.21.09072010 Procedure for Informal Conference on Appeal of Agency Decision & Procedures for Formal Administrative Hearings on Appeal of Agency Decision

CHAPTER 21

Rules and Regulations for the Procedures for Informal Conference on Appeal of Agency Decision and Procedures for Formal Administrative Hearings on Appeal of Agency Decision

Section 1. Authority. These rules are promulgated by the Department of Health, Office of Healthcare Licensing and Surveys, pursuant to W.S. 35-2-901, et seq., W.S. 35- 9-121.1, and the Wyoming Administrative Procedure Act at W.S. 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) These rules are being promulgated to establish a procedure for Healthcare Facilities to appeal adverse actions taken by the Department of Health, hereinafter referred to as the "Department," pursuant to its authority under Chapter 3, Construction Rules and Regulations for Healthcare Facilities.

(b) The Department may issue policies, bulletins, or both, to interpret the provisions of these rules and regulations. Such policies and bulletins shall be consistent with and reflect the intent of these rules and regulations. The provisions contained in policies or bulletins shall be subordinate to the provisions of these rules and regulations.

(c) 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 these rules and regulations.

Section 3. Definitions. The following definitions, as well as the definitions found in Chapter 3, Construction Rules and Regulations for Healthcare Facilities, shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, 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.

(a) "Adverse action" means any remedy or sanction defined by statute, rule, or regulation that may be imposed or recommended by the Department against a licensed and/or federally certified Healthcare Facility that has failed to achieve or maintain compliance with local, state or federal laws, statutes, rules, or regulations. Federal remedies or adverse actions are defined in the State Operations Manual published by the Centers for Medicare and Medicaid Services (CMS). An adverse action may be imposed in addition to or instead of termination from the federal Medicare certification program or may be imposed in addition to or instead of actions against the facility's license.

(b) "Applicable code authority" means the particular jurisdictional entity or authority ultimately responsible for interpretation of a published Code. For example: the International Code Council is the jurisdictional authority that issues interpretations and provides technical support for the International Building Code.

(c) "Informal conference" means, as agreed to by the parties, either a teleconference meeting, electronically enhanced meeting, or an in-person meeting between the parties, and any other relevant parties, to discuss the issues and to determine if a resolution may be reached without the necessity of further action.

(d) "Formal administrative hearing" means the process outlined below where

a hearing is held pursuant to the Wyoming Administrative Procedure Act at W.S. 16-3- 101, et seq.

Section 4. Informal Conferences. Facilities may request an informal conference to reconsider any decision made by the Department related to state construction requirements and/or federal regulatory requirements (when applicable). The informal conference will be conducted by the regulatory agency of the Department in accordance with written policies and procedures. Any decision made by the Department may be appealed in accordance with these rules.

Section 5. Informal Conference Procedures.

(a) Procedure if action based on state requirements. If a Healthcare Facility receives one or more deficiencies as a result of an inspection, receives mark-ups or comments on a set of plans, or receives notice of a pending or actual adverse action from the Department, which action is based solely on state construction requirements, the following informal procedure may be instituted to resolve the issue(s) in as expedient a manner as possible:

Initial Meeting:

(i) The Healthcare Facility, in collaboration with the Department, shall meet either by telephone, electronically, or in person to discuss the issue(s) and to determine whether an informal resolution of the issue(s) is possible and acceptable.

(ii) This initial meeting shall be conducted as soon as possible on a date acceptable to all parties.

(iii) The parties may agree at this initial meeting to another informal meeting between themselves to resolve the matter between the Department and the Healthcare Facility.

(iv) If the Healthcare Facility agrees at this initial meeting to an informal resolution of the issue, but desires to have an outside entity review the question, the parties each agree to outline the issue(s) and that party's position on the issue(s) in writing.

(v) A written statement of the issue(s) and positions of the parties shall be prepared to send to an outside entity within ten (10) working days of the meeting at which this decision was made. Submit Statement of the Issues and Party Positions to Code Authority:

(vi) Once this statement of the issue(s) and the parties' positions are reduced to writing so that both parties can agree to what is contained in the document, it shall be submitted by the Department to the applicable Code authority, such as the International Code Council or the American Institute of Architects, as agreed upon by the parties. Code Authority Decision:

(vii) Once the applicable Code authority renders its decision, and if the decision or interpretation is still unsatisfactory to the Healthcare Facility, it may request a formal administrative hearing.

(viii) The Healthcare Facility shall send a written request for a formal administrative hearing to the Department no later than ten (10) calendar days after receipt of the Code authority's decision.

(b) Procedure if action based on federal requirements. When a Healthcare Facility is seeking federal certification, federal requirements related to the physical environment, the Life Safety Code, and all other relevant federal codes will apply. If a Healthcare Facility receives deficiencies, mark-ups or comments on a set of plans, or notice of pending adverse action from the Department which action is based solely on federal construction and/or regulatory requirements, the following informal procedure may be instituted to resolve the issue(s) in as expedient a manner as possible:

Initial Meeting:

(i) The Healthcare Facility, in collaboration with the Department, shall meet either by telephone, electronically, or in-person to discuss the issue(s) and to determine whether an informal resolution of the issue is possible and acceptable.

(ii) This initial meeting shall be conducted as soon as possible on a date acceptable to all parties.

(iii) The parties may agree at this initial meeting to another informal meeting between themselves to resolve the matter between the Department and the Healthcare Facility.

(iv) If the Healthcare Facility agrees at this initial meeting to an informal resolution of the issue, but desires to have an outside entity review the question, the parties must each outline the issue(s) and that party's position on the issue(s) in writing.

(v) A written statement of the issue(s) and positions of the parties shall be prepared to send to an outside entity within ten (10) calendar days of the initial meeting.

Submission of Statement of the Issues and Party Positions to Code Authority:

(vi) Once this statement of the issue(s) and the parties' positions are reduced to writing so that both parties can agree to what is contained in the document, it will be submitted by the Department to the applicable Code authority. Code Authority Decision:

(vii) Once the applicable Code authority renders its decision and if the decision or interpretation is still unsatisfactory to the Healthcare Facility, the parties may agree to submit the question to the Centers for Medicare and Medicaid Services (CMS) within ten (10) working days of the date of the decision or interpretation from the Department or the Code Authority.

(viii) Decisions rendered by CMS are considered final; however, there is a federal appeal process, pursuant to 42 CFR 498, et seq.

Section 6. Formal Administrative Hearing Procedure.

(a) Procedure if action based on state construction requirements.

(i) If a Healthcare Facility receives a notice of one or more deficiencies, mark-ups, or comments with which it disagrees on a set of building plans, or a notice of a pending adverse action from the Department which action is based solely on state construction requirements, the following procedure may be instituted to resolve the issue through an administrative hearing process. The Department prefers to resolve all disputes through the informal review process. However, the formal hearing process may be initiated after the informal process has been exhausted, or may be requested immediately upon notice of a pending adverse action.

(ii) If a Healthcare Facility requests a formal administrative hearing, it shall provide written request for a formal administrative hearing to the Department within ten (10) working days of receiving notice of the adverse action.

(iii) The request shall provide the specific details about the issue and the position of the Healthcare Facility.

(iv) The Department shall refer the matter to the Office of Administrative Hearings (OAH) pursuant to its Contested Case Proceeding Rules, Chapter 2 (2008) and its Evidentiary Hearings and Decision rules, Chapter 3 (2002). Referral to the OAH shall be done within five (5) working days of receipt of the request from the Healthcare Facility.

(v) Healthcare Facilities are encouraged to request, and the Department will agree if appropriate, to the Expedited Contested Case procedures at Section 11 of Chapter 2 in order to obtain a ruling as quickly and efficiently as possible to prevent any unnecessary delay in the process.

(b) Procedure if action based on federal requirements.

(i) If the responses from the appropriate federal Code authorities (including CMS) are not satisfactory to the Healthcare Facility, it may still request a formal administrative hearing to review the decision.

(ii) If the Healthcare Facility desires a formal administrative hearing, it shall send a written request for a formal administrative hearing to the Department no later than ten (10) working days after receipt of the Code authority's decision.

(iii) The request shall provide the specific details about the issue and the position of the Healthcare Facility.

(iv) The Department shall refer the matter to CMS within five (5) working days of receipt of the request from the Healthcare Facility.

(v) All formal administrative hearings shall be conducted by CMS according to 42 C.F.R.498, et seq.

Section 7. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2010-09-07

Chapter 22 Rules and Regulations for Licensure of Rehabilitation Hospitals

Wyo. Code R. 048.0061.22.09122012 Rules and Regulations for Licensure of Rehabilitation Hospitals

State of Wyoming

Department of Health

Chapter 12

Rules and Regulations for Licensure of Hospitals

Thomas O. Forslund, Director

May 2012

State of Wyoming Department of Health

Chapter 22

Rules and Regulations for the Licensure of Rehabilitation Hospitals

Rules and Regulations for the

Wyoming Department of Health Aging Division Healthcare Licensing and Surveys

Additional information and copies may be obtained from:

Healthcare Licensing and Surveys

6101 Yellowstone Rd., Ste. 186C Cheyenne, WY 82002 Telephone: (307) 777-7123 Facsimile: (307) 777-7127 E-Mail Address: WDH-OHLS@wyo.gov Website: www.health.wyo.gov/ohls

This document is available in alternative format upon request.

CHAPTER 22

Rules and Regulations for the Licensure of Rehabilitation Hospitals

Section 1. Authority. This rule is promulgated by the Wyoming Department of Health pursuant to the Health Facilities Act at W.S. 35-2-901, et seq., and the Wyoming Administrative Procedure Act at W.S. 16-3-101, et seq.

Section 2. Purpose. This rule has been adopted to protect the health, safety, and welfare of patients and employees in rehabilitation hospitals.

Section 3. Severability. If any portion of this rule is found to be invalid or unenforceable, the remainder shall continue in effect.

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 purpose of this rule, the following shall apply:

(a) “Acceptable Plan of Correction” means the State Survey Agency approved the rehabilitation hospital’s plan to correct the deficiencies identified during a survey conducted by the State Survey Agency or its designated representative.

(b) “Certified Dietary Manager” means a person with education, training, and experience to competently perform the responsibilities of a dietary manager with consultation from or supervision of a Registered Dietitian. The Certified Dietary Manager has passed a nationally-recognized credentialing exam and participates in continuing education as needed to maintain certification status.

(c) “Certified Occupational Therapy Assistant” means a person licensed to assist in the practice of occupational therapy, and who works under the supervision of a registered occupational therapist pursuant to W.S. 33-40-102.

(d) “Certified Respiratory Therapy Technician” means a person who has successfully completed a one (1) year respiratory care training program, and who has been certified by the American Association for Respiratory Care (AARC).

(e) “Clinical Laboratory” means a facility for the microbiological, serological, chemical, hematological, biophysical, cytological, or pathological examination of materials derived from a human body for the purpose of obtaining information for the diagnosis, prevention, or treatment of disease or assessment of medical conditions.

(f) “Complaint Investigations” means those investigations required to be performed by the State Survey Agency.

(g) “Dietetic Technician Registered” means an individual who has completed at least a two (2) year associate’s degree, a dietetic technician program accredited by the Commission on Accreditation for Dietetics Education, has passed a national examination, and maintains registration through the completion of continuing education.

(h) “Dietitian” means a person who is registered by the Commission on Dietetic Registration and provides nutritional and dietary services.

(i) “Drug Administration” means an act in which a single dose of an identified drug is given to a patient.

(j) “Drug Dispensing” means the issuance of one (1) or more doses of a prescribed medication in containers that are correctly labeled to indicate the name of the patient, the contents of the containers, and all other vital information needed to facilitate correct patient usage and drug administration.

(k) “Governing Body” means the individual(s), group, or corporation that is legally responsible for the rehabilitation hospital.

(l) “Health Care Services” includes, but is not limited to, nursing, physical therapy, speech therapy, occupational therapy, respiratory therapy, social worker, nurse assistant, and dietary services. Staff shall be licensed or registered in accordance with Wyoming State Statutes.

(m) “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:

(i) Diagnostic and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons;

(ii) Rehabilitation services for the rehabilitation of injured, disabled, or sick persons;

(iii) Acute care;

(iv) Psychiatric care;

(v) Swing beds.

(n) “License” means the authority granted by the State Survey Agency to operate a hospital.

(o) “Licensed Practical Nurse (LPN)” means a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(p) “Licensee” means any person, association, partnership, or corporation holding a rehabilitation hospital license.

(q) “Life Safety Code” means NFPA 101 Life Safety Code cited in the Wyoming Department of Health, Chapter 3, Construction Rules and Regulations for Healthcare Facilities.

(r) “NEC” means the National Electrical Code.

(s) “NFPA” means the National Fire Protection Association.

(t) “Nursing Care Unit” means an organized unit of nursing service in which nursing services are provided on a continuous basis.

(u) “Nursing Service” means patient care services pertaining to the curative, restorative, and preventive aspects of nursing that are performed and/or supervised by a registered nurse pursuant to the medical care plan of the practitioner and the nursing care plan.

(v) “Nutrition Care Process” means the standardized process for providing nutritional care to patients as established by the American Dietetic Association. The four steps in the process include: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.

(w) “Occupational Therapist” means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Registered Occupational Therapist pursuant to W.S. 33-40-102.

(x) “Pharmacist” means a person licensed as a Pharmacist in Wyoming pursuant to W.S. 33-24-116.

(y) “Physical Therapist” means a person who is licensed to practice physical therapy in Wyoming pursuant to W.S. 33-25-101.

(z) “Physical Therapy Assistant” means a person who is licensed by the Wyoming Board of Physical Therapy to practice as a physical therapy assistant under the supervision of a registered Physical Therapist pursuant to W.S. 33-25-101.

(aa) “Physical Therapy Services” means services provided by a physical therapist or a physical therapy assistant licensed pursuant to W.S. 33-25-101.

(bb) “Physician” means a person who is licensed by the Wyoming Board of Medicine to practice medicine in Wyoming pursuant to W.S. 33-26-102.

(cc) “Quality Assessment and Performance Improvement (QAPI) Program” means a program developed and implemented by the rehabilitation hospital to evaluate and improve patient care and services.

(dd) “Registered Nurse” means a person who is a graduate of an approved school of professional nursing, and who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. 33-21-120.

(ee) “Respiratory Care” means the health specialty responsible for the treatment, management, diagnostic testing, control, and care of patients with deficiencies and abnormalities associated with the cardiopulmonary system.

(ff) “Speech Language Pathologist” means a person who is licensed in Wyoming to practice speech language pathology pursuant to W.S. 33-33-105.

(gg) “Speech Pathology” means the application of principles, methods, and procedures for the evaluation, monitoring, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language for preventing, identifying, evaluating, and reducing the effects of such disorders and conditions.

(hh) “State Survey Agency” means the Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys.

(ii) “Survey” means a periodic evaluation conducted by the State Survey Agency or its designated representative to determine compliance with State Rules and Regulations for Licensure of Rehabilitation Hospitals. A survey may be conducted on site or off site.

(jj) “Therapy Service” means physical therapy, occupational therapy, and speech language therapy.

Section 5. Licensure.

(a) Licensing Procedure.

(i) For an initial license to be issued, the State Survey Agency shall receive:

(A) A completed application form supplied by the State Survey Agency, including the completed items identified on the Rehabilitation Hospital Licensure Checklist supplied by the State Survey Agency.

(B) Each completed application shall be accompanied by the required licensure fee identified in Chapter 1, Rules and Regulations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.

(ii) For renewal of a full license for one (1) year beginning July 1, and unless suspended or revoked, expiring on June 30 of the following year, the State Survey Agency shall receive:

(A) A completed application form submitted no later than the date indicated in the renewal notice posted on the State Survey Agency website at: http://www.health.wyo.gov/ohls; and

(B) The licensure fee required in paragraph (a)(i)(B) of this section.

(b) Requirements for Licensure. The State Survey Agency shall consider:

(i) Initial, re-licensure, and complaint survey deficiencies cited by the State Survey Agency;

(ii) Life Safety Code deficiencies cited by the State Survey Agency;

(iii) Complaint investigations and resolutions;

(iv) Compliance with all laws and standards relating to communicable and reportable diseases, as required by the Wyoming Department of Health, State Health Officer, and Public Health Division; and

(v) The effectiveness of the quality management program to evaluate and improve patient care and services.

(i) Transfer or assignment of a rehabilitation hospital license is prohibited. The rehabilitation hospital shall comply with licensure requirements in paragraph (d) of this section in the event of a change in the ownership of a rehabilitation hospital.

(d) Change of Ownership.

(i) A change in ownership of a rehabilitation hospital occurs when there is a change in the legal entity responsible for the operation of the rehabilitation hospital, whether by lease or by ownership.

(ii) If the rehabilitation hospital is also certified for Medicare and/or Medicaid, the change of ownership determination by the Centers for Medicare and Medicaid Services will also be used to determine the licensure change in ownership.

(iii) The new owner shall submit no later than sixty (60) calendar days prior to the event the following items:

(A) A change in ownership application for licensure with the appropriate fee, as required in paragraph (a)(i)(B) of this section.

(B) The checklist items required for an initial applicant.

(iv) Within twenty-four (24) hours of the final transaction, the new owner shall submit a copy of the signed bill of sale or lease agreement that reflects the effective date of the sale or lease.

(e) Other changes. A licensure application and appropriate fee, as required in paragraph (a)(i)(B) of this section, shall be required for any of the following changes to be processed:

(i) Name change of the rehabilitation hospital.

(ii) The number of licensed beds increased or decreased.

(iii) Change in the main rehabilitation hospital address or ancillary locations.

(f) Provisional Licenses.

(i) A provisional license is a temporary license that may be issued in the following instances:

(A) For a new licensed provider.

(B) For a change in ownership, if deemed appropriate by the State Survey Agency.

(E) Whenever deficiencies are cited that are serious and have resulted in harm or potential harm to patients, residents, or clients.

(F) Whenever the facility fails to satisfactorily correct cited deficient practices.

(G) Whenever the facility fails to comply with any requirement of these rules.

(ii) The state Medicaid office will be notified by the State Survey Agency whenever a provisional license is issued or re-issued.

(iii) A provisional license will be issued with an expiration date to be determined by the State Survey Agency at the time of issuance.

(iv) A provisional license may be re-issued for an additional extended time, if deemed appropriate by the State Survey Agency.

(v) If a provisional license is issued in lieu of a regular license, the facility must return the regular license to the State Survey Agency by certified mail or hand delivery to Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, 6101 Yellowstone Rd., Ste. 186C, Cheyenne, WY 82002.

(vi) The provisional license shall be displayed in a public area within the rehabilitation hospital.

(g) Conditions for Denying, Revoking, or Suspending a License.

(i) Denial, revocation, or suspension of a license may occur for noncompliance with any provisions of these licensure rules, with state statute or federal law or federal rules and regulations.

(h) Suspension of Admissions.

(i) The State Survey Agency may suspend new admissions or re- admissions to the rehabilitation hospital when conditions are such that patient needs cannot be met. Conditions in a rehabilitation hospital shall not jeopardize the patient’s health or safety.

(i) Monitor.

(i) The State Survey Agency shall place a Wyoming Department of Health approved monitor at the rehabilitation hospital’s expense when conditions are such that patients’ needs are not being met by the rehabilitation hospital. The monitor shall insure that neither the health nor the safety of the patients is jeopardized.

(j) Hearings.

(i) Any rehabilitation hospital aggrieved by a decision of the State Survey Agency may request a hearing by submitting a written request to the State Survey Agency within ten (10) calendar days of receipt of the notice of adverse action.

Any request for hearing shall adhere to the time frames in (i) above.

(iv) Hearings requested under this rule shall be held in accordance with the provisions of the Wyoming Administrative Procedure Act.

(k) Posting of License.

(i) The current license issued by the State Survey Agency shall be displayed in a public area within the rehabilitation hospital.

(l) Surveys for Licensure.

(i) The State Survey Agency or its designated representative shall perform initial and periodic surveys for the renewal of licensure.

(A) These surveys shall be based on the current Rules and Regulations for Licensure of Rehabilitation Hospitals promulgated by the Wyoming Department of Health.

(B) The State Survey Agency shall provide copies of its cited deficiencies to the rehabilitation hospital within ten (10) working days after the last day of the surveys.

(C) The rehabilitation hospital shall provide an acceptable plan of correction to the State Survey Agency for all cited deficiencies within ten (10) calendar days after receipt of the deficiencies. The plan of correction shall be a written document and shall provide, but not be limited to, the following information:

(I) Who is responsible for the correction.

(II) What was done or will be done to correct the deficiency.

(III) Who will monitor to ensure that the situation does not again develop.

(IV) An appropriate date, not to exceed forty-five (45) calendar days after the last day of survey, for the correction of deficiencies.

(m) Voluntary Closure.

(i) If a rehabilitation hospital voluntarily ceases to operate, it shall notify the State Survey Agency in writing at least sixty (60) working days prior to closure.

(ii) The first working day after closure, the facility must return the license to the State Survey Agency by certified mail or hand delivery to Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, 6101 Yellowstone Rd., Ste. 186C, Cheyenne, WY 82002.

Section 6. Governing Body. There shall be a governing body legally responsible for the management and operation of the rehabilitation hospital.

(a) Bylaws shall be adopted by the governing body in accordance with legal requirements.

(i) The bylaws shall:

(A) Stipulate the basis upon which members are selected, term of office, and duties.

(B) Specify to whom responsibilities for the operation and maintenance of the rehabilitation hospital, including evaluation of the rehabilitation hospital practices, shall be delegated.

(b) Medical staff members shall be appointed by the governing body.

(i) There shall be a formal procedure established, governed by written rules and regulations, covering the application for medical staff membership and the method of processing applications.

(c) The rehabilitation hospital administrator, appointed by the governing body, shall be the executive officer of the rehabilitation hospital and shall be an individual qualified in rehabilitation hospital administration either by sufficient education or experience. She shall be responsible directly to such governing entities and shall execute all policies established by the governing body.

(i) The administrator shall:

(A) Keep the governing body fully informed on the operation of the rehabilitation hospital through annual or monthly written or oral reports and by attendance at meetings of the governing body.

(B) Be responsible for developing current written personnel policies and for establishing continuing in-service programs as indicated by personnel needs.

(C) Maintain current employee records containing evidence of adequate health examinations and absence of active communicable disease.

(d) The governing body shall be responsible to ensure the facility has an ongoing, facility-wide Quality Assessment and Performance Improvement (QAPI) plan.

Section 7. Medical Staff. The rehabilitation hospital shall have a medical staff organized under bylaws approved by the governing body and responsible to the governing body for the quality of all medical care provided patients and for the ethical and professional practices of its members.

Section 8. Emergency Services. Pursuant to 42 CFR 482.55 the rehabilitation hospital may opt not to have an Emergency Department. If it opts not to have an Emergency Department, signage designating such shall be posted in a prominent location to ensure the public does not perceive that the hospital has an emergency room. The hospital shall have the ability to provide basic life saving measures to patients, staff, and visitors and have written policies for appraisals of emergencies, initial treatment, and referral when appropriate.

Section 9. Radiology Services. The rehabilitation hospital shall maintain or have radiological services readily available to meet the needs of the patients. If the rehabilitation hospital has a radiological department on-site, it shall have:

(b) Written policies and procedures shall be in place for the operation of equipment, the use of radium or other radioactive isotopes, safety precautions, and radiation exposure.

Section 10. Laboratories.

(a) If laboratory services are provided on-site, the rehabilitation hospital shall have a well organized CLIA (Clinical Laboratory Improvement Act of 1988) certified, supervised clinical laboratory with the necessary space, facilities, equipment, and suitable location to perform those services commensurate with the rehabilitation hospital’s needs for its patients.

(b) If the rehabilitation hospital performs waived testing, it must comply with laboratory requirements.

(c) Anatomical and/or clinical pathology services and blood bank services shall be available either in the rehabilitation hospital or by other arrangements with a CLIA-certified laboratory.

Section 11. Outpatient Services. If the rehabilitation hospital provides outpatient services, there shall be policies and procedures relating to the staff, functions of the service, outpatient medical records, and necessary facilities in order to assure the health and safety of the patients.

(a) Outpatient services shall be organized into sections (clinics); the number will depend on the size of the medical staff, available facilities, and patient needs.

(i) Outpatient services shall have arrangements and communications with community agencies, such as other outpatient agencies, public health nursing, and health and welfare agencies.

(b) Patients on their initial visit to outpatient services shall receive a general medical evaluation; patients under continuous care shall receive periodic re-evaluation.

(c) There shall be a physician responsible for professional services. A physician or a qualified administrator shall be responsible for administrative services.

(d) Medical records for outpatient services shall be maintained and correlated with other rehabilitation hospital medical records. Information contained in the medical record shall be complete and sufficiently detailed relative to the patient’s history, examination, laboratory and other diagnostic tests, and diagnosis and treatment to facilitate continuity of care.

(e) Conferences shall be conducted to maintain a close liaison between the various sections within outpatient services and with other rehabilitation hospital services.

Section 12. Nursing Services.

(a) The rehabilitation hospital shall provide nursing services twenty-four (24) hours per day, seven (7) days a week. These services shall be supervised by a registered nurse.

(b) Job descriptions delineating the qualifications, responsibilities, and duties for each category of nursing personnel shall be in writing and approved by the rehabilitation hospital administrator or his designee.

(c) Personnel records, including the application and verification of credentials, shall be maintained for each member of the nursing staff. Documentation shall be maintained which verifies the current Wyoming licensure status for those persons requiring licenses. Electronic verification must be evidenced in the personnel file by hard copy.

(d) Medications shall be administered by a registered nurse, LPN, a certified medication aide (MA-C) if allowed by the rehabilitation hospital’s policy, or a student nurse in an approved school of nursing under the direct supervision of a registered nurse.

In all instances, this activity shall be in accordance with the Wyoming Nurse Practice Act.

(e) All medication orders shall be in writing and signed by the physician.

Telephone orders shall be used sparingly, and shall be signed or initialed by the physician within forty-eight (48) hours.

(f) Blood transfusions and intravenous medications shall be administered in accordance with state law. If administered by a registered nurse and/or LPN, they shall be administered only by those who have been specially trained.

(g) There shall be monthly meetings of the nursing staff. Minutes of these meetings shall be recorded.

(i) The minutes, when appropriate, shall reflect:

(A) The purpose of the staff meeting;

(B) Review and evaluation of nursing care, ways of improving nursing services, discussion of nursing care, and plans for individual patients;

(D) Establishment and/or interpretation of nursing services policies;

(E) Interpretation of administrative and medical staff policies, reports of meetings, etc.; and

(F) The names of individuals attending the meeting.

(h) New employees shall be oriented to the rehabilitation hospital, nursing services, and their jobs.

(i) Planned inservice programs shall be conducted at regular intervals for all nursing personnel, and records which document the date, time, topic, outline of content, and individuals present.

Section 13. Dietary Services. The rehabilitation hospital shall have an organized dietary service function directed by qualified personnel.

(a) The rehabilitation hospital shall provide dietary services that meet the nutritional needs of patients according to the science of nutrition.

(b) Dietary Supervision.

(i) Overall supervisory responsibility for dietary services shall be assigned to a full-time qualified dietary supervisor.

(A) If the qualified supervisor is not a registered dietitian, she shall be a Dietetic Technician Registered or a Certified Dietary Manager.

(iv) Reports of the consultant dietitian shall be made verbally and in writing to the rehabilitation hospital administrator. The reports shall be kept on file with notations made of actions taken by the facility.

(A) The reports shall include dates, length of time on-site, functions performed, and recommendations.

(v) The consultant or staff dietitian shall:

(A) Develop written plans and conduct or supervise inservice programs for dietary personnel on a monthly basis;

(B) Participate in the development of policies and procedures, as well as the development and approval of all menus;

(D) Maintain interdisciplinary communication and act as the liaison to the medical and nursing staffs.

(vi) The dietary supervisor shall be responsible for:

(A) Orientation, training, scheduling, and work assignments for all dietary service personnel;

(B) Menu planning, ordering or recommending the purchase of supplies, monitoring the dietary budget, controlling costs, maintaining associated records, etc.; and

(vii) If the dietary supervisor has responsibility for cooking, adequate time shall be allowed for supervisory management.

(A) Personnel having symptoms of a communicable disease that can reasonably be expected to be transmitted through food, a boil, an infected wound, or a respiratory infection, shall not be permitted to work until medical clearance is received from a physician.

(B) Personnel returning to work after an absence due to having been diagnosed with a communicable disease shall receive clearance from a physician.

Written clearance shall be maintained in the employee’s file. The rehabilitation hospital may also require physician’s approval in the event of an infectious outbreak or upon the advice of the infection control coordinator or the State Epidemiologist.

(ii) There shall be available an up-to-date manual of regimens for all therapeutic diets approved by the medical staff and the dietitian.

(d) Menus shall be planned and written in advance for regular and therapeutic diets. When changes in the menu are necessary, substitutions shall provide equal nutritive value.

Section 14. Social Services. There shall be policies and procedures for the social services’ staff and its functions.

(a) Social services shall be under the direction of a qualified social worker.

(b) Social services and other rehabilitation hospital services shall perform as an integrate unit.

(i) Social services shall participate in appropriate in-service training programs and conferences.

(c) Records of social services activity related to individual patients shall be kept and be available to the appropriate professional personnel concerned.

(i) Functions and activities recorded shall include, as appropriate:

(A) Medical social study of referred patients;

(B) Evaluation of financial status of the patients;

(D) Social therapy and rehabilitation of patients;

(E) Environmental investigations for the attending physicians;

(F) Participation on care transitions team; and

(G) Cooperative activities with community agencies.

(ii) Significant social services summaries shall be entered promptly in the patient’s central medical record for the benefit of all staff involved in the care of the patient.

(d) Adequate work areas shall be provided for social services’ staff which is easily accessible to patients and to the medical staff, and shall assure privacy for interviews.

Section 15. Rehabilitation, Physical Therapy, Speech Therapy, Audiology, and Occupational Therapy Services. The following requirements must be met:

(a) Written policies and procedures shall be in place to address the scope of services provided.

(c) Facilities and equipment for physical therapy, speech therapy, audiology, and occupational therapy shall be in good condition and adequate to meet patient needs.

(d) All therapies shall be given in accordance with a physician’s orders and such orders shall be incorporated in the patient’s record.

(e) Complete records shall be maintained for each patient who receives rehabilitation/therapy services and shall be part of the patient’s permanent medical record.

Section 16. Dental Services. If the rehabilitation hospital provides dental services, the department shall be organized comparable to other rehabilitation hospital services or departments. The appointment of dentists shall be in accordance with the rehabilitation hospital’s medical staff bylaws and rules and regulations.

(a) The following requirements shall be met:

(i) Members of the dental staff shall be licensed in Wyoming pursuant to W.S. 33-15-120;

(ii) There shall be a physician in attendance who is responsible for the medical care of the patient throughout the rehabilitation hospital stay;

(iii) Patients admitted for dental services shall be admitted in compliance with rehabilitation hospital regulations;

(iv) There shall be specific bylaws concerning the dental staff written as combined medical-dental staff bylaws or as separate or adjunct dental bylaws;

(v) Bylaws and rules and regulations shall specifically delineate the rights and privileges of the dentists; and

(vi) Complete records, both medical and dental, shall be required for each dental patient and shall be part of the rehabilitation hospital records.

Section 17. Pharmacy. The rehabilitation hospital shall have a pharmacy directed by a registered pharmacist. The pharmacy shall be administered in accordance with accepted professional principles.

(a) The pharmacist shall be responsible to the rehabilitation hospital administrator for developing, supervising, and coordinating all the activities of the pharmacy.

(b) Prescription medications shall be compounded in a proper location by a qualified pharmacist.

(i) Drugs shall be issued to floor units in accordance with approved policies and procedures.

(ii) Drug cabinets on the nursing units shall be routinely checked by the pharmacist and all floor stocks shall be controlled.

(d) Provisions shall be made for emergency pharmaceutical services.

Section 18. Health Information and Management System. The health information and management system shall be maintained in accordance with accepted professional principles for every patient evaluated or treated in the rehabilitation hospital.

(c) Records of public rehabilitation hospitals shall be preserved, either in the original form or by other permanent means, for a period of time determined by the rehabilitation hospital administrator, based upon the legally approved retention schedules for publically-funded rehabilitation hospitals established by the Wyoming State Archives and the State Records Committee.

(d) A system of identification and filing to ensure the prompt location of a patient’s medical records shall be maintained.

(e) Indexing shall be current within three (3) months following discharge of the patient.

(f) Medical records shall contain sufficient information to justify the diagnosis and warrant the treatment and end results.

(i) The medical records shall contain the following information:

(A) Identification data;

(B) Chief complaint;

(D) Past history;

(E) Family history;

(F) Physical examination;

(G) Provisional diagnosis;

(H) Clinical laboratory reports;

(I) X-ray reports;

(J) Consultations;

(K) Treatment, medical and surgical;

(L) Tissue report;

(M) Progress notes;

(N) Final diagnosis;

(O) Discharge summary; and

(P) Autopsy findings.

(g) In rehabilitation hospitals with house staff, the attending physician countersigns at least the history, physical examination, and summary written by the house staff.

Section 19. Infection Control Program. An infection control program shall be established based on nationally recognized standards of practice. The program shall prevent, identify, and control infections and communicable diseases.

(a) The infection control program is coordinated by the rehabilitation hospital administrator, the medical staff, and director of nursing services in conjunction with the hospital’s quality assurance and performance improvement programs.

(b) Problems identified are reported to the medical staff, nursing, administration, and addressed in the rehabilitation hospital’s quality assurance and in- service training programs.

Section 20. Sanitary Environment. The rehabilitation hospital shall provide for housekeeping, maintenance, and laundry services.

(a) There shall be written policies and procedures for each of these functions to ensure the use of approved practices, procedures, and products.

(i) A designated person shall be responsible for plant maintenance, laundry, and general housekeeping. These responsibilities may be assigned to a single person in small rehabilitation hospitals.

(ii) Housekeeping shall be responsible for keeping the rehabilitation hospital free of offensive odors, accumulations of dirt, rubbish, dust, insects, and rodents.

(iii) Laundry facilities shall have physical separation of clean and dirty areas, adequate ventilation, and temperature control.

(iv) There shall be written policies and procedures covering the sterilization process used on various types of equipment, surfaces, supplies, and instruments.

(A) There shall be a procedure for quality control in relation to the sterilization process.

(B) Humidifiers and any associated tubing shall be replaced after each usage and the length of continuous usage shall not exceed twenty-four (24) hours.

(v) There shall be written policies and procedures covering the disinfectants used on various types of equipment, surfaces, and instruments.

(vi) There shall be a written policy covering the cleaning and disinfecting of ice machines.

(vii) All garbage and kitchen refuse shall be kept in leak-proof, nonabsorbent containers with tight fitting covers. All garbage containers kept within the rehabilitation hospital buildings shall be washed, inside and out, daily. Other dry waste materials, normally designated “trash,” may be stored in plastic bags.

Section 21. Physical Environment. Rehabilitation hospital buildings shall be designed, constructed, arranged, equipped and maintained to ensure the safety of patients, personnel, and visitors and to provide adequate and efficient care and treatment to the patients.

Section 22. Disaster Plan. All rehabilitation hospitals shall develop and adopt a written disaster preparedness plan.

(a) For rehabilitation hospitals that are federally certified, the disaster preparedness plan shall be in accordance with, at a minimum, the edition of the NFPA 99, Standards for Health Care Facilities required by the federal government.

Section 23. Construction and Remodeling. Wyoming Department of Health Chapter 3, Construction Rules and Regulations for Healthcare Facilities, shall apply to all construction and remodeling of rehabilitation hospitals.

Section 24. Life Safety and Electrical Safety. Existing life safety and electrical safety in rehabilitation hospitals shall be maintained in accordance with the requirements of the edition of the NFPA 101 Life Safety Code that was in effect at the time the facility was licensed as a hospital.

(a) Where portions of a rehabilitation hospital have been licensed at different times, the existing life safety and electrical safety in each portion shall be maintained in accordance with the requirements of the NFPA 101 Life Safety Code that was in effect at the time that portion was added to the license.

(b) Rehabilitation hospitals that are federally certified shall meet, at a minimum, the edition of the NFPA 101 Life Safety Code required by the federal government.

History

Effective 2012-09-12

Chapter 25 Freestanding Emergency Centers

Wyo. Code R. 048.0061.25.06272019 § 1 Authority

The Wyoming Department of Health (Department) promulgates this Chapter under Wyoming Statutes 35-2-904, -907, and -908.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 2 Purpose and Applicability

(a) This Chapter applies to the operation of a freestanding emergency center.

(b) The Department may issue a provider manual, bulletin, or other guidance materials to interpret the provisions of this Chapter. Such guidance must be consistent with and reflect the policies contained in these Rules.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 3 Definitions

(a) The following definitions apply to this Chapter:

(i) "Advanced Practice Registered Nurse" or "APRN" means a person authorized by the Wyoming State Board of Nursing to practice as an advanced practice registered nurse pursuant to W.S. 33-21-134(b).

(ii) "Central registry" means the registry operated by the Wyoming Department of Family Services to index individuals who have been substantiated for:

(A) Abuse or neglect of children under W.S. 14-3-213; or

(B) Abuse, neglect, exploitation, or abandonment of vulnerable adults under W.S. 35-20-115.

(iii) "Emergency medical condition" means a condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in: placing the health of the individual or unborn child in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of bodily organs. All emergency medical conditions are viewed as "life threatening emergency medical conditions" under W.S. 35-2-901(a)(xxvi).

(iv) "Freestanding emergency center" or "center" means a facility, that pursuant to W.S. 35-2-901(a)(xxvi), "provides services twenty-four (24) hours a day, seven (7) days a week for life threatening emergency medical conditions and is at a location separate from a hospital."

(v) "Hospital" means an institution licensed pursuant to W.S. 35-2-902 and certified as a hospital or critical access hospital by the Centers for Medicare and Medicaid Services.

(vi) "Immediate jeopardy" means a situation in which a center's noncompliance with one or more requirements of these Rules has caused, or is likely to cause, serious injury, harm, impairment, or death to a patient.

(vii) "License" means the authority granted by the State Survey Agency to operate a freestanding emergency center pursuant to W.S. 35-2-902.

(viii) "Medical screening exam" means the process required to reach, with reasonable clinical confidence, a determination about whether an emergency medical condition does, or does not, exist.

(ix) "Registered Nurse" or "RN" means a person authorized by the Wyoming State Board of Nursing to practice as a registered professional nurse pursuant to W.S. 33-21-134(a).

(x) "Physician" means a person authorized by the Wyoming Board of Medicine to practice medicine pursuant to W.S. 33-26-301.

(xi) "Physician Assistant" or "PA" means a person authorized by the Wyoming Board of Medicine to practice as a physician assistant pursuant to W.S. 33-26-504.

(xii) "Plan of correction" means a center's plan to correct the deficiencies identified during a survey conducted by the State Survey Agency.

(xiii) "Practitioner" means a physician, Advanced Practice Registered Nurse, or Physician Assistant, and does not include a Registered Nurse.

(xiv) "State Survey Agency" means the Wyoming Department of Health, Aging Division, Healthcare Licensing and Surveys, including its staff and designees.

(xv) "Survey" means an onsite or offsite inspection conducted by the State Survey Agency to determine compliance with these Rules. The term includes activities commonly referred to in the field as surveys, revisits, complaint investigations, periodic surveys, and other inspections deemed necessary by the State Survey Agency.

(xvi) "Triage" means the clinical assessment of an individual's presenting signs and symptoms at the time of arrival, in order to prioritize when the individual will be seen by a physician or other qualified practitioner.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 4 Licensing

(a) A freestanding emergency center may not operate in Wyoming unless the center is licensed by the State Survey Agency under this Chapter.

(b) A center shall display its current license in a public area within the center.

(i) A provisional license provides a center with temporary authorization to operate while the center pursues compliance with these Rules. A provisional license is effective for no more than three (3) months. The State Survey Agency may extend the term of a provisional license for additional three (3) month periods, as deemed necessary by the State Survey Agency.

(ii) To apply for a provisional license, a center shall submit the following to the State Survey Agency:

(A) A complete and accurate application form, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls;

(B) A complete and accurate Freestanding Emergency Center Required Licensure Documentation Checklist, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls; and

(C) The required licensure fee, in the form of a check or money order made payable to "Treasurer, State of Wyoming," as identified in Rules, Department of Health, Health Quality, Chapter 1 (1998).

(iii) Upon receipt and review of the required application, checklist, and fee, the State Survey Agency may issue the center a provisional license if the State Survey Agency finds the center has demonstrated a good faith effort to comply with these Rules. The State Survey Agency may also issue a provisional license to a center as the State Survey Agency deems necessary to allow the center to become compliant with these Rules.

(d) After the State Survey Agency completes a survey under Section 5(b)(i) of this Chapter, the State Survey Agency may issue a license to a provisionally-licensed center if the State Survey Agency determines the center has submitted an acceptable plan of correction or corrected any deficiencies cited by the State Survey Agency.

(e) The State Survey Agency may renew a license according to the following conditions:

(i) To apply for licensure renewal, a center shall submit the following to the State Survey Agency:

(A) A complete and accurate application form, available from the State Survey Agency upon request or at http://health.wyo.gov/aging/hls; and

(B) The required licensure fee, in the form of a check or money order made payable to "Treasurer, State of Wyoming," identified in Rules, Department of Health, Health Quality, Chapter 1 (1998).

(ii) Upon receipt of the required application and fee, the State Survey Agency may renew the center's license if the State Survey Agency finds the center has demonstrated good faith effort to comply with the regulatory requirements.

(f) A center may not transfer a license, even if the center changes ownership.

(i) If a center undergoes a change of ownership, the center shall:

(A) Provide written notice no later than sixty (60) calendar days prior to the effective date of the change of ownership to the State Survey Agency that outlines the specific details of the change, parties involved, and proposed effective date;

(ii) A change of ownership occurs when there is a change in the legal entity responsible for the operation of the center, whether by lease or by ownership.

(g) If a center changes the center's name or address, the center shall submit the appropriate form and fee established by the State Survey Agency no later than sixty (60) days before the change in center name or address is effective.

(h) If a center voluntarily terminates operations, the center shall notify the State Survey Agency in writing within sixty (60) days before the voluntary termination of operations.

(i) A center voluntarily terminating operations shall provide for the continued storage of medical, financial, and personnel records for a period of six (6) years.

(ii) The notice provided to the State Survey Agency must include the name, address, email, and other contact information of the custodian of the center's medical, financial, and personnel records.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 5 Surveys

(a) A center shall submit to and comply with a survey performed by the State Survey Agency.

(b) The State Survey Agency shall perform:

(i) A survey before the State Survey Agency may issue a license under Section 4(d) of this Chapter;

(ii) A survey as necessary to monitor or resolve previously-identified deficiencies;

(iii) A survey as necessary to periodically monitor compliance with these Rules;

(iv) A survey upon receipt of a complaint against a center for the alleged violation of these Rules or other applicable laws; and

(v) Any other surveys the State Survey Agency deems necessary to enforce the provisions of these Rules, to enforce other applicable law, or to protect the public health, safety, or welfare.

(d) While under survey, a center shall provide the State Survey Agency with immediate access to all center records.

(e) If immediate jeopardy is identified during a survey, the State Survey Agency shall verbally notify the administrator or the administrator's designee. The center must:

(i) Immediately develop a written action plan to remove the immediate risk to the patient(s);

(ii) Provide the written action plan to the State Survey Agency for review and approval; and

(iii) Upon approval, implement the action plan.

(f) The State Survey Agency shall notify the administrator or administrator's designee when an immediate jeopardy situation has been removed.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 6 Deficiencies and Actions Against a License

(a) If the State Survey Agency determines during a survey that a center is out of compliance with any provision of these Rules or other applicable law, the following conditions apply:

(i) The State Survey Agency shall provide the center a statement of deficiencies within ten (10) business days of the survey exit date.

(ii) If a center receives a statement of deficiencies, the center shall comply with the following provisions:

(A) The center shall submit an acceptable plan of correction to the State Survey Agency within ten (10) business days.

(B) The plan of correction must be a written document that provides the following information:

(I) Who will be charged with the responsibility to correct each deficiency;

(II) What will be done to correct each deficiency;

(III) How the plan of correction will be incorporated into the center's quality management program;

(IV) Who will be charged with monitoring the center to ensure each deficiency does not occur or develop again; and

(V) The deadline by when the center expects to correct all deficiencies, which may not exceed sixty (60) calendar days after the survey exit date.

(iii) If the State Survey Agency determines it will take the center longer than the sixty (60) calendar days to implement the plan of correction and there is no threat to the health or safety of patients, the State Survey Agency may extend the sixty (60) calendar day deadline.

(b) Pursuant to W.S. 35-2-905, the State Survey Agency may take action against a center according to the following conditions:

(i) The State Survey Agency may take action against a center if the State Survey Agency finds that the center:

(A) Violated a provision of these Rules or other applicable laws;

(B) Permitted, aided, or abetted the commission of any illegal act by a facility licensed by the State Survey Agency; or

(ii) Action against a center may include:

(A) Placing conditions upon a center's license;

(B) Installing a monitor or manager, at the center's expense, that has been approved by the State Survey Agency;

(D) Denying, suspending, or revoking a center's license.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 7 Governing Body

(a) A governing body of a center shall:

(i) Adopt and maintain bylaws that define, identify, and establish responsibilities for the operation and performance of the center;

(ii) Establish administrative policies including qualifications and responsibilities of the medical director and center administrator;

(iii) Ensure the center does not provide care that exceeds twenty-four (24) hours of treatment until discharge or transfer;

(iv) Provide appropriate personnel, physical resources, and equipment for the delivery of safe and effective emergency medical care;

(v) Approve policies for the provision of an effective procedure for the immediate transfer of patients requiring emergency care beyond the capabilities of the center to a hospital; and

(vi) Meet at least annually and keep minutes or other records necessary for the orderly conduct of the center. Meetings held by the center's governing body must be separate meetings with separate minutes.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 8 Center Administrator

(a) Prior to licensure, a center shall employ and designate a center administrator.

(b) A person is eligible to serve as center administrator if the person possesses the education, training, and experience necessary to oversee the management and operations of a center.

(i) Oversee management and operation for the center;

(ii) Comply with policies, rules and regulations, and statutory provisions pertaining to the health and safety of patients;

(iii) Serve as the liaison between the governing body and the staff;

(iv) Plan, organize, and direct activities that may be delegated by the governing body;

(v) Control the purchase, maintenance, and distribution of the equipment, materials, and facilities of the center;

(vi) Establish lines of authority, accountability, and supervision of staff;

(vii) Establish controls related to the custody of the official documents of the center and to maintaining the confidentiality, security, and physical safety of data on patients and staff; and

(viii) Ensure personnel policies are adopted, implemented, and enforced to facilitate attainment of the mission, goals, and objectives of the center.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 9 Medical Director

(a) Prior to licensure, a center shall employ and designate a medical director.

(b) A person is eligible to serve as a medical director, including the center administrator, if the person is a Wyoming licensed physician and:

(i) Board Certified or Board Eligible in Emergency Medicine; or

(ii) Board Certified in Internal Medicine with a minimum of 3 years of emergency medicine experience; or

(iii) Board Certified in Family Medicine with a minimum of 3 years of emergency medicine experience.

(i) Establish minimum staff qualifications for the provision of care based on necessary education, experience and specialized training, consistent with State law and acceptable standards of practice;

(ii) Promulgate written protocols necessary for the provision of services at the center;

(iii) Oversee and evaluate the provision of services at the center;

(iv) Promulgate a list of equipment, supplies, drugs, and biologicals, which are necessary to provide emergency services and must be available at the center at all times;

(v) Direct the center's infection control program, quality management program, and patient transfer program;

(vi) Be on-site at the center as necessary to fulfill the duties imposed by these Rules and the center's governing body; and

(vii) Ensure that at all times a practitioner or RN is on-site at the center who possesses the following certifications:

(A) Advanced Cardiovascular Life Support (ACLS);

(B) Trauma Nursing Core Course (TNCC) or an Advanced Trauma Care for Nurses (ATCN) Course; and

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 10 Duties and Powers of a Licensed Freestanding Emergency Center

(a) A center shall provide:

(i) Dietary services according to Section 11 of this Chapter;

(ii) Emergency services according to Section 12 of this Chapter;

(iii) Laboratory services according to Section 13 of this Chapter;

(iv) Pharmaceutical services according to Section 14 of this Chapter;

(v) Radiologic services according to Section 15 of this Chapter; and

(vi) Respiratory services according to Section 16 of this Chapter.

(b) A center shall adopt, implement, and enforce:

(i) An emergency preparedness plan according to Section 17 of this Chapter;

(ii) An infection control program according to Section 18 of this Chapter;

(iii) A quality management program according to Section 19 of this Chapter;

(iv) A patient transfer policy according to Section 20 of this Chapter;

(v) A patient rights policy according to Section 21 of this Chapter;

(vi) A records policy according to Section 22 of this Chapter; and

(vii) A staffing policy according to Section 23 of this Chapter.

(d) A center shall maintain a physical environment according to the following conditions:

(i) A center must be designed, constructed, arranged, equipped, and maintained, including the provision of fire safety, in accordance with Chapter 3 of these Rules.

(ii) If a center constructs, remodels, or changes the use of center space, the center shall comply with Chapter 3 of these Rules.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 11 Dietary Services

(a) A center shall maintain a nourishment station within the center that contains refrigerated storage, a self-dispensing ice machine, and a handwashing sink.

(b) A center shall designate a person responsible for properly receiving, storing, and handling food at the center.

(c) A center may not offer meal services, except the center may provide nutritional snacks as needed in accordance with practitioner orders.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 12 Emergency Services

(a) A center shall display in all its advertising, publications, signs, or other forms of communication the term "Freestanding" in a prominent manner sufficient to distinguish the center from a hospital emergency department.

(b) A center shall participate in the local Emergency Medical Service (EMS) and trauma system, consistent with the center's capabilities and capacity and the locale's existing EMS and trauma plans and protocols.

(c) A center shall receive and maintain formal designation through the Wyoming Trauma Program administered by the Department according to W.S. 35-1-801 to -805.

(d) If a center does not provide diagnosis or treatment services to a victim of sexual assault, the center shall refer the victim seeking a forensic medical examination to a hospital or other health care facility that provides services to victims of sexual assault.

(e) Without regard to the patient's ability to pay, a center shall provide a patient that presents to the center:

(i) A medical screening examination to determine if an emergency medical condition exists; and

(ii) Any necessary stabilizing treatment.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 13 Laboratory Services

(a) A center shall provide basic laboratory testing necessary to meet the emergency needs of patients and to adequately support the center's clinical capabilities, including:

(i) Chemical examinations of urine by stick or tablet methods, or both (including urine ketones);

(ii) Blood glucose;

(iii) Stool specimens for occult blood;

(iv) Pregnancy test; and

(v) International normalized ratio.

(b) A staff member may not perform laboratory services or report laboratory results unless the staff member is designated as qualified by the appropriate medical staff by virtue of the staff member's education, experience, and training.

(c) A center shall have an agreement with a hospital or independent laboratory to provide any additional laboratory services needed for a patient.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 14 Pharmaceutical Services

(a) A center shall provide pharmaceutical services necessary to meet the emergency needs of patients and to adequately support the center's clinical capabilities.

(b) A center shall:

(i) Maintain the pharmacy or drug storage area according to relevant federal and state law;

(ii) Package and dispense drugs and biologicals according to relevant federal and state law;

(iii) Keep drugs and biologicals in a locked storage area; and

(iv) Destroy drugs and biologicals as necessary according to accepted medical practices.

(c) A staff member shall immediately report a drug administration error, adverse drug reaction, or incompatibility to the attending practitioner.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 15 Radiologic Services

(a) A center shall provide radiological services necessary to meet the emergency needs of patients and to adequately support the center's clinical capabilities, including plain film x-ray.

(b) A staff member may not use radiographic equipment unless the staff member is designated as qualified by the appropriate medical staff by virtue of the staff member's education, experience and training.

(c) A center shall ensure that a Wyoming-licensed radiologist is available to interpret radiographic tests that are determined by a practitioner to require a radiologist's specialized knowledge.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 16 Respiratory Services

(a) A center shall provide respiratory services necessary to meet the emergency needs of patients and to adequately support the center's clinical capabilities.

(b) A staff member may not provide respiratory services unless under the orders of a practitioner.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 17 Emergency Preparedness

(a) A center shall develop and maintain an emergency preparedness plan in accordance with the Chapter 3 of these Rules.

(b) A center shall:

(i) Ensure the plan includes ongoing coordination with community agencies and other local health care facilities;

(ii) Review the plan annually; and

(iii) Update the plan as necessary.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 18 Infection Control

(a) A center shall prevent, identify, and control infections and communicable diseases, according to nationally recognized standards of practice and applicable laws.

(b) A center's infection control program must:

(i) Prevent, identify, and control infections and communicable diseases;

(ii) Report issues involving the control of infections and communicable diseases to the center's quality management program; and

(iii) Maintain documentation related to corrective actions and outcomes.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 19 Quality Management

(a) A center shall implement a quality management function pursuant to W.S. 35‑2‑910.

(b) A center's quality management program must:

(i) Ensure and evaluate the quality of patient care provided at the center; and

(ii) Provide for the annual review of:

(A) The utilization of the center's services, including the number of patients served and volume of services;

(B) The center's health care policies;

(D) The initiation and documentation of appropriate remedial action to address deficiencies found through the quality management program, as well as documentation of the outcome of remedial action.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 20 Patient Transfer

(a) A center shall maintain a patient transfer agreement with at least one Wyoming hospital.

(b) A center may enter into more than one transfer agreement as necessary to meet the emergency needs of patients and to adequately support the center's clinical capabilities.

(i) Include written protocols that establish when a patient requires transfer to a hospital according to a transfer agreement;

(ii) Provide that the transfer of a patient may not be predicated upon arbitrary, capricious, or unreasonable discrimination based upon considerations such as race, religion, national origin, age, gender, physical condition, economic status, insurance status, or ability to pay;

(iii) Include a written operational plan to provide for patient transfer transportation services if the center does not provide transportation services, itself;

(iv) Recognize the right of a patient to request transfer into the care of a physician or a hospital of the patient's own choosing. If a patient requests or consents to transfer for economic reasons, the practitioner or center administration shall fully disclose to the patient the eligibility requirements established by the patient's chosen physician or hospital;

(v) Recognize the right of a patient to refuse a transfer and, if transfer is refused, ensure that reasonable steps are taken to secure the written informed consent of the patient;

(vi) Provide that a patient may not be transferred unless center staff verify that qualified practitioners are available and on-duty at the receiving hospital to accept transfer;

(vii) Provide that in determining the use of medically appropriate life support measures, personnel, and equipment, the transferring practitioner shall exercise that degree of care which a reasonable and prudent practitioner exercising ordinary care in the same or similar locality would use for the transfer;

(viii) Provide that a copy of those portions of the patient's medical record which are available and relevant to the transfer and to the continuing care of the patient be forwarded to the receiving physician and receiving hospital with the patient. If all necessary medical records for the continued care of the patient are not available at the time the patient is transferred, the records shall be forwarded to the receiving physician and hospital as soon as possible; and

(ix) Provide that the transferring practitioner shall determine and order life support measures that are medically appropriate to stabilize the patient before transfer and to sustain the patient during transfer. In addition, the transferring practitioner shall determine and order the utilization of appropriate personnel and equipment for the transfer.

(d) If a patient has an emergency medical condition that has not been stabilized, a center may not transfer a patient unless:

(i) The patient, after being informed of the center's obligations and of the risk of transfer, signs a written request for transfer that provides the reason for the request and that the patient is aware of the risks and benefits of the transfer; or

(ii) A practitioner signs a certification that, based on the information available at the time of transfer:

(A) Provides a summary of the risks and benefits of the transfer; and

(B) Finds the medical benefits reasonably expected from the provision of care at the receiving hospital to outweigh the risk of transfer to the patient, and, in the case of labor, to the unborn child, which may also include a finding that the center cannot adequately stabilize the patient due the lack of relevant staff or equipment.

(e) If a center transfers a patient, the center shall retain a copy of the transfer documentation provided to the receiving hospital for its own records.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 21 Patient Rights

(a) A center shall promote and protect patient rights.

(b) A center shall:

(i) Treat a patient with respect, consideration, and dignity;

(ii) Provide a patient appropriate privacy;

(iii) Provide a patient, to the degree known, appropriate information concerning the patient's diagnosis, treatment, and prognosis. When it is medically inadvisable to give such information to a patient, the center shall provide the information to a person designated by the patient or to a legally authorized person;

(iv) Provide a patient the opportunity to participate in decisions involving the patient's health care, except when the patient's participation is contraindicated for medical reasons; and

(v) Provide the patient written information regarding the patient's rights, including the following subjects:

(A) Patient conduct and responsibilities;

(B) Services available at the center;

(D) Fees for services provided at the center;

(E) The center's payment policies; and

(F) The center's procedure for filing and pursuing a grievance, including all relevant steps from filing the initial grievance to achieving a resolution.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 22 Records

(a) A center shall maintain a log of all patients. The log must include, as applicable:

(i) The patient's name;

(ii) The patient's date and time of arrival;

(iii) The patient's mode of arrival;

(iv) The patient's chief complaint;

(v) Whether the patient was treated, or refused or was denied treatment;

(vi) The time of discharge or transfer;

(vii) The place that the patient discharged or transferred to, including home or hospital; and

(viii) The mode of discharge transportation.

(b) If a patient receives services at a center, the center shall create and maintain a patient medical record. A patient medical record must include, as applicable:

(i) The patient's identification and social data;

(ii) The patient's chief complaint;

(iii) The patient's triage level;

(iv) The patient's pertinent medical history;

(v) The patient's properly executed consent forms;

(vi) Reports of medical screening examinations, diagnostic and laboratory test results, and consultation findings;

(vii) All practitioners' orders and notes, nurses' notes, and reports of treatment and medications;

(viii) Any other pertinent information necessary to monitor the patient's prognosis;

(ix) The patient's final diagnosis; and

(x) The patient's discharge summary.

(d) A center shall maintain all records according to professional standards of practice, including storage of records in a secure and designated area.

(e) A center's medical records policy must:

(i) Ensure the confidentiality of patient records and safeguard against loss, destruction, or unauthorized use, in accordance with applicable law;

(ii) Govern the use and removal of records from the record storage area;

(iii) Specify the conditions under which record information may be released and to whom; and

(iv) Specify when the patient's written consent is required for release of information.

(f) Personnel records shall be maintained for each person employed at the center which include:

(i) The employment application;

(ii) Verification of criminal background check and Central Registry check;

(iii) Licensure verification;

(iv) Current certification and competency in Basic Life Support (BLS) and other certifications required under this Chapter;

(v) Immunizations and other medical tests; and

(vi) Results of medical examinations required as a part of employment.

(g) Equipment records shall be maintained per the manufacturer's recommendations.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 23 Staff

(a) A center may not permit a staff member to provide a service unless:

(i) The staff member possesses the necessary education, training, experience, licensure, and certifications; and

(ii) The medical director has authorized the staff member to provide the particular service.

(b) A center shall employ sufficient staff to allow for:

(i) A practitioner or RN certified in ACLS, TNCC or ATCN, and PALS to be on-site at the center at all times;

(ii) A practitioner to be on-call and immediately available by telephone or radio if there is no practitioner on-site at the center; and

(iii) An adequate number of practitioners and RNs to be available on-call to meet the emergency needs of patients in a timely manner.

(A) Investigates the conduct at issue in a thorough manner;

(B) Determines, based on the findings of its investigation, that the direct care staff member may be allowed to have unsupervised access to patients and the center's operational systems; and

(C) Maintains documentation of its investigation and determination in the direct care staff member's subsequent personnel file.

History

Effective 2019-06-27

Wyo. Code R. 048.0061.25.06272019 § 24 Equipment

(a) A center shall maintain adequate, age-appropriate equipment and supplies to provide services.

(b) Equipment must be tested and maintained according to the manufacturer guidelines.

(c) Adequate equipment and supplies is determined by the amount, type, and extensiveness of services provided by the center and includes, at a minimum:

(i) Personal protection equipment and supplies;

(ii) Patient assessment and diagnostic measurement equipment and supplies;

(iii) Suctioning equipment and supplies;

(iv) Airway management equipment and supplies;

(v) Bleeding control and wound management equipment and supplies;

(vi) Immobilization equipment;

(vii) Cardiac equipment and supplies;

(viii) Ingested poisons equipment and supplies;

(ix) Obstetrics and gynecology equipment and supplies;

(x) Heat and cold related injuries equipment and supplies; and

(d) The emergency drug cart and adjunctive emergency equipment must be checked by an appropriate, designated staff member after each use to assure that all items required for immediate availability are contained in the cart and in usable condition.

History

Effective 2019-06-27

153 Hospital, State - Patient Bill of Rights

Chapter 1 State Hospital - Patient Bill of Rights

Wyo. Code R. 048.0029.1.07191990 State Hospital - Patient Bill of Rights

Chapter I

PATIENT BILL OF RIGHTS: ADMINISTRATIVE POLICIES AND PROCEDURES

Section 1. Authority. The Board of Charities and Reform, Pursuant to W.S. 25-10-120, is authorized to promulgate rules creating a Patients' Bill of Rights and establishing the procedures by which such rights shall be enforced, limited or denied.

Section 2. Purpose.

(a) These rules are adopted to create a Patients' Bill of Rights and establish the administra- tive procedures whereby patients' rights shall be enforced, limited or denied.

(i) The creation of a Patients' Bill of Rights acknowledges the importance of recognizing and preserving the rights and dignity of individuals served by the State Hospital while providing the most effective treatment possible, with the goal of advancing each patient's welfare and health.

(ii) The guidelines, procedures and criteria contained in these rules are intended to facili- tate the provision of care and services by providing official guidelines to hospital staff and employees, and all others involved in the provision and administration of such care and services.

Section 3. Definitions.

(a) "Head of hospital" means the individual in charge of the State Hospital;

(b) "Hospital" means the Wyoming State Hospital at Evanston, Wyoming;

(i) A psychiatrist with three years of residency training in psychiatry;

(ii) A psychologist with a doctoral degree from an accredited program;

(iii) A social worker with a master's degree from an accredited program and two years of clinical experience under the supervision of a qualified mental health professional;

(iv) A registered nurse with a graduate degree in psychiatric nursing and two years of clinical experience under the supervision of a qualified mental health professional.

(d) "Minor" or "minor person" means a person who has not attained the age of nineteen.

(e) "State" means the State of Wyoming, and any of its political subdivisions.

(f) "Treatment" means diagnosis, evaluation, medication, therapy or prescribed care includ- ing observation, supervision or discharge planning.

Section 4. Patients' Bill of Rights.

(a) A person admitted to the hospital for the purposes of receiving mental health services shall be accorded the following:

(i) The right to appropriate treatment and related services in a setting and under conditions that: PAT-5.2 (Addendum) pages

(A) Are most supportive of the person's personal liberty; and Patient Bill of Rights Page Administrative Policies and Procedures 29 Jun 90

(B) Restrict such liberty only to the extent necessarily consistent with the person's treatment needs, applicable requirements of law, and applicable judicial orders.

(ii) The right to an individualized, written treatment or service plan developed pursu- ant to and in compliance with W.S. 25-10-113, including:

(A) The right to treatment based on such plan;

(B) The right to periodic review and reassessment of treatment and related service needs as required by W.S. 25-10-116; and

(C) The right to appropriate revision of the plan. Appropriate revision in- cludes any revision necessary to provide a description of mental health services that may be needed after the person is discharged from the hospital or its program(s).

(iii) The right to ongoing participation, in a manner appropriate to the person's capabilities, in the planning of mental health services to be provided the person. This right of participa- tion includes the right to participate in the development and periodic revision of the plan described in subsection (ii).

(A) In connection with such participation, the right to be provided with a reasonable explanation, in terms and language appropriate to a person's condition and ability to understand, of:

(I) The person's general mental condition and, if the program or the hospital has provided a physical examination, the person's general physical condition.

(II) The objectives of treatment:

(III) The nature, duration, and significance of possible adverse effects of recommended treatments.

(IV) The reasons why a particular treatment is considered appropriate.

(V) Any appropriate and available alternative treatments, services, and types of providers of mental health services, including the right of the patient to seek an opinion of an outside mental health professional (at the patient's own expense).

(iv) The right not to receive a mode or course of treatment established pursuant to the treatment plan, in the absence of the person's informed, voluntary, written consent to such mode or course of treatment, except treatment:

(A) During an emergency situation if such treatment is pursuant to or docu- mented contemporaneously by the written order of a responsible mental health professional; or

(B) As permitted under applicable law in the case of a person committed by a court to the hospital or its treatment program(s).

(v) The right not to participate in experimentation in the absence of the person's informed, voluntary, written consent.

(A) The right to appropriate protections in connection with such participation.

Appropriate protections include the right to a reasonable explanation of the procedure to be followed, the benefits to be expected, the relative advantages of alternative treatments, and the potential discomforts and risks.

(B) The right and opportunity to revoke consent to such participation.

(vi) The right to freedom from restraint, seclusion, or other similar interventions which may be administered solely for purposes of discipline, staff convenience, or as a substitute for a less restrictive therapeutic treatment program.

(A) In the event of an emergency situation, in which it is likely that patients could harm themselves or others, and in which less restrictive means of restraint are not feasible, patients may be physically restrained or placed in isolation only on a qualified mental health professional's written order which explains the rationale for such action.

(B) Restraint or seclusion during an emergency situation shall not be ordered by a medical doctor who is also not a qualified mental health professional.

(vii) The right to humane treatment environment that affords a person reasonable protection from harm and appropriate privacy with regard to personal needs.

(A) A humane treatment environment includes the right to be free from any physical, verbal, sexual, financial, or psychological abuse, exploitation, or punishment.

(B) Personal privacy and dignity shall be protected.

(viii) The right to confidentiality of the person's records, in accordance with W.S. 25- 10-122.

(ix) The right to access, upon request, to the person's own mental health care records, except the person may be refused access to:

(A) Information in the records provided by a third party under assurance that such information will remain confidential; and

(B) Specific material in the records if the mental health professional respon- sible for the mental health services concerned has made a determination in writing that access would be detrimental to the person's health. However, such material may be made available to a similarly licensed health professional selected by the person, and the health professional selected may, in the exercise of professional judgment, provide the person with access to any or all parts of the specific material or otherwise disclose the information contained in the material to the person.

(x) The right, in the case of a person admitted on a residential or inpatient care basis:

(A) To converse with others privately;

(B) To have convenient and reasonable access to the telephone and to send and receive uncensored and unopened mail; and

(I) However, if a mental health professional treating the person determines that denial of access to a particular person is necessary for treatment purposes, the mental health profes- sional may, for a specific, limited, and reasonable period of time, deny access if the mental health profes- sional has ordered the denial in writing and the order has been incorporated in the treatment plan for the person. A order denying access shall include the reasons for denial.

(II) Any denial of access to a particular person shall be reviewed by a qualified mental health professional at regular intervals not to exceed seven (7) days.

(xi) Right of access to:

(A) A protection service within the hospital through the Human Rights Com- mittee;

(B) A protection system established by the State of Wyoming through the state patient advocate;

(C) The system established under the Protection and Advocacy for Mentally Ill Individuals Act of 1986 (42 U.S.C. SS 10801 et seq.), to protect and advocate the rights of mentally ill individuals. This right of access includes opportunities and facilities for private communication.

(xii) The right to be informed promptly at the time of admission and periodically thereafter, of the right described in this section.

(A) Such information shall be in language and terms appropriate to the person's condition and ability to understand.

(B) Such information shall include patient's right under the Fair Labor Stan- dards Act, 42 U.S.C. SS 201 et seq., which includes:

(I) The right to refuse to perform services for the hospital;

(II) The right to have the need or desire to work documented in the patient's individual treatment plan in the event the patient chooses to perform services;

(III) The individual treatment plan shall specify the nature of the services and whether the services are voluntary or performed for compensation;

(IV) The agreement to perform services may be terminated at any time.

(xiii) The right to assert grievances with respect to infringement of the rights de- scribed in these rules, including the right to have such grievances considered in a fair, timely and impar- tial grievance procedure provided for by the hospital, in accordance with Section 5(a)(iii) of these rules.

(xiv) The right to exercise the rights described in this section without reprisal, includ- ing reprisal in the form of denial of any appropriate, available treatment.

(xv) The right to referral, as appropriate, to other providers of mental health services upon discharge.

(b) The rights described in these rules shall be in addition to and not in derogation of any other statutory or constitutional rights.

(i) The right to confidentiality of and access to records described in provisions designated (a)(viii) and (a)(ix) shall remain applicable to records pertaining to a person after the person's discharge from the hospital or program(s), with the following exception: Records and reports which are made under the Hospitalization of Mentally Ill Persons Act (W.S. 25-10-101 through 25-10-404), and directly or indirectly identify a patient, former patient, or person for whom an application for hospitaliza- tion has been filed, may be provided without the person's consent, if the records and reports as provided:

(A) By and between a mental health center, the State Hospital and hospitals designated under W.S. 25-10-104; and

(B) Only for the purpose of facilitating referral treatment, admission, readmis- sion or transfer of the patient under the Hospitalization of Mentally Ill Persons Act.

(c) No otherwise eligible person will be denied admission to the hospital or its program(s) for mental health services as a reprisal for the exercise of the rights described in these rules.

(i) Nothing in these rules shall:

(A) Obligate an individual mental health or health professional to administer treatment contrary to the professional's clinical judgement;

(B) Prevent the hospital or any of its programs from discharging any person for whom the provision of appropriate treatment, consistent with the clinical judgement of the mental health professional primarily responsible for the person's treatment, is or has become impossible as a result of the persons' refusal to consent to the treatment.

(C) Require the hospital or any of its programs to admit any person who, while admitted on prior occasions to such program or facility, has repeatedly frustrated the purposes of admis- sion by withholding consent to proposed treatment; or

(D) Obligate the hospital or any of its programs to provide treatment services to any person who is admitted to such program or facility solely for diagnostic or evaluative purposes.

(ii) In order to assist a person admitted to a program or facility in the exercise or protection of the person's rights, the person's attorney or legal representative shall have reasonable access to:

(A) The person;

(B) The areas of the hospital or its program(s) where such person has received treatment, resided, or had access; and

(C) Pursuant to the written authorization of the person, the records and infor- mation pertaining to such person's diagnosis, treatment, and related services described in paragraph (a) (ix).

(iii) The hospital and each of its programs shall post a notice listing and describing the rights described in this section of all persons admitted to the hospital or any of its program.

(A) The notice shall be in language and terms appropriate to the ability of the persons to whom the notice is addressed to understand.

(B) Each notice should conform to the format and content for such notices, and shall be posted in appropriate locations.

(d) When a person is adjudicated by a court of competent jurisdiction as being incompetent to exercise the rights or provide the authorization described in paragraphs (i), (ii) or (iii) of this subsec- tion, such rights may be exercised or such authorization provided by the individual appointed by the court as the person's guardian for the purpose of:

(i) Exercising the right to consent to treatment or experimentation described in the provisions designated as (a)(iv) and (a)(v) of this section;

(ii) Exercising the right to confidentiality of or access to records described in provi- sions designated as (a)(viii) or (a)(ix) of this section;

(iii) Providing authorization as described in subparagraph (c)(ii)(C) of this section; or

(iv) Avoiding conflicts of interest.

(e) The following shall apply with respect to minors:

(i) A minor's parent or legal guardian may, on behalf of the minor:

(A) Exercise the right to consent to treatment to experimentation described in the provisions designated as (a)(iv) and (a)(v) of this section;

(B) Exercise the right to confidentiality of or access to records described in provisions designated as (a)(viii) or (a)(ix) of this section; or

(ii) Notwithstanding provision (e)(i) above, a minor, and not the minor's parent or legal guardian, may exercise the rights contained in these rules and provide any necessary authorization to exercise the rights, in the following cases:

(A) The minor's parent or legal guardian cannot with reasonable diligence be located and the minor's need for treatment is sufficiently urgent to require immediate attention;

(B) The minor was living apart from the parent or guardian and managing his own affairs regardless of his source of income, at the time of admission or commitment;

(D) The minor is in the active military service of the United States;

(E) The minor is emancipated under W.S. 14-1-201 through 14-1-206.

Section 5. Administrative Policies and Procedures.

(a) In addition to any policies and procedures required by the Patients' Bill of Rights con- tained in section 4 of these rules, the hospital shall establish appropriate policies and procedures as required to implement and enforce these rules. Appropriate policies and procedures required to imple- ment and enforce these rules include but are not limited to the following:

(i) Affirm and protect the patient's right stated under Section 4, to include:

(A) Ensure that all allegations of mistreatment, abuse or neglect, as well as any injuries to patients, are reported immediately to the administrator or to other officials in accordance with State law and through established hospital standard reporting procedures;

(B) Ensure that action is taken as necessary to prevent the potential of further abuse while an investigation is in process;

(C) Provide for an immediate and thorough investigation of all allegations by trained, experienced personnel delegated with all necessary authority; results of all investigations must be reported to the administrator or designated representative, or to other officials in accordance with state law, within five working days of the incident;

(D) Establish reasonable and appropriate corrective actions, including educa- tion, training and/or punishment for any hospital-affiliated individual who has been found to be respon- sible for acts of mistreatment, abuse or neglect of patients;

(E) Prohibit the employment of individuals with a conviction or substantial documentation of child or patient abuse, neglect or mistreatment;

(F) Provide training and informational materials on patients' rights and on the prevention of abuse/neglect/mistreatment for administrators, mental health professionals and direct care staff and volunteers; each new staff member should be presented this information at the time of employ- ment and training should be given for each of the groups at least annually.

(ii) The hospital shall designate and staff an administrative function charged with the following responsibilities:

(A) An assessment and report, to be submitted to the head of the hospital and the hospital's governing body on at least an annual basis, of the hospital's compliance or lack thereof with the requirements in these rules, and any applicable statutory, constitutional and accreditation stan- dards.

(B) Establishment and implementation of procedure(s) which provide every person admitted to the hospital or any of its programs with adequate notice of the rights contained in these rules.

(C) To act in the capacity of liaison for the hospital and its programs to the services and systems enumerated in provision 4(a)(xiii) of these rules.

(iii) The hospital shall develop and implement an administrative procedure for the review of patient grievances with respect to the protection and enforcement of patients' rights, in com- pliance with provision 4(a)(xiii) of the Patients' Bill of Rights. This procedure shall include, but is not limited to the following elements: A formal procedure to assist patient's with problems or complaints will be provided to the patient.

1. The complaint or grievance may be verbal or written and may be registered with the hospital designated patient representative or with the state designated patient advocate or with any external advocate the patient chooses.

2. The complaint may be registered at any time.

3. The names, addresses and telephone numbers of the hospital patient representative, the state patient advocate, and external advocacy organizations will be posted and/or otherwise made available to all patients.

4. Access to external advocacy organizations will include contact information about:

a) Protection and Advocacy, Inc.; b) Private attorneys; c) Legal services; d) Other mental health, legal and family consumer organizations; and e) The Chairman of the Wyoming State Mental Health Grievance Committee.

5. If the patient chooses to file a formal grievance with the hospital, patient representative and/or with the state patient advocate:

a) A response to the initial complaint will be made within twenty-four (24) hours, exclusive of weekends and holidays.

b) The state patient advocate, the Human Rights Committee of the Wyoming State Hospital, and the head of the Wyoming State Hospital will work to resolve the grievance with the patient.

c) If unresolved, the state patient advocate will present the patient's grievance to the Wyoming State Mental Health Grievance Committee for resolution.

History

Effective 1990-07-19

156 Information Practices

Chapter 1 Information Practices

Wyo. Code R. 048.0032.1.04032008 Information Practices

WYOMING DEPARTMENT OF HEALTH

CHAPTER 1

INFORMATION PRACTICES

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Wyoming Public Records Act (W.S. 16-4-201, et seq.), W.S. 14-3-214, 42 CFR 2.53(a)(b) and (d), 42 CFR 2.2 Sec. 290dd-3, 42 CFR 401.134 and 45 CFR Parts 160, 162, and 164, for the purpose of protecting health and personally identifiable information.

Section 2. Applicability.

(a) These rules apply to and govern the protection of privacy of personally identifiable information, to respect the rights of individuals who are the subject of this information, to develop procedures for the exercise of those authorized and required uses and disclosures of this information.

(b) The Department may issue manuals, bulletins, or both to interpret the provisions of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

(c) 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 these rules and regulations.

(a) "Access." The ability to view and/or obtain copies of personal information held by the Department, as the records custodian.

(b) "Agency." Any bureau, board, commission, committee, or sub-agency of the state, county, municipality, or other political subdivision which is created by or pursuant to the Wyoming Constitution, statute, or ordinance, other than the state legislature and the judiciary.

(c) "Confidential." The status of personal information according to federal regulations, state statutes, executive order, or agency regulations that connotes some commitment to withhold from authorized users information obtained from an individual or institution.

(d) "Department." Shall refer to the Department of Health and/or its component divisions.

(e) "Disclosure." To permit access to, or the release, transfer, or other communication of confidential information contained in Department records to any party, by oral, written, electronic or any other means.

(f) "File." Any aggregation of individual records gathered for a particular purpose and organized or indexed as a unit. Information pertaining to an individual recorded and retained by the agency.

(g) "Information." Any communication or representation of knowledge such as facts, data, or opinions in any medium or form, including textual, numerical, graphic, cartographic, narrative, or audiovisual forms.

(h) "Personal Information." All information that describes anything about an individual, such as records of financial transactions, medical treatments, or other services; any information that is or can be retrieved from a record or record-keeping system by reference to the name, number, or some other identifying feature associated with the individual to whom the information pertains.

(i) "Personnel Record" includes, but is not limited to, hiring records, basic employee information, payroll records, tax records, employment actions, general benefits information and any other relevant documents that can legally be used to make employment-related decisions.

(j) "Record." Any grouping of information about an individual that is maintained by the Department in a file that contains a name or identifying number or symbol assigned to the individual used to make a decision about the rights, character, opportunities, benefits, or liabilities of the individual to whom the record pertains.

(k) "Right to Privacy." An individual's right to decide what information about themselves may be shared with others.

(l) "Right to Request Restriction of Use and Disclosure." The right of an individual to request that their personal information not be divulged or used by others.

(m) "Routine Use." The use of a record for the purpose for which it was collected according to statutory authority or agency regulation.

(n) "Subject." An individual or legal entity about whom personal information is maintained in an information system.

Section 4. Disclosure. Records that are determined by the Department to be public records shall be available for inspection during normal business hours of the Department. Records that are determined by the Department to be confidential or not otherwise subject to disclosure pursuant to the Public Records Act or other federal or state law, shall not be disclosed without authorization from the individual or a legal representative of the individual about whom the information pertains or in accordance with state and federal regulations.

Section 5. Notice of Use and Disclosure. The Department provides individuals with notices of use and disclosure processes in accordance with State and Federal legislation. Requests may be made to the appropriate authority. Such requests will be provided in a timely manner.

Section 6. Access Requests. The individual who is the subject of a confidential record are afforded the opportunity to see or receive a copy of their record in accordance with State and Federal regulations. Requests shall be submitted in writing to the appropriate authority. Forms are available through the Department.

Section 7. Correction of Records. The individual who is the subject of the record has the right to bring to the attention of the custodian of the record any erroneous, inaccurate, or misleading information that is contained in the record, subject to access restrictions imposed by the Wyoming Public Records Act (W.S. 16-4-201, et seq.) and 45 CFR 164.526. Individuals have the right to petition to correct inaccuracies by submitting a written request to the Department's Staff Physician identifying the specific record to be corrected, the erroneous portion of the record, and the proposed correction.

Section 8. Use and Disclosure Restrictions. The Department may permit an individual to request that the Department restrict the use and/or disclosure of personally identifiable information, subject to State and Federal law and Department policy and procedure. Such a request shall be submitted in writing to the appropriate custodian of records within the Department or to the Department's Staff Physician or the State Health Officer.

Section 9. Disclosure of Personnel Records. Contents of an individual's personnel records are made available in accordance with W.S. 16-4-201, et seq.:

Section 10. Maintenance of Records. The Department in maintaining records will:

(a) Maintain any record used to make determinations about an individual with such accuracy, relevance, timeliness, and completeness as is reasonably necessary to assure fairness to the individual.

(b) Establish physical, administrative and technical safeguards and specific policies for the protection of data maintained by the Department.

(c) Maintain all systems containing personal information in a manner that is conducive to disclosure and access subject to state and federal law, including, but not limited to the Wyoming Public Records Act (W.S. 16-4-201, et seq.) and 45 CFR Parts 160, 162 and 164.

(d) Only maintain information about an individual necessary to accomplish the department's purposes as authorized by statute.

History

Effective 2008-04-03

Chapter 2 Processing and Fee Schedules for Public Record Requests

Wyo. Code R. 048.0032.2.08122026 § 1 Authority and Purpose

These rules are promulgated by the Department of Health (Department) by the authority of Wyo. Stat. Ann. § 9-2-106(a)(vii) and pursuant Wyo. Stat. Ann. §§ 16-4-201, et seq., and Wyo. Stat. Ann. §§ 16-3-101, et seq. to establish uniform procedures, fees, costs, and charges for inspecting, copying, and producing public records.

History

Effective 2026-08-12

Wyo. Code R. 048.0032.2.08122026 § 2 Incorporation by Reference

(a) The Department hereby incorporates by reference the following rules: Wyoming Department of Administration and Information (A&I), Director's Office Section, Chapter 2, Uniform Procedures, Fees, Costs, and Charges for Inspecting, Copying, and Producing Public Records, adopted by A&I and effective on September 6, 2016. The incorporated material may be found at the following: https://rules.wyo.gov/. The incorporated rules may also be requested from the Wyoming Secretary of State office (Administrative Services Division) by email at rules@wyo.gov or via the Secretary of State office rules website at https://rules.wyo.gov.

(b) For the rules incorporated by reference:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) Any code, standard, rule, or regulation incorporated by reference does not include any later amendments or editions of the incorporated mater beyond the applicable date identified in subsection (a) of this section; and

(iii) The incorporated rules are maintained at the Department office (2300 Capitol Avenue, Hathaway Building, Fourth Floor, Cheyenne, Wyoming 82002) and are available for public inspection and copying at the same location.

History

Effective 2026-08-12

Wyo. Code R. 048.0032.2.08122026 § 3 Further Provision

Section 2 of this Chapter applies to all Department functions unless otherwise specified by law.

History

Effective 2026-08-12

157 Institutional Health Services

Chapter 2 Rules and Regulations for Additional Institutional Services

Wyo. Code R. 048.0033.2.04022009 Rules and Regulations for Additional Institutional Services

CHAPTER 2

ADDITIONAL INSTITUTIONAL SERVICES

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to W.S. 9-2-106(d) and the Wyoming Administrative Procedures Act at W.S. 16-3-101.

Section 2. Purpose and Applicability.

(a) These rules have been adopted to specify the conditions under which the Director of the Department of Health may authorize the Wyoming Life Resource Center, the Wyoming State Hospital, the Wyoming Pioneer Home, the Veterans' Home of Wyoming, and the Wyoming Retirement Center to provide services to persons with conditions other than those specified in the provisions governing those State institutions in Title 25 of the Wyoming Statutes.

(c) 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 these rules and regulations.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which the words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and visa versa. Throughout these rules 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.

(a) "Alternate institution" means an institution within the Department of Health that will provide services to persons with conditions other than those specified in the provisions governing those State institutions in Title 25 of Wyoming statutes.

(b) "Director" means the Director of the Department of Health.

(d) "Institution" means the Wyoming Life Resource Center, the Wyoming State Hospital, the Wyoming Pioneer Home, the Veterans' Home of Wyoming, or the Wyoming Retirement Center.

(e) "Services" means evaluation, treatment, therapy, medical, residential, and general care and maintenance of persons residing in an institution.

(f) "Title 25" means W.S. 25-5-101 through 25-5-135; 25-8-101 through 25-8-104; 25-9-101 through 25-9-106; and 25-10-101 through 25-10-127.

Section 5. General Provisions.

(a) The Director may authorize the institutions to provide services to persons with conditions other than those specified in the provisions governing those State institutions in Title 25 of the Wyoming Statutes when the following conditions are met and documented:

(i) There is a need for such services;

(ii) The services can be provided effectively by the institution, to include:

1. Sufficient numbers of staff qualified and with appropriate training to treat the population and who represent the various disciplines required for appropriate care;

2. A range of services that is consistent with state of the art services provided to the population;

3. Available space in the institution to provide adequate living area and areas for specific or specialized services that may be required by the population; or

4. Specialized equipment necessary to serve the population.

(iii) The services can be delivered in a manner that assures the safety of all persons served by the institution;

(iv) The services provided are statutorily authorized for any of the institutions;

(v) The service needs are similar to those authorized for any of the institutions; or

(vi) The services are necessary to protect the public health and safety.

Section 6. Process.

(a) A written plan shall be developed and implemented by the Department of Health prior to the transfer of clients between institutions, to include:

(i) Screening of the client by a team of staff from the receiving institution;

(ii) Notification of the planned transfer to the client and the client's guardian, if applicable. Notification may also be provided to the client's family and to Protection and Advocacy, if applicable and if appropriate authorization is provided;

(iii) Arrangements for transfer of all relevant documentation, including medical and clinical records;

(iv) Plans for timely and safe transport to the receiving institution; and

(v) An estimated timeline for completion of the transfer.

(b) Once the above plan has been developed, it shall be submitted to the Director for final approval of the transfer. In making the final decision on the transfer, the Director shall consider the proximity of the proposed institution to the client's home community. If possible, the client should be placed in the alternate institution that best provides the needed service, that is as close to the client's home community, as possible.

(c) The Director shall provide forums for institutions to increase the coordination between institutions and provide opportunities to discuss programming, placements, and the transfer of clients between the institutions.

(d) The placement of clients in an institution for services other than those specified in the provisions governing the institution, shall be reviewed by the Director on a quarterly basis to ensure the client's needs are adequately addressed and the placement is consistent with the provisions of Section 5(a) of these rules.

History

Effective 2009-04-02

159 Mandatory Screening of Newborn Infants

Chapter 1 Mandatory Screening of Newborns for Metabolic and Genetic Conditions

Wyo. Code R. 048.0035.1.08072020 Mandatory Screening of Newborns for Metabolic and Genetic Conditions

MANDATORY SCREENING OF NEWBORN INFANTS FOR INBORN ERRORS OF METABOLISM

CHAPTER 1

MANDATORY SCREENING OF NEWBORNS FOR METABOLIC AND GENETIC CONDITIONS

Section 1. Authority. The Wyoming Department of Health ("Department") promulgates these Rules under Wyoming Statutes 35-4-801, -802.

Section 2. Purpose and Applicability.

(a) The purpose of these Rules is to implement the mandatory screening of newborns program, as provided under W.S. 35-4-801, -802.

(b) The purpose of this Chapter is to establish the requirements and procedures for the mandatory screening of newborns for metabolic and genetic conditions.

Section 3. Definitions.

(a) Except as otherwise specified, the terminology used in these rules is the standard terminology and has the standard meaning used in healthcare, including newborn screening.

(b) The following definitions shall apply in the interpretation and enforcement of these Rules.

(i) "Qualified healthcare professional" means a person licensed to provide healthcare in the state of Wyoming and operating within a scope of practice that includes collecting bloodspot specimens and performing pulse oximetry, as appropriate.

(ii) "Wyoming Newborn Screening Panel" means the mandatory screening for metabolic and genetic conditions to be administered to each child born in Wyoming as contemplated under W.S. 35-4-801(a), which is made publicly available at https://health.wyo.gov/publichealth/mch/newbornscreening/.

Section 4. Wyoming Newborn Screening Panel.

(a) As determined by the committee established under W.S. 35-4-801(b), the Wyoming Newborn Screening Panel must include the following tests for metabolic and genetic conditions:

(i) Initial bloodspot specimen collection performed according to section 5 of this Chapter, which screens for amino acid disorders, endocrine disorders, fatty acid oxidation disorders, hemoglobin disorders, organic acid disorders, and other metabolic and genetic disorders.

(ii) Second bloodspot specimen collection performed according to section 6 of this Chapter, which screens for an abbreviated panel; and

(iii) Pulse oximetry screening performed according to section 7 of this Chapter, which screens for critical congenital heart disease (CCHD).

Section 5. Initial Bloodspot Specimen Collection.

(a) If a child is born in a Wyoming hospital, the hospital shall collect and deliver the child's initial bloodspot specimen for the Wyoming Newborn Screening Panel according to subsection (c) of this section.

(b) If a child is not born in a Wyoming hospital, the person attending the delivery shall arrange to have the child's initial bloodspot specimen collected and delivered according to subsection (c) of this section.

(c) A qualified healthcare professional shall collect a child's initial bloodspot specimen for the Wyoming Newborn Screening Panel according to the following requirements and procedures.

(i) The initial bloodspot specimen must be collected according to the following timelines.

(A) If the child is full-term and healthy, the qualified healthcare professional shall collect the initial bloodspot specimen between twenty-four (24) and forty-eight (48) hours after birth.

(B) If the child is to be discharged before twenty-four (24) hours after birth, the qualified healthcare professional shall collect the initial bloodspot specimen before discharge according to best medical practices.

(C) If the child is not full-term or healthy, the qualified healthcare professional shall collect the initial bloodspot specimen according to best medical practices.

(D) If the child requires an exchange transfusion, the qualified healthcare professional shall collect the initial bloodspot specimen prior to the exchange transfusion and according to best medical practices. If the qualified healthcare professional fails to collect the initial bloodspot specimen prior to the exchange transfusion, the qualified healthcare professional shall indicate that the child was transfused in the appropriate section of the bloodspot specimen collection card.

(E) If the child needs to be transferred to another hospital, the transferring hospital shall ensure that a qualified healthcare professional collect the initial bloodspot specimen prior to transfer or make arrangements with the receiving hospital to collect the initial bloodspot specimen. The transferring hospital shall notify the Wyoming Department of Health Newborn Screening Program if a child is transferred prior to initial bloodspot specimen collection.

(ii) The initial bloodspot specimen must be collected according to the following procedure.

(A) The qualified healthcare professional shall collect the initial bloodspot specimen from capillary blood drawn by heel prick or an alternative method authorized by the Department.

(B) The qualified healthcare professional shall transfer the collected bloodspot specimen directly onto the bloodspot section of the bloodspot specimen collection form provided by the Department. All circles on the form must be saturated with blood from one side only. After saturation, the form must air-dry horizontally on a dry, clean, and non-absorbent surface for three (3) to four (4) hours.

(iii) The initial bloodspot specimen collection form provided by the Department must be completed according to the following procedure.

(A) The qualified healthcare professional shall complete the bloodspot specimen collection form accurately and legibly.

(B) A complete bloodspot specimen collection form must provide all required information including maternal and infant demographics, infant birth weight, time of birth, specimen collection time, physician information, and submitter information.

(iv) The initial bloodspot specimen must be delivered according to the following procedures.

(A) The Department shall ensure access to contracted courier services for timely transport of initial bloodspot specimens collected by qualified healthcare professionals. Timely transport is delivery to the contracted laboratory within twenty-four (24) hours of collection, or as early as possible.

(B) The qualified healthcare professional shall arrange for timely transport of the initial bloodspot specimen via contracted courier service or overnight express services to the contracted laboratory after appropriate dry time and completion of the bloodspot specimen collection form. Timely transport means as defined in subsection (c)(iv)(A) of this section.

(C) A contracted courier service shall pick up initial bloodspot specimens from birthing hospitals and deliver bloodspot specimens to the contracted laboratory.

(d) The Department shall provide program brochures, consent and waiver forms, and specimen collection forms to hospitals, physicians, and other qualified healthcare professionals twice yearly and upon request.

(e) The Department shall ensure access to contracted laboratory services for analysis of initial bloodspot specimens.

Section 6. Second Bloodspot Specimen Collection.

(a) A qualified healthcare professional shall collect a child's second bloodspot specimen for the Wyoming Newborn Screening Panel according to the following requirements and procedures.

(i) The second bloodspot specimen must be collected by a qualified healthcare professional between seven (7) and fourteen (14) days after birth.

(ii) The second bloodspot specimen must be collected according to the following procedure.

(A) The qualified healthcare professional shall collect the second bloodspot specimen from capillary blood drawn by heel prick or an alternative method authorized by the Department.

(iii) The bloodspot specimen collection form provided by the Department must be completed according to the following procedure.

(A) The qualified healthcare professional shall complete the bloodspot specimen collection form accurately and legibly.

(B) A complete bloodspot specimen collection form must provide all required information including maternal and infant demographics, specimen collection time, physician information, and submitter information.

(iv) The qualified healthcare professional shall arrange for transport of the second bloodspot specimen to the contracted laboratory after appropriate dry time and completion of the bloodspot specimen collection form.

(b) The Department shall provide program brochures and specimen collection forms to hospitals, physicians, and other qualified healthcare professionals twice yearly and upon request.

Section 7. Pulse Oximetry Screening.

(a) If a child is born in a Wyoming hospital, the hospital shall perform pulse oximetry screening for Critical Congenital Heart Disease (CCHD).

(b) If a child is not born in a Wyoming hospital, the person attending the delivery shall arrange for a qualified healthcare professional to perform pulse oximetry screening for CCHD.

(d) The hospital or qualified healthcare professional shall collect CCHD screening data using a method prescribed by the Department.

(e) The Department shall offer hospitals, physicians, and other qualified healthcare professionals training and resources on national recommendations for CCHD screening.

(f) The Department shall provide brochures to hospitals, physicians, and other qualified healthcare professionals for the purpose of informing families about CCHD screening.

Section 8. Informed Consent.

(a) Before performing the initial and second bloodspot specimen collection or pulse oximetry screening, the qualified healthcare professional shall obtain the informed consent of the child's parent or guardian, according to W.S. 35-4-801(c). The qualified healthcare professional performing the initial bloodspot specimen collection shall inform the child's parent or guardian about the importance of a second bloodspot specimen collection between approximately seven (7) and fourteen (14) days of age.

(b) If a parent or guardian objects to the initial bloodspot specimen collection or pulse oximetry screening:

(i) The child is exempt from the objected screening;

(ii) The parent or guardian shall complete a written waiver form; and

(iii) The qualified healthcare professional shall assure completion of the written waiver form documenting the objection and submit the waiver form to the Department within ten (10) days of birth.

(i) The child is exempt from the objected screening; and

(ii) The parent or guardian shall complete a written waiver form.

Section 9. Fees.

(a) If a child's initial bloodspot specimen is collected by a qualified healthcare professional at a hospital, the hospital shall pay the Department a fee of $97.32 per initial bloodspot specimen collection performed.

(b) If a child's initial bloodspot specimen is collected by a qualified healthcare professional in a non-hospital setting, the qualified healthcare professional shall pay the Department a fee of $97.32 per initial bloodspot specimen collection performed.

(c) The fees assessed under this section cover the reasonable costs of the initial and second bloodspot specimen collection for the same child, initial confirmatory testing, courier services, laboratory services, specialty follow-up services, program education, and other services necessary to maintain functionality and sustainability of this self-funded program.

(d) The Department, in consultation with the designated committee pursuant to W.S. 35-4-801(d), may increase the fees assessed under this section, if it is determined that the cost of the program necessitates such increase, but in no instance may this fee be increased more than twenty-five percent (25%) without revising these rules.

History

Effective 2020-08-07

Chapter 2 Mandatory Screening of Newborns for Hearing Loss

Wyo. Code R. 048.0035.2.06162021 § 1 Authority

The Wyoming Department of Health ("Department") promulgates these Rules under Wyoming Statutes 35-4-801, -802.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 2 Purpose and Applicability

(a) The purpose of these Rules is to implement the mandatory newborn hearing screening, as provided under W.S. 35-4-801, -802.

(b) The purpose of this Chapter is to establish the requirements and procedures for mandatory newborn hearing screening.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 3 Definitions

(a) Except as otherwise specified, the terminology used in these Rules is the standard terminology and has the standard meaning used in healthcare.

(b) The following definitions apply in the interpretation and enforcement of these Rules:

(i) "Hearing screening" means an objective, physiological measurement used to identify individuals at risk for hearing loss.

(ii) "Trained individual" means a person who has received instruction on hearing screening protocols and the operation of hearing screening equipment.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 4 Wyoming Newborn Hearing Screening

(a) The Wyoming Newborn Hearing Screening includes:

(i) An initial hearing screening according to Section 5 of this Chapter; and

(ii) A rescreening, as necessary, according to Section 6 of this Chapter.

(b) The Wyoming Newborn Hearing Screening must be performed according to one of the following methods:

(i) Auditory Brainstem Response (ABR);

(ii) Automated Auditory Brainstem Response (AABR); or

(iii) Otoacoustic Emissions (OAE), either Transient Evoked OAE (TEOAE) or Distortion Product OAE (DPOAE).

(i) If ABR is performed, the normal ABR must be to click stimulus at 35 dBnHL (decibels above normal hearing levels) or less in each ear;

(ii) If AABR is performed, the normal AABR must be to click stimulus at 35 dBnHL or less in each ear;

(iii) If TEOAE is performed, the normal TEOAE response must be for click stimulus at 84 dBSPL (decibels of sound pressure levels) presentation level or less in each ear; or

(iv) If DPOAE is performed, the normal DPOAE response must be 1500-6000 Hz (Hertz) stimuli at 65-55 dBSPL or less in each ear.

(d) The Wyoming Newborn Hearing Screening must be completed in each ear.

(e) Stimulus presentation level and the arrangement of electrodes and transducers of the hearing screening equipment must be in accordance with manufacturer specifications.

(f) Regardless of the timing requirements under Sections 5 and 6 of this Chapter, the Wyoming Newborn Hearing Screening and rescreening may be delayed due to transfers and medical contraindications. The birthing hospital, trained midwives, and attending physicians outside of hospitals shall document the delays, and ensure hearing screening has taken place prior to ultimate discharge.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 5 Initial Hearing Screening

(a) If a child is born in a Wyoming hospital, the child shall receive a hearing screening by a trained individual before discharge.

(b) If a child is born outside of a Wyoming hospital, the attending physician, midwife, or person attending the delivery shall offer to provide or arrange a hearing screening for the child.

(c) If a child is transferred to another Wyoming birthing hospital, the hospital that transfers the child shall be responsible for ensuring that the hearing screening takes place. If a Wyoming resident child is transferred to a hospital outside of Wyoming, the transferring Wyoming hospital shall ensure that hearing screening takes place either prior to transfer, at the receiving hospital, or upon the child's return to Wyoming.

(d) The trained individual performing the newborn hearing screening shall identify risk factors for hearing loss at the time of the screening.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 6 Rescreening

(a) If a child fails the initial screening:

(i) The trained individual who performed the initial screening shall advise the parent or legal guardian of the importance that rescreening occur within seven (7) to ten (10) days of initial screening; and

(ii) A trained individual shall rescreen the newborn within seven (7) to ten (10) days of the initial screening.

(b) If a child fails the rescreening, the trained individual shall facilitate the referral for diagnostic audiologic evaluation including providing the following notifications within twenty-four (24) hours of the failed rescreening:

(i) Written notification to the primary care physician that the child has failed the Wyoming Newborn Hearing Screening and that diagnostic audiologic evaluation is recommended;

(ii) Written notification to the parent or legal guardian that the child has failed the Wyoming Newborn Hearing Screening, that diagnostic audiologic evaluation is recommended, and that the primary care physician has been notified; and

(iii) Written notification to the Department that the child has failed the Wyoming Newborn Hearing Screening.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 7 Reporting

(a) All hearing screening results, identified risk factors, and status of newborns not screened shall be reported at least monthly to the Department in the form and manner prescribed by the Department.

(b) An audiologist who completes a diagnostic audiologic evaluation from a Wyoming Newborn Screening referral shall provide written notification of all screening and evaluation results to the Department in the form and manner prescribed by the Department within fifteen (15) calendar days of completed evaluations. Reporting of diagnostic audiologic evaluation results may include, but not limited to:

(i) Diagnostic audiologic evaluation reports for a diagnosis of normal hearing bilaterally; and

(ii) Diagnostic audiologic evaluation reports for any diagnosis of hearing loss regardless of type, degree, or laterality, including undetermined.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 8 Informed Consent

(a) Before performing the initial hearing screening, rescreening, or diagnostic audiologic evaluation, a trained individual shall obtain the informed consent of the child's parent or guardian, according to W.S. 35-4-801(c).

(b) If the parent or guardian objects to the initial hearing screening, rescreening or diagnostic audiologic evaluation:

(i) The child is exempt from the objected hearing screening;

(ii) The parent or guardian must complete a written waiver form; and

(iii) The trained individual shall assure completion of the written waiver form documenting the objection and submit the waiver form to the Department within thirty (30) calendar days of birth.

History

Effective 2021-06-16

Wyo. Code R. 048.0035.2.06162021 § 9 Fees

(a) If a child's initial hearing screening is collected by a trained individual at a hospital, the hospital shall pay the Department a fee of sixty-five dollars ($65.00) per initial hearing screening performed.

(b) The fees assessed under this section cover the reasonable costs of the initial hearing screening and rescreening for the same newborn, referrals, equipment, education and training, and other services necessary to maintain functionality and sustainability of this self-funded program.

(c) The Department, in consultation with the designated committee pursuant to W.S. 35-4-801(d), may increase the fees assessed under this section, if it is determined that the cost of the program necessitates such increase, but in no instance may this fee by increased more than twenty-five percent (25%) without revising these rules.

History

Effective 2021-06-16

161 Medicaid

Chapter 1 Definitions

Wyo. Code R. 048.0037.1.11072011 Definitions

CHAPTER 1

Rules and Regulations for Medicaid Definitions

Section 1. Authority. This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. § 42-4-101, et seq. and the Wyoming Administrative Procedure Act at W.S. § 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) This Chapter has been adopted to govern the definitions for all other chapters of the Wyoming Department of Health Medicaid Rules which come into effect on or after the effective date of this Chapter.

(b) 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.

Section 3. Definitions.

(a) Except as otherwise specified, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

(b) For the purpose of these rules and regulations, the following definitions shall apply:

(i) "Abuse." A pattern of practice by a provider or a client that results in healthcare utilization which is inconsistent with sound fiscal, business, or medical practices, and results in unnecessary costs to Medicaid, or in payment for services that are not medically necessary or that fail to meet professionally recognized standards for healthcare. Abuse is characterized by, but not limited to, any one of the following:

(A) The repeated submission of claims by a provider from which documentation of required material information is missing, incorrect or not provided for review when requested. Examples include, but are not limited to: incorrect or missing procedure or diagnosis codes, missing or invalid signatures, invalid prescription documentation, incorrect mathematical entries, incorrect third party liability information, or the incorrect use of procedure code modifiers;

(B) The repeated submission of claims by a provider presenting procedure codes which overstate the level or amount of services provided (i.e., upcoding);

(C) The repeated submission of claims by a provider for services which are not reimbursable under Medicaid, or the repeated submission of duplicate claims;

(D) Failure by a provider to develop and maintain legible medical records which document the nature, extent and evidence of the medical necessity of services provided;

(E) Failure of a provider to use generally accepted accounting principles or other accounting methods which relate entries on the medical record to entries on the claim;

(F) Excessive or inappropriate patterns of referral;

(G) The repeated submission of claims by a provider for services which were not medically necessary;

(H) The repeated submission of claims by a provider for services which exceed that requested or agreed to by the client or the client's responsible relative or guardian;

(I) The submission of claims for services not medically necessary under the generally accepted practice of providers of such services;

(J) Overprescribing or misprescribing products or services;

(K) The repeated submission of claims by a provider without complying with the provisions of these rules;

(L) A client permitting the use of the client's Medicaid identification by any unauthorized individual for the purpose of obtaining services;

(M) A client obtaining services which are not medically necessary for the purpose of resale or for the use of a non-client;

(N) A client obtaining duplicate services from more than one

(1) provider for the same medical condition, other than confirmation of a diagnosis, evaluation or assessment; or

(O) Misuse, which with respect to a client means the request for or utilization of services that are inappropriate and with respect to a provider means the furnishing of services that are inappropriate, or the submission of claims that do not accurately reflect the services provided.

(ii) "Acquired Brain Injury (ABI)." Any of the following:

(A) Any combination of focal and diffuse central nervous system dysfunction, both immediate and/or delayed, at the brain stem level and above;

(B) Acquired through the interaction of any external forces and the body, oxygen deprivation, infection, toxicity, surgery, and vascular disorders not associated with aging;

(D) Caused by an external physical force or by a metabolic disorder(s);

(E) Includes traumatic brain injuries, such as open or closed head injuries, and non-traumatic brain injuries, such as those caused by strokes, tumors, infectious disease, hypoxic injuries, metabolic disorders, and toxic products taken into the body through inhalation or ingestion;

(F) Does not include brain injuries that are congenital or brain injuries induced by birth trauma; and

(G) Are not developmental or degenerative.

(iii) "Acquired Brain Injury Home and Community Based Waiver." The "Acquired Brain Injury Home and Community Based Waiver" submitted to and approved by the Centers for Medicare and Medicaid Services pursuant to Section 1915(c) of the Social Security Act.

(iv) "Active treatment." Active treatment as set forth in 42 C.F.R. § 441.154.

(v) "Acute." Having a short and relatively severe course.

(vi) "Acute stabilization." The process of bringing to stability an acute medical, psychiatric or psychological condition.

(vii) "Administrative transportation." Transportation by means other than an ambulance to obtain covered services.

(viii) "Admission." The act that allows an individual to officially enter into a facility or program to receive covered services, which does not include an individual that is transferred from one unit of a hospital to another unit in the hospital or to a separate part of a hospital unit.

(ix) "Admission certification." The determination by the Department that all or part of a client's inpatient hospitalization meets or met the medical necessity criteria and that Medicaid funds may be used to pay the attending physician, hospital, and other providers of inpatient hospital services for providing medically necessary services, subject to the Department's normal procedures and standards and subject to withdrawal of admission certification pursuant to Chapter 8. An admission certification may specify the number of days for which Medicaid payment for inpatient hospital services is approved.

(x) "Admitting diagnosis." The admitting practitioner's tentative or provisional diagnosis of the client's condition which provides the basis for examination and treatment when the practitioner requests admission certification.

(xi) "Adult." An individual who has reached the age of majority as provided by W.S. § 14-1-101. Emancipated minors may consent to services to the same extent as an adult as provided by W.S. § 14-1-101.

(xii) "Adult Developmental Disabilities Home and Community Based Waiver." The "Adult Developmental Disabilities Home and Community Based Waiver" submitted to and approved by the Centers for Medicare and Medicaid Services pursuant to Section 1915(c) of the Social Security Act.

(xiii) "Advanced Practitioner of Nursing (APN)." A professional registered nurse who is licensed in a specialty area of advanced nursing practice by the Wyoming Board of Nursing or a similar agency in another state.

(xiv) "Adverse action." For an applicant, client, participant, or other person receiving covered services, an adverse action is a termination, reduction, or denial of services or eligibility, including a reduction in the level of care of a nursing facility resident. For a provider, an adverse action is the termination, suspension or other sanction of a provider (other than in those situations set forth below), the denial or withdrawal of admission certification, the determination of a per diem rate pursuant to Chapter 7, or the denial or reduction of a Medicaid payment to a provider (other than those set forth below).

(A) The following terminations, suspensions or other sanctions of a provider are not adverse actions:

(I) A termination, suspension, or other sanction based on the provider's loss of or failure to provide to Medicaid documentation of required licensure or certifications.

(II) A termination, suspension, or other sanction based on a provider's exclusion by OIG or termination by Medicare;

(III) A termination, suspension, or other sanction based on a finding of fraud, abuse, or other prohibited activities by a judicial or administrative process where the provider was afforded notice and the right to a hearing.

(B) The following reductions, denials, or recoveries of overpayments are not adverse actions:

(I) A reduction, denial, or recovery described in Section 12(c)(d) and (e) of Chapter 16 of these Rules;

(II) A reduction, denial, or recovery due solely by a change in Federal or State law; or

(III) An appeal of a rate setting methodology.

(xv) "Advocate." A person, chosen by the client or legal guardian, who supports and represents the rights and interests of the client in order to ensure the client's full legal rights and access to services. The advocate can be a friend, a relative, or any other interested person. An advocate has no legal authority to make decisions on behalf of a client.

(xvi) "Aged." A person sixty-five (65) years of age or older.

(xvii) "Alien." A person residing in, and who is not a citizen of, the United States of America.

(xviii) "Allowable cost." Medicare allowable costs as determined by 42 U.S.C. § 1395f, except as otherwise specified by the Medicaid Rules.

(xix) "Ancillary services." Those services listed as ancillary services on a hospital's most recently available cost report.

(xx) "Ancillary services charges." Charges for furnishing ancillary services to a client reported on a claim.

(xxi) "Annuity." A contract or agreement by which a beneficiary receives fixed, non-variable payments on an investment for a lifetime or a specified number of years. A commercial (non-employment related) annuity set up on or after February 8, 2006, is considered an available asset unless it meets the following criteria:

(A) The annuity is irrevocable and nonassignable;

(B) The annuity is actuarially sound, and pays out principal and interest in equal monthly installments (no balloon payments) to the individual in sufficient amounts that the principal is paid out within the actuarial life expectancy of the individual as published by the Office of the Chief Actuary of the United States Social Security Administration;

(C) The average number of years of expected life remaining for the individual must equal or exceed the stated life of the annuity.

(D) The Department is named as the residual beneficiary of the funds remaining in the annuity, not to exceed any Medicaid funds expended on the individual during his/her lifetime, unless there is a community spouse and/or a minor or disabled child, in which case the Department must be named as the secondary beneficiary; and

(E) The annuity is issued by an insurance company licensed and approved to do business in the state of Wyoming.

(xxii) "Applicant." Any person applying for benefits under programs provided pursuant to W.S. § 42-1-101.

(xxiii) "Application." An applicant's request for a Medicaid funded program in a form specified by the Department.

(xxiv) "Application date." The date the signed application is received and date stamped by Wyoming Department of Health, Department of Family Services or an outstation facility.

(xxv) "Appropriate." Medical treatment or service that is medically necessary, suitable to a client's well-being based on current practices, and documented in the client's medical record.

(xxvi) "Appropriate bed." A certified bed in a nursing facility that is:

(A) Available; and

(B) In a room where the other bed, if any, is occupied by a member of the same sex or the spouse of the client.

(xxvii) "Appropriate placement." The placement of an individual in a treatment setting when the individual's needs meet the minimum standards for admission to that treatment setting and the individual's needs for treatment do not exceed the level of services which the treatment setting is capable of providing.

(xxviii) "Assets" as defined by W.S. § 42-2-401(a)(1), et seq.

(xxix) "Assignment of rights to benefits." As defined by 42 C.F.R. §§ 433.145 to 433.148. The transfer from an applicant or client to the Department of the applicant's or client's rights, or the rights of another, to medical support or payments for services from any third party payer.

(xxx) "Attending physician." The physician primarily responsible for a client's treatment in a hospital.

(xxxi) "Attorney General." The Attorney General of the State of Wyoming, its agent, designee or successor.

(xxxii) "Base rate." A rate in effect on a date chosen by the Department.

(xxxiii) "Billed charges." The charges billed by a provider to the Department for furnishing covered services to clients.

(xxxiv) "Capital costs." Capital related costs as defined in 42 C.F.R. § 413.130, including, but not limited to, costs incurred by a facility for construction, depreciation, interest, rent and leases.

(xxxv) "Case management." Services that assist clients in gaining access to needed medical, waiver, or Wyoming Medicaid state plan services, as well as social, educational, and other services, regardless of the funding source.

(xxxvi) "Case manager." A registered nurse, healthcare professional or individual designated by the Department to provide case management.

(xxxvii) "Centers for Medicare and Medicaid Services (CMS)." The Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, its agent, designee, or successor.

(xxxviii) "Certified." Certified by the Department or survey agency as in compliance with applicable statutes and rules.

(xxxix) "Certified mail, return receipt requested." Certified mail, return receipt requested as provided by the United States Postal Service, or delivery via a commercial delivery service which provides tracking of the communication and written documentation of its delivery. "Certified mail, return receipt requested" does not include communication by facsimile transmission, telephone, or e-mail.

(xl) "Certified Registered Nurse Anesthetist (CRNA)." A professional registered nurse who is licensed in a specialty area of advanced nursing practice by the Wyoming Board of Nursing or a similar agency in another state.

(xli) "Change of ownership." A change in a provider's or facility's ownership, control, operation, management contract, or leasehold interest.

(xlii) "Child." Any person who does not meet the definition of adult.

(xliii) "Children's Developmental Disabilities Home and Community Based Waiver." The waiver submitted to and approved by the Centers for Medicare and Medicaid Services pursuant to Section 1915(c) of the Social Security Act.

(xliv) "Children's hospital." An inpatient hospital which is:

(A) Designated by the Secretary of Health and Human Services as a children's specialty hospital;

(B) Exempt from the Medicare prospective payment system (PPS); and

(xlv) "Claim." A request by a provider for Medicaid payment for covered services provided to a client.

(xlvi) "Classification in Mental Retardation." The most recent Classification in Mental Retardation of the American Association on Mental Deficiency.

(xlvii) "Client." A person who has been determined eligible for Medicaid.

(xlviii) "Client or applicant information." Any medical records, financial records, or other records, in whatever form, which contain any of the following information about an applicant or client:

(A) Names and addresses;

(B) Services provided;

(D) Evaluations by DFS of personal information;

(E) Medical data, including, but not limited to, diagnoses and history of disease or disability;

(F) Information received for the purpose of verifying income eligibility and the amount of Medicaid payments;

(G) Information received in connection with the identification of third party payers, including information contained in the Medicaid Management Information System (MMIS);

(H) Claims, claims histories, and Medicaid payments made to providers, including any information regarding the amount of payments made on behalf of a client;

(I) Any other information generated or maintained by the Department or in the possession of or subject to the control of any agent or contractor of the Department.

(xlix) "Commission for the Accreditation of Rehabilitation Facilities (CARF)." The Commission for the Accreditation of Rehabilitation Facilities, its agent, designee, or successor.

(l) "Comprehensive Outpatient Rehabilitation Facility (CORF)."CORF as described in 42 C.F.R. § 400.200.

(li) "Consultation." An opinion or advice rendered by one physician to another physician as part of the evaluation or treatment of a client.

(lii) "Consumer Price Index (CPI)." The consumer price index for all Urban Consumers (CPI-U) (United States city average), as determined by the United States Department of Labor and Statistics.

(liii) "Contestant." The person who requests a hearing.

(liv) "Contested case." A proceeding under these rules involving an adverse action.

(lv) "Continued stay review." A report that contains information about a client performed at specified intervals during a client's stay at a facility. A continued stay review shall contain the information and be in the form specified by the Department.

(lvi) "Copayment." A Department-established fee charged to a client by a provider.

(lvii) "Cost report." A cost report prepared and submitted in conformance with Medicaid requirements. "Cost report" includes any supplemental request by the Department for additional information relating to the facility's costs.

(lviii) "Cost reporting period." The fiscal period used by a facility to report its costs to Medicare.

(lix) "Cost that must be incurred." A cost that must be incurred by an efficiently and economically operated facility.

(lx) "Covered services." Services which are Medicaid reimbursable pursuant to the rules of the Department.

(lxi) "Credit balance." Medicaid funds received by a provider that are owed to the Department for any reason.

(lxii) "Current market value." The amount for which property can be expected to sell on the open market in the community at the time of the estimate or at the time of transfer or sale, also known as fair market value (FMV).

(lxiii) "Current Procedural Terminology (CPT®)." The most recent edition of the Current Procedural Terminology published by the American Medical Association.

(lxiv) "Dementia." An individual has dementia if the individual:

(A) Has a primary diagnosis of dementia, as defined in the DSM, including Alzheimer's disease; or

(B) Has a non-primary diagnosis of dementia, unless the individual's primary diagnosis is a major mental illness.

(lxv) "Denial of payment for new admissions." The denial of Medicaid payments for all clients admitted to a facility after a specified date. Payments that are denied shall not be retroactively paid to a facility.

(lxvi) "Dentist." A person licensed to practice dentistry by the Wyoming Board of Dental Examiners or a similar agency in another state.

(lxvii) "Department." See Wyoming Department of Health.

(lxviii) "Department of Family Services (DFS)." The Wyoming Department of Family Services (DFS), its agent, designee or successor.

(lxix) "Department of Family Services Registry." Pursuant to W.S. § 35- 20-115 et seq., the Central Registry of the Department of Family Services that includes substantiated reports of abuse, neglect, exploitation, or abandonment of vulnerable adults and children.

(lxx) "Desk review." A review by the Department or a vendor contracted by the Department of a provider's financial records, cost reports, and/or other supporting documentation to determine if documentation and/or cost reports are in compliance with Medicaid program requirements.

(lxxi) "Developmental Disabilities Division (DDD)." The Developmental Disabilities Division of the Department, its agent, designee, or successor.

(lxxii) "Developmental disability." As defined in federal law (42 U.S.C.§ 15002(8)), a severe, chronic disability of an individual that:

(A) Is attributable to a mental or physical impairment or combination of mental and physical impairments;

(B) Is manifested before the individual attains age twenty-two (22);

(D) Results in substantial functional limitations in three (3) or more of the following areas of major life activity:

(I) Self-care;

(II) Receptive and expressive language;

(III) Learning;

(IV) Mobility;

(V) Self-direction;

(VI) Capacity for independent living;

(VII) Economic self-sufficiency; and

(E) Reflects the individual's need for a combination and sequence of special, interdisciplinary, or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated.

(lxxiii) "Diagnosis codes." Codes contained in the latest version of the International Classification of Diseases, Clinical Modification (ICD-CM).

(lxxiv) "Diagnostic and Statistical Manual of the American Psychiatric Association (DSM)." The most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association.

(lxxv) "Dietician." A person who is registered as a dietician by the Commission on Dietetic Registration.

(lxxvi) "Dietician services." Services furnished by a registered dietician, including:

(A) Menu planning;

(B) Consultation with and training of caregivers; and

(lxxvii) "Direct supervision." Supervision in which the responsible practitioner is physically present in the building where the services are being provided.

(lxxviii) "Director." The Director of the Department of Health, the Director's agent, designee, or successor.

(lxxix) "Discharge." The act by which an individual who has been a patient in a facility or a client in a program ceases to be a patient and the facility or program ceases to be legally responsible for providing care for such individuals."Discharge" does not include:

(A) A nursing home resident's temporary absence from the facility for treatment in a hospital, home visits or a trial community stay, provided such temporary absence is no longer than thirty (30) consecutive days;

(B) An LTC-HCBS client's temporary absence from the client's home for periods that do not exceed thirty (30) consecutive days;

(C) An individual that is transferred from one unit of a hospital to another unit in the hospital, an individual that is transferred to a distinct part of a hospital unit, or an individual that is transferred to another hospital; or

(D) An individual's temporary absence.

(lxxx) "Discharge planning." To make arrangements during a client's inpatient stay for the client to receive appropriate services upon discharge.

(lxxxi) "Dispensing fee." The amount of Medicaid reimbursement allowed by the Department as payment for the service of dispensing any prescribed drug or product.

(lxxxii) "Disposable medical supplies." Supplies prescribed by a practitioner which have a medical purpose, are specifically related to the active treatment or therapy of the client for a medical illness or physical condition, and which are consumable and/or expendable and non-durable. Supplies must meet the definition of medically necessary and shall be prescribed by an appropriate licensed practitioner.

(lxxxiii) "Disproportionate Share Hospital (DSH)." A hospital located in Wyoming that is entitled to a DSH disproportionate share payment pursuant to Chapter 32 of the Wyoming Medicaid Rules.

(lxxxiv) "Disproportionate share payments." Medicaid payments made by the Wyoming Department of Health to a disproportionate share hospital, including payments for inpatient and outpatient hospital services and Qualified Rate Adjustment payments.

(lxxxv) "Division of Criminal Investigation (DCI)." The Wyoming Division of Criminal Investigation within the Office of the Attorney General created at W.S. § 9-1-611, its agent, designee or successor.

(lxxxvi) "Division of Preventive Health and Safety." The Division of Preventive Health and Safety of the Department, its agent, designee or successor.

(lxxxvii) "Drug."

(A) Substances recognized as drugs in official United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States, or official National Formulary, or any supplement to any of them;

(B) Substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in a person;

(D) Substances intended for use as a component of any article specified in (A) through (C) Substances (other than food) intended to affect the structure or any function of a person's body; or

(E) "Drug" includes over-the-counter (OTC) drugs.

(lxxxviii) "Drug used as a restraint." Any drug that:

(A) Is administered to manage a participant's behavior in a way that reduces the safety risk to the participant or others;

(B) Has the temporary effect of restricting the participant's freedom of movement; and

(lxxxix) "Durable Medical Equipment (DME)." Equipment prescribed by a practitioner that has a medical purpose, is not considered to be experimental or investigational, is designed to withstand repeated use in the home, and primary purpose is not to enhance the personal comfort of the client or provide convenience for the client or caregiver. Equipment must be medically necessary and shall be prescribed by an appropriate licensed practitioner.

(xc) "Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services." Services for clients under the age of twenty-one (21) through the HEALTH CHECK program pursuant to Chapter 6 of the Wyoming Medicaid Rules.

(xci) "Eligible." Entitled to receive Medicaid.

(xcii) "Emergency." The sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in:

(A) Placing the patient's health in serious jeopardy;

(B) Serious impairment to bodily functions; or

(xciii) "Emergency detention." A person detained or involuntarily hospitalized pursuant to W.S. § 25-10-109, et seq.

(xciv) "Enrolled." A provider that has signed a provider agreement and has been certified as a provider with the Department.

(xcv) "Expanded services." Medically necessary healthcare, including diagnostic services and treatment, which are reimbursable pursuant to 42 U.S.C. § 1396d, and which are not otherwise reimbursable under the Wyoming Medicaid State Plan.

(xcvi) "Extended Wyoming Medicaid state plan services." Services made available to a participant whose needs for that service exceed the Wyoming Medicaid state plan service limitations established for the general Medicaid population. Extended services include:

(A) Occupational therapy services;

(B) Physical therapy services;

(D) Any other services covered by Medicaid.

(xcvii) "Extraordinary care clients." Clients who require skilled nursing facility and swing bed extraordinary care for those conditions which have received prior authorization from the Department because they have a Minimum Data Set (MDS) Activities of Daily Living Sum score of ten (10) or more, and require special care or clinically complex care as recognized under the Medicare RUG-III classification system.

(xcviii) "Facility rate." A facility's Medicaid allowable payment.

(xcix) "Federal fiscal year." The period beginning October 1st of each year and ending the following September 30th.

(c) "Federal Medicaid funds." Federal funds paid by HHS to the State pursuant to 42 U.S.C. § 1396b and subsequently paid to a provider.

(ci) "Federal Medicaid Assistance Percentage (FMAP)." Federal medical assistance percentage as defined in 42 U.S.C. § 1396d(b).

(cii) "Federally Qualified Health Center (FQHC)." Federally qualified health center (FQHC) as defined in 42 U.S.C. § 1396d(l)(2)(B).

(ciii) "Field audit." An onsite examination, verification and review conducted by employees, agents, or representatives of the Department or HHS of a provider's records and any supporting or related documentation.

(civ) "Financial records." All records, in whatever form, used or maintained by a provider in the conduct of its business affairs and which are necessary to substantiate or understand claims or a provider's cost reports submitted to the Department.

(cv) "Fiscal agent." The Department's agent responsible for processing claims and supporting operational functions.

(cvi) "Foster care." The term used by DFS when a child is in the State's custody as a foster child.

(cvii) "Fraud." An intentional deception or misrepresentation made by an individual with the knowledge that the deception or misrepresentation may result in overpayments. "Fraud" includes any actions or inactions that constitute fraud under federal or state law.

(cviii) "Functionally necessary." A waiver service that is:

(A) Required due to the diagnosis or condition of the participant;

(B) One or both of the following:

(I) Recognized as a prevailing standard or current practice among the provider's peer group, or

(II) Intended to make a reasonable accommodation for functional limitations of a participant, to increase a participant's independence;

(C) Provided in the most efficient manner and/or setting consistent with appropriate care required by the participant's condition; and

(D) Not utilized experimentally or investigationally and is generally accepted by the medical community.

(cix) "Funding." The combination of federal and state funds available to pay for covered services. Funding does not include any other funds available to the Department that are not designated for covered services.

(cx) "Generally Accepted Accounting Principles (GAAP)." Accounting concepts, standards and procedures established by the American Institute of Certified Public Accountants.

(cxi) "Generally Accepted Auditing Standards (GAAS)." Auditing standards, practices, and procedures established by the American Institute of Certified Public Accountants.

(cxii) "Good cause." A specified reason based on accepted standards that supports an individual's action and thereby eliminates the penalty, which normally is imposed for failure to cooperate with child support or third party liability requirements as defined by 42 C.F.R. § 433.147(c)(1).

(cxiii) "Guardian." A person lawfully appointed as a guardian to act on the behalf of the client, participant, or applicant.

(cxiv) "Health and Human Services (HHS)." The United States Department of Health and Human Services, its agent, designee, or successor.

(cxv) "Healthcare Common Procedure Coding System (HCPCS)." Codes as contained in the latest version of the HCPCS Book.

(cxvi) "Home and Community Based Waiver Services (HCBS)."Services provided under a waiver from CMS that are not otherwise available under the Wyoming Medicaid state plan. Such services enable the elderly, disabled, and chronically mentally ill persons, who would otherwise be placed in an institution, to live in the community. Section 1915(c) of the Social Security Act specifies the services that may be included as HCBS waiver services.

(cxvii) "Home." A home is any property in which an individual (and spouse, if any) has an ownership interest and serves as the individual's principal place of residence. This property includes the shelter in which an individual resides, the land on which the shelter is located and related outbuildings as defined by 20 C.F.R. § 416.1212.

(cxviii) "Hospice." An optional benefit under the Medicaid program for individuals who are terminally ill and elect to receive hospice care.

(cxix) "Hospital." An institution that:

(A) Is approved to participate as a "hospital" under Medicare;

(B) Is maintained primarily for the treatment and care of patients with disorders other than mental diseases or tuberculosis;

(D) Meets the requirements of 42 C.F.R. § 482.66; and

(E) Is licensed to operate as a "hospital" by the State of Wyoming or, if the institution is out-of-state, licensed by the state in which the institution is located.

(cxx) "Immediate jeopardy."

(A) A situation in which the provider's noncompliance with one (1) or more requirements of participation in Medicaid has caused or is likely to cause serious injury, harm, impairment, or death to a client or a substantial and immediate threat to the health or safety of clients; or

(B) As defined in 42 C.F.R. § 488.301.

(cxxi) "Inpatient." An inpatient as defined by 42 C.F.R. § 440.2(a).

(cxxii) "Inpatient hospital service." Inpatient hospital service as defined in 42 C.F.R. § 440.10.

(cxxiii) "Inpatient psychiatric services for individuals under age twenty- one (21)." Inpatient psychiatric services for individuals under age twenty-one (21) as defined in 42 C.F.R. § 441.

(cxxiv) "Institution for Mental Diseases (IMD)." An institution for mental diseases as defined by 42 C.F.R. § 435.1010.

(cxxv) "Institution for Mental Diseases (IMD) services." Services that meet the standards of 42 C.F.R., Ch. IV, Subch. C, Part 441.

(cxxvi) "Intellectual disability." Significantly sub-average general intellectual functioning with concurrent deficits in adaptive behavior manifested during the developmental period.

(cxxvii) "Intellectually disabled." A person with an intellectual disability.

(cxxviii) "Interdisciplinary team."

(A) A team that meets the requirements of 42 C.F.R. § 441.156; or

(B) A group consisting of representatives of the person, the person's family or legally authorized representative, or the professions, disciplines or service areas that are relevant to identifying the client's needs, as described in the comprehensive functional assessments and program design.

(cxxix) "Interim payments." Payments to a new facility during the time between the effective date of the new facility's or newly certified facility's provider agreement and the determination of a per diem rate.

(cxxx) "Intermediate Care Facility for People with Intellectual Disability (ICF/ID)." Intermediate Care Facility for People with Intellectual Disability (ICF/ID) means an intermediate care facility for the mentally retarded or intermediate care facility for people with mental retardation (ICFMR or ICF/MR) as those phrases are used in 42 U.S.C. 1396d(d) or other applicable federal statutes, rules and regulations.

(cxxxi) "International Classification of Disease-Clinical Modification(ICD-CM) ." The most recent version of the International Classification of Diseases.

(cxxxii) "Irrevocable trust." A trust which may not be revoked after its creation.

(cxxxiii) "Inventory for Client and Agency Planning (ICAP)." An instrument used by the Developmental Disabilities Division to help determine eligibility and to determine the needs of the participant, available from Riverside Publishing, its successor, or designee.

(cxxxiv) "JCAHO." The Joint Commission on Accreditation of Healthcare Organizations.

(cxxxv) "Laboratory services." Professional or technical laboratory services.

(cxxxvi) "Legally authorized representative." A minor child's parent or legal guardian, an individual's legal guardian, an attorney who presents written authorization that he or she represents an individual or entity, or any other person who is authorized in writing to act on behalf of an individual or entity. Any legally authorized representative, other than a parent or licensed attorney acting on behalf of a participant, must attach to the first document submitted to the Department a copy of a written authorization to act on behalf of the individual with respect to the matter in question. Formal authorizations must be legally enforceable and may include, but shall not be limited to, powers of attorney, court appointments or health care directives.

(cxxxvii) "LT101." A form, or its successor, used by Developmental Disabilities Division to document an individual's functional capacity and medical necessity for long term care services.

(cxxxviii) "LT-ABI-105." A document, or its successor, completed by the selected case manager and used by Developmental Disabilities Division to verify that the participant or applicant meets the ICF/ID level of care.

(cxxxix) "LT-MR-104." A document, or its successor, completed by the selected case manager and used by Developmental Disabilities Division to verify that the participant or applicant meets the ICF/ID level of care.

(cxl) "Local agency." The county offices of Department of Family Services, its agent, designee, or successor.

(cxli) "Lock-in." Restricting a client's participation in Medicaid to receiving covered services from a provider or providers designated by the client and approved by the Department.

(cxlii) "Mechanical restraint." Any device attached or adjacent to a participant's body that he or she cannot easily move or remove that restricts freedom of movement or normal access to the body.

(cxliii) "Medicaid allowable costs." Medicaid program costs as determined from Medicare cost reports that have been submitted to the Medicare Fiscal Intermediary. Allowable costs are calculated using Medicare payment principles. Medicaid allowable costs and calculations of payments shall not be adjusted because of changes that result from a Medicare appeal or reopening.

(cxliv) "Medicaid allowable payment." The maximum Medicaid reimbursement as determined pursuant to the rules of the Department.

(cxlv) "Medicaid fee schedule." The Medicaid fee schedule as established pursuant to Chapter 3.

(cxlvi) "Medicaid Fraud Control Unit (MFCU)." The Medicaid Fraud Control Unit of the Wyoming Attorney General's Office, its agent, designee, or successor.

(cxlvii) "Medicaid funds." The combination of federal Medicaid funds and state Medicaid funds that is available to the Department to make payments to providers. The federal portion shall be known as the FMAP. The state portion shall be known as the State Medicaid percentage.

(cxlviii) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act and/or the Wyoming Medical Assistance and Services Act of 1967, as amended. "Medicaid" includes any successor or replacement program enacted by Congress or the Wyoming Legislature.

(cxlix) "Medicaid Management Information System (MMIS)." The Medicaid Management Information System as certified by CMS and implemented by the Department. (cl) "Medicaid payments." The payments made by the Department for covered services.

(cli) "Medical necessity" or "medically necessary." A determination that a health service is required to diagnose, treat, cure or prevent an illness, injury or disease which has been diagnosed or is reasonably suspected to relieve pain or to improve and preserve health and be essential to life. The service must be:

(A) Consistent with the diagnosis and treatment of the client's condition;

(B) In accordance with the standards of good medical practice among the provider's peer group;

(C) Required to meet the medical needs of the client and undertaken for reasons other than the convenience of the client and the provider; and

(D) Performed in the most cost effective and appropriate setting required by the client's condition.

(clii) "Medical necessity for long-term care services." The determination made using the LT101 assessment form or other tool designated by the Department, which documents the need of the applicant or client for long-term care services from a skilled nursing facility, swing bed facility or a Home and Community Based Waiver Services program.

(cliii) "Medical records." All records, in whatever form, in the possession of or subject to the control of a provider which describe the client's diagnosis, treatment or condition.

(cliv) "Medical supplies." Disposable, semi-disposable or expendable medical supplies. "Medical supplies" does not include durable medical equipment, oxygen or oxygen supplies.

(clv) "Medicare." The health insurance program for the aged and disabled under Title XVIII of the Social Security Act.

(clvi) "Medicare crossover claim." A claim for services provided to a client who is eligible for Medicare and Medicaid, paid by Medicare.

(clvii) "Medicare Economic Index (MEI)." Medicare economic index for primary care services, (MEI) as defined in 42 U.S.C. § 1396a(bb)(3)(A).

(clviii) "Mental disorder." A condition defined in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), excluding a sole diagnosis of mental retardation or a specific developmental disorder.

(clix) "Mental health center." A facility located in Wyoming which is certified by the Mental Health and Substance Abuse Services Division as a "mental health center."

(clx) "Mental Health and Substance Abuse Services Division." The Mental Health and Substance Abuse Services Division of the Department, its agent, designee, or successor.

(clxi) "Minimum Data Set (MDS)." A core set of standardized screening and assessment elements by which a resident's physical, mental, psychosocial and behavioral status is identified. This assessment forms the basis for a comprehensive assessment wherein the resident's strengths and weaknesses can be evaluated, and a plan of care developed to meet his individual needs.

(clxii) "Monitor." To track a client's utilization of covered services by any or all of the following methods:

(A) Review of claims;

(B) Review of Inpatient Census Reports (ICRs);

(D) Consultation with providers;

(E) Consultation with the client or the client's authorized representative; or

(F) Any other reasonable method.

(clxiii) "Most recently available cost report." A facility's most recent Medicare cost report which has been submitted to Medicare in accordance with Medicare standards and procedures.

(clxiv) "Neglect." Neglect as defined by 42 C.F.R. § 488.301, W.S. § 35- 20-102, et seq., and W.S. § 14-3-202, et seq.

(clxv) "Negotiated rate." The rate agreed upon by the Department and a provider for services furnished to a client.

(clxvi) "New admission." The admission of a client who has never been in a facility or, if previously admitted, had been discharged or had voluntarily left the facility.

(clxvii) "Nonallowable cost." Costs which are not reasonably related to covered services.

(clxviii) "Nurse midwife." An "advanced practice registered nurse" as defined by W.S. § 33-21-120(a)(i), et seq., or licensed as a nurse practitioner by the Wyoming State Board of Nursing or a similar agency in another state and who is certified as a nurse midwife by the American College of Nurse-midwives.

(clxix) "Nurse practitioner." An "advanced practice registered nurse" as defined by W.S. § 33-21-120(a)(i), et seq., or licensed as a nurse practitioner by the Wyoming State Board of Nursing or a similar agency in another state.

(clxx) "Nursing facility." A nursing facility as defined by 42 U.S.C. § 1396r(a).

(clxxi) "Nursing facility services." Nursing facility services as defined by 42 U.S.C. § 1396d(f).

(clxxii) "Occupational therapist." A person licensed as an occupational therapist by the Wyoming State Board of Occupational Therapy or a similar agency in another state.

(clxxiii) "Occupational therapy services." Occupational therapy services, including both individual therapy and group therapy, that are:

(A) Prescribed by a physician;

(B) Provided by or under the scope of practice of an occupational therapist; and

(clxxiv) "The Omnibus Budget Reconciliation Act of 1993 (OBRA '93)."

The Omnibus Budget Reconciliation Act of 1993, Pub. L. No. 103-66.

(clxxv) "Orthotics." Medical appliances or devices, other than routine foot appliances, used to strengthen weak or defective parts of the body, to aid mobility or to serve other medical purposes.

(clxxvi) "Outpatient." An outpatient as defined by 42 C.F.R. § 440.2(a).

(clxxvii) "Outpatient hospital services." Outpatient hospital services as defined in 42 C.F.R. § 440.20(a).

(clxxviii) "Over the counter (OTC) drugs." Drugs which are legally available without a prescription.

(clxxix) "Overpayments." Medicaid funds received by a provider or client to which the provider or client is not entitled for any reason including payments which exceed the Medicaid allowable payment. Overpayments include but are not limited to:

(A) Payments made as a result of system errors;

(B) Payments for services furnished to a non-client;

(D) Payments for services which are not documented and/or supported by records and/or financial records;

(E) Payments for services for which admission certification has been denied or withdrawn;

(F) Payments which exceed a provider's usual and customary charge, unless otherwise permitted by the Department's rules;

(G) Payments resulting from fraud; or

(H) Payments resulting from abuse.

(clxxx) "Participant." An individual who has been determined eligible for covered services on a Waiver.

(clxxxi) "Participant objectives." A set of meaningful and measurable goals for the participant and the methods used to train the participant on the goals.

(clxxxii) "Patient." An individual receiving healthcare services.

(clxxxiii) "Per diem rate." The total, daily allowable rate for covered services.

(clxxxiv) "Person with a related condition." An individual who has a severe, chronic disability, as specified in 42 C.F.R. § 435.101, which provides that the disability:

(A) is attributable to:

(I) Cerebral palsy or epilepsy; or

(II) Any other condition other than mental illness found to be closely related to mental retardation because this condition results in impairment of general intellectual functioning or adaptive behavior similar to that of persons with mental retardation, and requires treatment or services similar to those required for these persons; and

(B) Is manifested before the person reaches age twenty-two (22); and

(D) Results in substantial functional limitations in three (3) or more of the following areas of major life activity;

(I) Self-care;

(II) Understanding the use of language;

(III) Learning;

(IV) Mobility;

(V) Self-direction; or

(VI) Capacity for independent living.

(clxxxv) "Personal care services." Services to assist a participant with the activities of daily living, including eating, bathing, dressing, personal hygiene, and household activities.

(clxxxvi) "Personal restraint." The application of physical force or physical presence without the use of any device for the purposes of restraining the free movement of the body of the participant. The term personal restraint does not include briefly holding, without undue force, a participant in order to calm or comfort him or her, or holding a participant's hand to safely escort him or her from one area to another.

(clxxxvii) "Pharmacy." An entity licensed to operate a pharmacy by the Wyoming State Board of Pharmacy or a similar board or agency in another state.

(clxxxviii) "Physical therapist." A person licensed to practice as a physical therapist by the Wyoming State Board of Physical Therapy or a similar agency in another state.

(clxxxix) "Physical therapy services." Maintenance or restorative physical therapy services (including either individual therapy or group therapy) that are:

(A) Prescribed by a physician;

(B) Provided by or under the scope of practice of a licensed physical therapist; and

(cxc) "Physician." A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners or a comparable agency in another state.

(cxci) "Plan of care." A written plan of care developed by qualified individuals approved by the Department.

(cxcii) "Power of Attorney." A written legal document created pursuant to W.S. §§ 3-5-101, et seq., 34-1-103 et seq., 35-22-402, et seq., or other similar law of another State, granting someone authority to act as agent or attorney-in-fact for the grantor.

(cxciii) "Practitioner." A health professional licensed by an agency or board of the State of Wyoming or a similar agency in another state who is acting within the scope of his or her licensure. "Practitioner" includes physicians and mid-level practitioners.

(cxciv) "Prepayment or post payment review." The prepayment or post payment review of a provider's or client's claims by the Department to determine whether such claims reflect generally accepted practices.

(cxcv) "Prescription." A written, faxed, electronic or oral order, as required by the Board of Pharmacy, from a practitioner that a certain drug, medical supply, device or service is medically necessary.

(cxcvi) "Prosecution, Recovery, Investigation, Collection and Enforcement" (PRICE). The Prosecution, Recovery, Investigation, Collection and Enforcement Unit of DFS, its agent, designee or successor.

(cxcvii) "Principal diagnosis." Principal diagnosis as defined by 42 C.F.R.§412.60(c)(1).

(cxcviii) "Prior authorization." A written, faxed or electronic approval from the Department that permits payment or coverage of a service that is covered if such authorization is obtained. Prior authorization must be requested and received pursuant to Chapter 3. Services requiring a prior authorization may also be referred to as "prior authorized" in these rules.

(cxcix) "Private pay rate." The published semi-private routine daily rates a nursing facility charges to non-recipients, other than Medicare clients, after all discounts, allowances and subsidies are subtracted for the same or similar services in effect on the first day of each rate year. "Private pay rate" does not include the cost of Medicare Part A and/or Part B premiums or deductibles, or the cost of any other insurance premiums or deductibles.

(cc) "Procedure codes." Codes contained in the latest version of the CPT Book.

(cci) "Prosecution, Recovery, Investigation, Collection and Enforcement (PRICE)". The Prosecution, Recovery, Investigation, Collection and Enforcement Unit of DFS, its agent, designee or successor.

(ccii) "Prospective Payment System (PPS) Inflation factor." The CMS Prospective Payment System Hospital Market Basket index for the period in question, as published by DRI Data Resources, Inc., in Healthcare Costs, which is published quarterly by the DRI/McGraw division of McGraw-Hill, Inc.

(cciii) "Provider." Any individual or entity that has a current provider agreement, is licensed and/or certified to provide services, and is enrolled with the Department.

(cciv) "Provider agreement." A written contract between a provider and the Department in which the provider agrees to comply with the provisions of the agreement as a condition of receiving Medicaid payment for services provided to clients.

(ccv) "Psychiatric Residential Treatment Facility (PRTF)." Any non- hospital facility with a provider agreement with a State Medicaid Agency to provide the inpatient services benefit to Medicaid-eligible individuals under the age of twenty-one (21).

(ccvi) "Psychologist." A person licensed to practice psychology by the Wyoming State Board of Psychology or a comparable agency in another state.

(ccvii) "Public health nurse." A registered nurse who is either under contract to the County to perform public health nursing functions or is an employee of the Department that is assigned public health nursing functions.

(ccviii) "Qualified intellectual disabilities professional." A person who ensures the client receives those services and interventions identified in the individual program plan. Qualified intellectual disabilities professionals must have at least one (1) year of experience working directly with persons with intellectual or other developmental disabilities and be one of the following: a doctor of medicine, a doctor of osteopathy, a registered nurse, or an individual who holds at least a bachelor's degree in a professional category designated as a human services professional (including, but not limited to: sociology, special education, rehabilitation counseling, and psychology).

(ccix) "Qualified mental health professional." A mental health practitioner whose qualifications meet standards set by the Mental Health and Substance Abuse Services Division.

(ccx) "Qualified Rate Adjustment (QRA) Payment." Annual lump sum supplemental payment equal to a portion of the difference between a qualifying hospital's Medicaid allowable costs for the payment period and its pre-QRA Medicaid payments for the same period, minus amounts payable by other third parties and beneficiaries. The Department will determine annual QRA payments prior to determining disproportionate share hospital payments.

(ccxi) "Readmission." The act by which an individual is admitted to a provider from which the individual had been discharged on or before the thirty-first (31st) day after the previous discharge for treatment of any diagnosis, excluding newborn admissions which occur within twenty-eight (28) days after the newborn's initial discharge.

(ccxii) "Re-evaluation of medical necessity." The completion of an LT101 done in conjunction with the six (6) month renewal of the LTC HCBS plan of care or the twelve (12) month Assisted Living Facility Waiver renewal plan of care.

(ccxiii) "Registered nurse." A person licensed to practice nursing by the Wyoming Board of Nursing or a similar agency in another state.

(ccxiv) "Reopen." A request by a hospital, pursuant to the procedures and standards established by Medicare, to re-examine or review the correctness of a cost settlement determination or decision made by or on behalf of Medicare.

(ccxv) "Representative payee." A person or organization appointed by the Social Security Administration to manage Social Security, Veterans' Administration, Railroad Retirement, Welfare Assistance, or other state or federal benefits or entitlement program payments on behalf of an individual who cannot manage or direct the management of his/her own money.

(ccxvi) "Reserved bed." A licensed bed in a facility reserved for a client who is temporarily absent.

(ccxvii) "Residence." The place a client uses as his or her primary dwelling place and intends to continue to use indefinitely for that purpose.

(ccxviii) "Respite care." Services provided:

(A) On a short-term basis pursuant to the individual plan of care;

(B) To a participant who is unable, unassisted, to care for himself or herself; and

(ccxix) "Restraint." A ‘‘personal restraint,'' ‘‘mechanical restraint,'' or ‘‘drug used as a restraint," as those terms are defined in this Chapter.

(ccxx) "Revenue codes." Revenue codes as contained in the latest version of the UB Editor.

(ccxxi) "Rural Health Clinic (RHC)." Rural health clinic (RHC) as defined in 42 U.S.C. § 1396d(l)(1).

(ccxxii) "Seclusion." The involuntary confinement of a participant or client alone in a room or an area from which the participant is physically prevented from leaving.

(ccxxiii) "Service care plan." A written plan prepared for a Waiver applicant by the LT101 assessor or their designee that describes the type and frequency of provider of services for all funding sources that will meet or move the applicant toward meeting the needs identified in the LT101 assessment.

(ccxxiv) "Service limitations." Limits on the quantity of covered services which are reimbursed by Medicaid as set forth in the rules of the Department.

(ccxxv) "Services." Programs authorized by W.S. § 42-4-103 and offered pursuant to these rules.

(ccxxvi) "Settled cost report." A facility's cost report:

(A) Which has been submitted to Medicare in accordance with Medicare standards and procedures;

(B) Which has been cost settled by the Medicare intermediary using Medicare principles of cost reimbursement;

(D) For which a notice of Medicaid program reimbursement has been issued.

(E) A cost report is settled notwithstanding a request to reopen.

(ccxxvii) "Skilled nursing service." Professional nursing services provided which are included within the definition of "practice of professional nursing" as set forth in the Wyoming Nurse Practice Act.

(ccxxviii) "Social Security Administration (SSA)." A division of the United States Department of Health and Human Services, its agent, designee, or successor that administers federal Social Security programs.

(ccxxix) "Social Security Number (SSN)." Nine-digit number issued to U.S. Citizens, permanent residents and temporary working residents, by the Social Security Administration.

(ccxxx) "Social worker." A person licensed as a licensed clinical social worker by the Wyoming Board of Mental Health Professionals or a similar agency in another state.

(ccxxxi) "Specialized services." Specialized services as defined in 42 C.F.R. § 483.120.

(ccxxxii) "Specialty services." Services identified by the Department and approved by CMS.

(ccxxxiii) "Speech, hearing and language services." The following services, if furnished either as individual therapy or group therapy, provided by a speech pathologist or audiologist or under the scope of practice of a speech pathologist or audiologist, and prescribed by a physician:

(A) Speech pathology and audiology services, including articulation, pragmatic language training, and devices used by the participant;

(B) Assessment of participant's use of visual cues;

(D) Assessment of a person's need for alternative speech output devices; or

(E) Speech, hearing and language services may be provided as individual therapy and group therapy.

(ccxxxiv) "Speech pathologist." A person licensed to practice speech pathology by the Wyoming Board of Speech Pathology and Audiology or a similar agency in another state.

(ccxxxv) "State fiscal year." The twelve-(12) month period beginning each July 1st and ending the following June 30th.

(ccxxxvi) "State Medicaid funds." The dollar amount of the state general funds appropriated by the Wyoming Legislature for the Medicaid program which constitutes the State Medicaid percentage.

(ccxxxvii) "State Medicaid percentage." The state percentage as determined pursuant to 42 U.S.C. § 1396d(b).

(ccxxxviii) "State monitor." An individual who is an employee or contractor of the provider's certifying division of the Department and that is appointed by the Director to do any one or more of the following:

(A) Assure that participants receiving services from the provider are receiving appropriate levels of services and are free from abuse, neglect, and exploitation;

(B) Oversee the abatement of the areas of non-compliance by the provider;

(D) Report to the Department on whether the provider is operating in compliance with the Medicaid Rules, properly implementing a quality improvement plan or both.

(ccxxxix) "State survey agency." The Office of Healthcare Licensing and Surveys of the Department, its agent, designee or successor.

(ccxl) "Supervision." The ready availability of the supervisor for consultation and direction of the individual providing services. Contact with the supervisor by telecommunications is sufficient to show ready availability if such contact is sufficient to provide quality care.

(ccxli) "Supervisor." An individual licensed to provide services who take professional responsibility for such services, even when provided by another individual or individuals.

(ccxlii) "Supplemental Security Income (SSI)." The program enacted as Title XVI of the Social Security Act.

(ccxliii) "Survey." Any survey as defined in 42 C.F.R. § 488.301.

(ccxliv) "Swing bed." A bed in a hospital which is certified for either inpatient hospital service or nursing facility services.

(ccxlv) "Swing bed services." Nursing facility services provided to a client in a hospital bed which is certified for either inpatient hospital services or nursing facility services.

(ccxlvi) "Technical denial." A determination by the Department to deny payment or recoup payments previously made because of a provider's failure to comply with the timeliness or other procedural requirements of any of the Wyoming Medicaid Rules. A technical denial is a final agency action, not an adverse action. Technical denial includes, but is not limited to, the denial of payment or recoupment of payments because of a provider's:

(A) Failure to timely and properly obtain admission certification;

(B) Failure to timely and properly obtain prior authorization;

(D) Furnishing non-covered services to a client; or

(E) Furnishing covered services in excess of the service limitations.

(ccxlvii) "Temporary absence" or "temporarily absent." When a client is out of a facility for hospitalization, therapeutic home visits, or for any other reason, and is expected to return to the facility.

(ccxlviii) "Third Party Liability (TPL)." The right of the Department to recover, on behalf of a client, from a third party payer the costs of Medicaid services furnished to the client.

(ccxlix) "Third Party Payer." A person, entity, agency, insurer, or government program that may be liable to pay, or that pays pursuant to a client's right of recovery arising from an illness, injury, or disability for which Medicaid funds were paid or are obligated to be paid on behalf of the client. Third party payer includes, but is not limited to:

(A) Medicare;

(B) Insurance companies;

(D) Persons or entities or others alleged to be legally liable for injury to a client for which Medicaid provides services to the client;

(E) A spouse or parent who is obligated by law or court order to pay all or part of such costs; or

(F) A client's estate.

(ccl) "Time out." The restriction of a participant for a reasonable period of time to a designated area from which the participant is not physically prevented from leaving, for the purpose of providing the participant an opportunity to regain self-control.

(ccli) "Treatment plan." A written description of expected services outcome developed approved and signed by a clinical professional. The treatment plan must:

(A) Contain a description of the methods and activities and their frequency that will be employed by specific persons to implement the treatment; and

(B) Specify the changes in the client's symptoms and behavior that are expected during the course of the treatment plan.

(cclii) "Usual and customary." The provider's charge to the general public for the same or similar services.

(ccliii) "Utilization review." A review of the cost effectiveness of the utilization of covered services. The review shall be undertaken in accordance with the standards and procedures specified by the Department and disseminated to providers by manuals and bulletins.

(ccliv) "Waiting list." A list of applicants who are eligible for but are not receiving covered services because of limits imposed by funding or program scope.

(cclv) "Waiver." An exception of Medicaid standards granted by CMS to the Wyoming Medicaid Program pursuant to Section 1915(c) or 1115 of the Social Security Act.

(cclvi) "Working days." 8:00 a.m. through 5:00 p.m., Mountain Time, Monday through Friday, exclusive of State holidays.

(cclvii) "Wyoming Department of Health (WDH or the Department)." The Wyoming Department of Health, its agent, designee or successor.

(cclviii) "Wyoming Life Resource Center." The Wyoming Life Resource Center as established pursuant to W.S. § 25-5-101, et seq.

(cclix) "Wyoming Medical Service Area (WMSA)." The geographic area surrounding the client's residence within Wyoming commonly used by other persons in the same area to obtain similar services, including the following cities or towns outside Wyoming: Craig, Colorado; Idaho Falls, Montpelier and Pocatello, Idaho; Billings and Bozeman, Montana; Kimball and Scottsbluff, Nebraska; Belle Fourche, Custer, Deadwood, Rapid City and Spearfish, South Dakota; and Ogden and Salt Lake City, Utah.

History

Effective 2011-11-07

Chapter 3 Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims

Wyo. Code R. 048.0037.3.04072022 Provider Enrollment and Participation, Pre-Authorization, Payment and Submission of Claims

CHAPTER 3

Provider Enrollment and Participation, Pre-Authorization,

Payment and Submission of Claims by Providers

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute 42-4-101 through -124.

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to govern the enrollment and participation in the Medicaid program by providers of covered services, including pre-authorization, and payment and submission of claims by providers, except as otherwise specified in the rules of the Department.

(b) This Chapter applies to all clients and providers for all furnished Medicaid services.

(c) The Department may issue manuals and bulletins to interpret this Chapter. Such manuals and bulletins shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to this Chapter.

Section 3. Definitions. Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning as used in health care, Medicaid and Medicare.

Section 4. Provider Qualifications.

(a) The Department shall establish qualifications for individuals or entities to enroll as a provider of Medicaid covered services consistent with state and federal law.

(b) To qualify for enrollment as a provider of covered Medicaid services, an individual or entity shall, at a minimum, satisfy the following criteria:

(i) Meet applicable licensing and certification standards found in Wyoming statutes and rules, or in the statutes and regulations of the state in which the provider is located, or in the statutes and regulations of the state in which the services are provided. If applicable, a provider shall comply with Medicare certification standards;

(ii) Not be excluded from participation in federally funded health care programs by the U.S. Department of Health and Human Services, Office of Inspector General; and,

(iii) Be assigned a National Provider Identifier (NPI) number by the National Plan and Provider Enumeration System, as applicable.

Section 5. Provider Enrollment and Participation.

(a) The Department shall not pay Medicaid Funds to any individual or entity that provides services to a client unless the individual or entity is a party to a fully executed provider agreement and is enrolled by the Department.

(b) The following procedure governs the enrollment of providers in the Medicaid program:

(i) An individual or entity that wishes to participate in the Medicaid program shall apply to be a provider on the forms specified by the Department, and shall submit the qualifying documentation and information required by the Department to be enrolled as a provider.

(ii) The Department or its designated agent shall review and make a determination on the application within thirty (30) calendar days of the date it receives the application and all necessary qualification documentation, including any supplemental information requested by the Department.

(iii) If the application is approved, the provider and the Department shall execute a provider agreement as specified by the Department.

(iv) If the application is denied, the Department shall notify the applicant of its decision in writing in accordance with Wyoming Medicaid Rules Chapter 4.

(c) The provider's enrollment shall become effective when all requisite state and federal verifications have been completed and the provider agreement has been fully executed. It shall remain in effect for five (5) years from the effective date of the provider agreement or until terminated. Enrollment may be renewed upon application.

(d) The Department may retroactively enroll an individual or entity as a provider that previously furnished services to a client.

(i) The Department may provide Medicaid reimbursement for such services if the following requirements have been met:

(A) The individual or entity successfully applies to be a provider and states the requested effective date of enrollment;

(B) The services are otherwise reimbursable pursuant to Wyoming Medicaid Rules; and

(C) The individual or entity demonstrates it was qualified to provide the services for which it seeks reimbursement at the time services were delivered.

(ii) No Medicaid reimbursement shall be made before the provider seeking such reimbursement has been enrolled by the Department.

(e) Conditions of Provider's Participation.

(i) A provider shall not discriminate against any individual on the basis of race, color, religion, national origin, sex, disability, or age, except as allowed by law.

(ii) A provider shall not place restrictions or criteria on the services it will make available, the type of health conditions it will accept, or the persons it will accept for care or treatment, unless the provider applies those restrictions or criteria to all individuals seeking the provider's services.

(iii) A provider may not refuse to furnish services to a Medicaid client on account of a third party's potential liability for the service(s).

(iv) A provider shall comply with the Social Security Act, the Wyoming Medical Assistance and Services Act, and all rules and regulations promulgated under those Acts. A provider shall comply with other federal and state laws applicable to the services offered by the provider to clients.

(v) A provider shall comply with applicable licensing and certification standards found in Wyoming statutes and rules, or in the statutes and regulations of the state in which the provider is located, or in the statutes and regulations of the state in which the services are provided. If applicable, a provider shall comply with Medicare certification standards.

(vi) If acting as an employer or contractor of personnel a provider entity shall ensure:

(A) Its personnel operate within the limits and scope of practice allowed under the individual's professional licensure or certification and within the limits of the entity's licensure or certification; and

(B) It complies with the U.S. Department of Health and Human Services, Office of Inspector General's regulations and guidance on employment of individuals excluded from participation in federally funded health care programs.

(vii) A provider shall comply with all applicable state and federal laws in safeguarding information about applicants and clients.

(f) Termination of Provider Enrollment.

(i) The Department shall terminate a provider's enrollment if:

(A) The provider loses, or fails to provide documentation of, required licensure or certification. The termination shall be effective the same date the provider's license or certification status changes;

(B) The provider is excluded from participation in federally funded health care programs by the U.S. Department of Health and Human Services, Office of Inspector General. The termination shall be effective the same date the provider was excluded from the federal programs;

(C) The provider has been terminated from participation in Medicare when Medicare certification is a prerequisite to enrollment in Medicaid. The duration of the provider's termination for Medicaid shall be the same as and shall run contemporaneously with the provider's termination from participation in Medicare. The provider's remedies in regard to the termination under this subsection are limited to those provided by Medicare; or

(D) There was a finding of fraud, abuse, or other prohibited activities of the provider by a judicial or administrative process where that provider was afforded a notice and the right to a hearing.

(E) If a provider's enrollment is terminated under this subsection it is not an adverse action as defined, and the Department is not required to notify the provider in writing in accordance with Wyoming Medicaid Rules Chapter 4.

(ii) The Department may terminate a provider's enrollment pursuant to Wyoming Medicaid Rules Chapter 16. If a provider's enrollment is terminated under this subsection the Department shall notify the provider of the adverse action in writing in accordance with Wyoming Medicaid Rules Chapter 4.

(g) The Department may reenroll a terminated provider if:

(i) The Department has been reimbursed for all overpayments or a payment agreement is in effect;

(ii) The Department is satisfied that sufficient safeguards have been implemented to ensure that the factors which led to the termination will not recur; and

(iii) The provider successfully completes the Medicaid enrollment process.

Section 6. Provider Change in Ownership.

(a) A provider's Medicaid enrollment and any associated billing privileges are not transferrable and cannot be transferred at the time an individual provider's practice or a provider entity is sold or transferred.

(b) No party to a provider agreement shall assign or otherwise transfer any of its rights pursuant to that agreement.

(c) A provider shall not use its Medicaid enrollment or a provider agreement as collateral for any financial obligations.

(d) A provider which proposes a change in ownership, control, operation, management contract, or leasehold interest shall notify the Department in writing of the proposed change no later than sixty (60) days before the effective date of the proposed change.

(e) The prospective owner shall be required to enroll as a Medicaid provider in order to seek reimbursement for Medicaid covered services.

(f) A new owner shall not bill for claims until both the effective date of the sale or transfer has passed and the owner has been enrolled as a Medicaid provider.

(g) A provider entity that has changed ownership shall not be reimbursed for claims under the old provider agreement with dates of service on or after the effective date of the change in ownership.

(h) Wyoming Medicaid is not responsible for reimbursement of services provided during gaps in provider eligibility which arise as a result of a change in ownership.

(i) A change in the ownership of a provider entity as specified in this section shall not relieve the original provider of its obligations pursuant to the provider agreement or this Chapter.

Section 7. Out-of-State Providers.

(a) A service furnished by an enrolled provider located outside Wyoming is Medicaid reimbursable if:

(i) The services are needed because of a medical emergency;

(ii) The client is located outside of Wyoming and the client's health would be endangered if required to return to the state;

(iii) The Department determines, on the basis of medical advice, that the needed medical services, or necessary supplementary resources, are more readily available in the other state;

(iv) It is general practice for clients in a particular locality in Wyoming to use medical resources in another state;

(v) The client is referred to a provider outside Wyoming when prior authorized and comparable services are not available within the state;

(vi) The out-of-state provider is closer to the client's residence than a provider of comparable services within Wyoming; or

(vii) The client is less than 22 years of age; and

(A) Is a foster child and in the custody of the Wyoming Department of Family Services who resides with a foster family out of state and whose Medicaid coverage cannot otherwise be transferred to the receiving state; or

(B) Has been placed in an out-of-state institution.

Section 8. Provider Records.

(a) A provider shall collect and maintain medical and financial data, records, and information as necessary to provide services.

(b) A provider shall develop and maintain a record keeping system that includes a separate record for each client served.

(c) A provider shall maintain medical and financial records, including information regarding dates of service, diagnoses, services furnished, and claims, for at least six (6) years after the end of the state fiscal year in which payment for services was rendered.

(i) If any litigation, claim, audit or other action involving the records is initiated before the expiration of the six (6) year period, the records shall be maintained until the litigation, claim, audit or other action and any subsequent administrative or legal proceedings are resolved.

(ii) Such records shall be maintained for three (3) years in hard-copy, after which they may be maintained on micro-fiche, micro-film, or electronically.

(d) A provider shall make its financial records and the client's medical records available upon request to representatives of the Department, the United States Department of Health and Human Services, Health Care Finance Administration (HCFA), the Comptroller General of the United States, the Wyoming Attorney General, or the Medicaid Fraud Control Unit (MFCU).

(e) The Department may copy provider records as necessary to fulfill its authorized functions.

(f) The refusal of a provider to make financial or medical records available and accessible shall result in:

(i) The immediate suspension of all Medicaid payments to the provider including payments for services furnished after the date of the request. No payments shall be made to the providers until the Department determines that adequate records have been produced and maintained; and

(ii) All Medicaid payments made to the provider during the period for which records supporting such payments are not produced shall be repaid to the Department within ten (10) days after written request for such repayment.

Section 9. Verification of Client Data.

(a) The Department issues Medicaid identification numbers to clients. The provider is responsible for verifying the validity of each client's Medicaid identification.

(b) The provider will not be paid for any claims submitted for treatment of an individual who does not have a valid Medicaid identification number. If a provider receives payment from an individual that is later determined to be eligible for Medicaid, the provider shall refund any such payment to the individual before seeking Medicaid reimbursement.

(c) If a provider furnishes services to an individual who purposely fails to notify the provider that he is a Medicaid client, the provider may submit a claim to Medicaid or seek reimbursement or payment from the client. A provider that elects to seek Medicaid reimbursement shall accept such payment as payment in full.

(d) A provider that furnishes services to an individual who becomes a Medicaid client after the date services were provided may submit a claim to the Department seeking Medicaid reimbursement for services furnished during the period the individual was eligible for Medicaid.

Section 10. Prior Authorization.

(a) The Department may require prior authorization before provision of certain Medicaid covered services. The failure to obtain prior authorization before providing services precludes Medicaid reimbursement for such services. Prior authorization is not a guarantee of the client's eligibility or a guarantee of Medicaid payment.

(b) Before providing services that require prior authorization, the provider shall request such authorization using the forms specified by the Department.

(i) Medically necessary;

(ii) Consistent with the diagnosis and treatment of the client's condition;

(iii) In accordance with the standards of good medical practice among the provider's peer group;

(iv) Required to meet the medical needs of the client and undertaken for reasons other than the convenience of the client and provider;

(v) Performed in the most cost effective and appropriate setting required by the client's condition; and,

(vi) Meet any additional criteria established by Wyoming Medicaid Rules or the coverage policies of the Department.

(d) Upon review, the Department or its designee may request additional information or documentation from the provider as necessary to determine that the above requirements have been met. The provider may request further review of the request for prior authorization following its submission of additional documentation.

(e) When the Department denies a request for prior authorization based upon the failure to meet the requirements set forth above, it shall inform the provider of the denial. The Department shall provide written notice to the client of the denial in accordance with Wyoming Medicaid Rules Chapter 4. Only the client has a right to a hearing pursuant to this section.

Section 11. Medicaid Allowable Payment.

(a) The Department shall establish and maintain payment rates for Medicaid services to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available, to the extent that such care and services are available to the general population in the geographic area.

(b) Except as otherwise specified in this Chapter or the Wyoming Medicaid Rules, the Medicaid Allowable Payment shall not exceed the lower of the provider's usual and customary charges or the Medicaid fee schedule in effect on the date services were provided. The Medicaid fee schedule may include specific fees for services and/or a methodology for establishing such fees. The fee schedule is available upon request from the Department.

Section 12. Payment of Claims.

(a) Medicaid is the payer of last resort. A provider may not seek Medicaid payment for services furnished to a client until payment from third parties has been sought pursuant to Wyoming Medicaid Rules Chapter 35.

(b) For Medicaid enrolled providers, if the service is a covered service, a provider may not request, receive or attempt to collect any payment from the client or the client's family for the service, with the exception of section 9(c) of this Chapter. The provider shall accept the Medicaid allowable payment as payment in full for the services.

(c) A provider that provides a noncovered service to a client may seek payment from the client if the provider informed the client in writing of the client's potential liability before providing the service, and the client agreed in writing to pay for such services before they were furnished.

(d) A provider that provides a covered service to a client that is in excess of service limits may seek payment from the client if the provider informed the client in writing of the client's potential liability before providing the service, and the client agreed in writing to pay for such services before they were furnished.

(e) A provider may seek copayment from clients as permitted by Department policy as reflected in the Department's manuals and bulletins. The amount of the permitted copayment shall be automatically deducted by the Department from the Medicaid Allowable Payment. Collection of a permitted copayment is at the discretion of the provider.

Section 13. Submission of Claims.

(a) The Department shall deny claims which are improperly submitted or which contain errors of any kind. Such claims may be resubmitted, subject to applicable federal and state requirements.

(b) A provider shall not bill the Department in excess of the provider's usual and customary charge for the service. The provider shall not bill the client or the Department for administrative fees such as standard processing or late fees.

(c) An individual provider shall not submit claims for reimbursement unless the services were rendered personally by that provider, or by an intern or resident while acting under the clinical supervision of that provider when allowed by applicable licensing or credentialing bodies. A provider entity shall not submit claims for reimbursement unless the services were rendered by qualified employed or contracted personnel acting under the supervision and control of the provider entity.

(d) A provider may seek Medicaid payment through a business agent for services furnished to a client by the provider if the business agent's compensation is related to the actual cost of processing the billing, is not related on a percentage or other basis to the amount of the claim, and is not dependent upon payment of the claim.

(e) A provider is responsible for all claims, whether submitted directly or through an agent, designee, employee or other intermediary.

(f) Any loss of Medicaid reimbursement caused by provider error is the responsibility of the provider and the provider may not bill the client for such services.

(g) A provider shall complete all required documentation, including required signatures, prior to claims submission to the Department. Documentation prepared or completed after the submission of the claim may be deemed by the Department or its designee as insufficient to substantiate the claim, in which case Medicaid funds shall be withheld or recovered.

(i) Claims shall be submitted to the Department in the manner and on the forms specified by the Department.

(ii) Claims shall include prior authorization number, if applicable, and

(iii) Claims shall include other documentation or records as the Department may request as outlined in the applicable Medicaid provider manual.

(iv) Claims submitted to the Department for standard processing, among other requirements shall include:

(A) Valid client identification (ID) number for the client of service;

(B) Valid provider NPI number and taxonomy for the service provided, including specification of the rendering provider as applicable;

(D) Appropriate billing code units as established by the Department; and,

(E) Other provider or specific claim fields as required for a "clean claim" by the Department.

(v) Any paid claim that does not meet the claims submission criteria established by the Department will be voided after appropriate provider notification. "Claim voids" conducted under this authority shall not be subject to reconsideration or the administrative hearing process described in Wyoming Medicaid Rules Chapter 4.

(vi) The Department shall deny claims not timely submitted. Claims shall be submitted and finalized on or before twelve (12) months after the date of service or the date of discharge, whichever is later, except for the following:

(A) Medicare cross-over claims shall be submitted within six (6) months after the date Medicare acts on the claim; or

(B) In the event of retroactive eligibility, such claims shall be submitted within six (6) months of the date of the determination of retroactive eligibility.

Section 14. The Department shall recover overpayments pursuant to the Wyoming Medicaid Rules Chapter 16. In addition to using its own internal processes for recovery of overpayments, the Department may refer a matter involving suspected overpayments to the MFCU at any time.

History

Effective 2022-04-07

Chapter 4 Medicaid Administrative Hearings

Wyo. Code R. 048.0037.4.03242020 § 1 Authority

. This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at Wyoming Statute § 42-4-101, et seq.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 2 Purpose and Applicability

(a) This Chapter shall apply to all contested cases involving Medicaid in accordance with Medicaid rules, except as otherwise specified in the Department's Medicaid rules.

(b) The Department may issue manuals and bulletins to interpret this Chapter. The provisions contained in manuals or bulletins shall be subordinate to this Chapter.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 3 Definitions

. Except as otherwise specified in Chapter 1 of the Wyoming Department of Health's Medicaid Rules, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 4 Right to Hearing

(a) An applicant has a right to a hearing if their application is denied or not acted upon within the time frames specified by the Department.

(b) A client has a right to a hearing if eligibility or services are denied, reduced, terminated or suspended.

(c) A provider has a right to a hearing regarding an adverse action following the request for reconsideration as specified in Chapter 16 of the Wyoming Department of Health's Medicaid Rules.

(d) Pharmaceutical manufacturers shall have the same rights to a hearing as providers.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 5 Notice of Right to Hearing and Adverse Action

(a) Applicants and clients. The Department shall provide notice at the time of any adverse action. The notice shall include:

(i) An explanation of:

(A) The individual's right to request a hearing; or

(B) An explanation of circumstances where a hearing will be granted based on a change in the law.

(ii) The method for requesting a hearing;

(iii) The individual's right to be represented by a legally authorized representative, including a lawyer admitted to practice in Wyoming, a relative, friend or other spokesperson;

(iv) Notice that the individual shall notify the Department in writing that they will be represented;

(v) The intended action;

(vi) The effective date of the intended action;

(vii) The reason(s) for the intended action;

(viii) The specific regulations that support, or the change in federal or state law that requires the action;

(ix) Where applicable, an explanation of the circumstances under which benefits may be continued if a hearing is requested pursuant to 42 C.F.R. § 431.231.

(b) Providers. The Department shall notify a provider of the right to a hearing following the request for reconsideration, at the time of the notice of adverse action, except when issuing a notice of claims payment or denial. The notice shall include:

(i) A statement of the intended action;

(ii) The effective date of the intended action;

(iii) The reason(s) for the intended action;

(iv) The specific regulations that support, or the change in federal or state law that requires the action;

(v) The right to representation by a lawyer admitted to practice in Wyoming.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 6 Time of Notice

(a) Applicants. The Department shall mail the notice after a final determination is made.

(b) Clients. The Department shall mail notice of adverse action at least ten (10) business days before the effective date, except:

(i) The Department may mail notice, not less than five (5) business days before the effective date if, the circumstance indicate probable fraud by a client, and if possible, there are facts that have been verified through secondary sources.

(ii) The Department may mail notice not later than the effective date if:

(A) The Department has been notified that a client is deceased;

(B) The Department receives a clear written statement signed by a client that:

(I) The client no longer wishes to receive services; or

(II) Provides information which requires termination or reduction of services. The statement must also include that the client understands that by providing the Department with the information, immediate termination or reduction of the client's services will result;

(D) The client's whereabouts are unknown and the Department's mail is returned, indicating there is no forwarding address;

(E) The Department establishes that the client has been accepted for benefits by another local jurisdiction, state, territory or commonwealth;

(F) A change in the level of medical care is prescribed by the client's physician; or

(G) The notice involves an adverse determination based on preadmission screening requirements for individuals with mental illness or intellectual disability.

(i) The Department shall notify a provider of the denial or reduction of payments after the denial or reduction.

(ii) The Department shall notify a provider of a termination, suspension or other adverse action in accordance with Chapter 16 of the Wyoming Department of Health's Medicaid Rules.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 7 Request for Hearing

(a) A client's request for a hearing shall be submitted electronically via email to the Department, made verbally to the Department, mailed to the Department via certified mail, return receipt requested, or personally delivered to the Department within twenty (20) business days after the mailing of the notice of adverse action.

(b) A provider's request for a hearing shall be mailed via certified mail, return receipt requested, or personally delivered to the Department within twenty (20) business days after the mailing of the notice of adverse action.

(i) A provider's request for hearing shall state with specificity the reasons for the request. Failure to provide a statement of reasons shall result in the dismissal of the request with prejudice.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 8 Procedure after Request for Hearing

(a) The Department shall evaluate the request and, within ten (10) business days following the receipt of the request notify the requesting party in writing whether the request has been accepted or rejected.

(b) Denial of hearing.

(i) The Department may deny a request for hearing if the action complained of is not an adverse action as defined, or the request does not meet the requirements of this Chapter.

(ii) A denial of a request for hearing is a final decision of the Department.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 9 Maintaining Services Pending Appeal

(a) If the Department mails the required notice and the client requests a hearing before the effective date of the action, the Department may not terminate or reduce services until the final decision is rendered after the hearing unless:

(i) The Hearing Officer determines at the hearing that the sole issue is one of federal or state law or policy; and

(ii) The Department promptly informs the client in writing that services are to be terminated or reduced pending the final decision.

(b) If the adverse action is affirmed, the Department may institute recovery procedures against the client to recoup the cost of any services or goods furnished to the client, to the extent they were furnished solely by reason of this section, and may recover any overpayments made to a provider pursuant to 42 C.F.R. § 431.230(b).

(c) The Department shall reinstate and continue services until a decision is rendered if the action resulted from other than the application of federal or state law or policy pursuant to 42 C.F.R. § 431.231(c)(3).

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 10 Hearing Procedures

In addition to the specific Sections to follow, all contested case hearings shall be conducted in accordance with the Office of Administrative Hearings Rules, specifically Chapter 2 of the Uniform Rules for Contested Case Practice and Procedure.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 11 Timing of Hearing

A hearing shall be held within forty (40) days of the request for hearing unless otherwise provided by law, by agreement of the parties, or if a contestant requests a continuance.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 12 Representation

(a) Any applicant, client, or provider has the right to represent themselves, to be represented by a lawyer admitted to practice in Wyoming, or, by an authorized representative, if the contestant is an applicant or client.

(i) The contestant shall notify the Department in writing if the contestant intends to be represented for the hearing.

(ii) A non-lawyer authorized to represent an applicant or client may advocate for the applicant or client in a representative capacity, draft pleadings or other documents. However, this section does not authorize a person, who is not a lawyer admitted to practice in Wyoming, to provide legal advice or services, or represent any person before the courts of the State of Wyoming.

(b) A provider which is a corporation, professional corporation, limited liability company, partnership, governmental entity, or any other legal entity, may appear and be represented by a lawyer admitted to practice in Wyoming.

(c) If the contestant is represented by an attorney, payment of attorney's fees and costs associated with the representation are the responsibility of the contestant.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 13 Decisions

(a) The hearing officer shall make proposed findings of fact and conclusions of law within twenty (20) business days of the close of the hearing and forward them to the Director for the final decision. This time may be extended if the parties or other interested persons are to submit briefs; but may not be extended by more than ten (10) working days, unless the parties stipulate, in writing or on the record at the hearing, to a later date.

(i) Within ten (10) business days of the close of the hearing, or such additional time as the hearing officer may allow, each party shall be allowed to file with the hearing officer any proposed findings of fact and conclusions of law, together with a supporting brief. Such proposals and briefs shall be served on all other parties.

(ii) Within ten (10) business days after the issuance of the hearing officers proposed findings of fact and conclusions of law, any of the parties may submit exceptions. Such exceptions shall be filed with the Director and served on all other parties.

(b) Within ten (10) business days after the period for submitting exceptions, the Director shall make and enter into the record the final decision. The final decision shall be served on all parties to the proceedings.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 14 Appeals

. Appeals from a final decision of the Department shall be in accordance with W.S. § 16-3-114 through 16-3-115, and Rule 12 of the Wyoming Rules of Appellate Procedure.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 15 Transcripts and Record

(a) When a contested case is set for hearing, the Department shall assign a docket number to the case and enter the case with its number and date of filing on a docket. The Department shall maintain a separate file for each docketed case in which all pleadings, transcriptions, correspondence, papers, and exhibits for that case shall be maintained. All items shall have noted thereon the assigned docket number and the date of filing.

(b) All contested case hearing proceedings shall be recorded, electronically, through the use of a qualified court reporter, or any other appropriate means determined by the agency or the hearing officer. Transcriptions of oral proceedings or written transcripts of a witness's testimony may be obtained by contestant from the Department upon payment of the cost.

(i) In a nonpublic investigatory proceeding, requests for copies or transcripts may be limited to testimony of the requesting party.

(ii) Where a contestant can demonstrate indigence and cannot effectively perfect his or her appeal without a transcript, the Department may waive the payment of the fee.

History

Effective 2020-03-24

Wyo. Code R. 048.0037.4.03242020 § 16 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules.

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(iv) The Department incorporates the administrative practice and procedure rules found in Chapter 2 of the Uniform Rules for Contested Case Practice and Procedure adopted by the Office of Administrative Hearings and effective July 20, 2017 found at: http//soswy.state.wy.us/Rules/RULES/9644.pdfhttps://rules.wyo.gov, Reference Number 270.0001.2.07202017.

History

Effective 2020-03-24

Chapter 5 Long Term Care Facility Remedies, Terminations

Wyo. Code R. 048.0037.5.11161995 Long Term Care Facility Remedies, Terminations

WYOMING DEPARTMENT OF HEALTH WYOMING MEDICAID RULES

CHAPTER 5

MEDICAID LONG TERM CARE FACILITY REMEDIES/TERMINATIONS

Section 1. Authority. This rule is promulgated by the Department of Health pursuant to W. S. § 42-4-101 et seq., and the Wyoming Administrative Procedures Act at W. S. § 16-3-101 et seq.

Section 2. Purpose and Applicability.

(a) This Chapter establishes the standards and procedures for imposing remedies on nursing facilities which participate in the Medicaid program and which are not in compliance with the require- ments of participation of the Medicaid program. It is intended to ensure prompt compliance with the requirements of participation.

(b) This Chapter is to be read in conjunction with:

(i) Applicable federal statutes and regulations, including 42 C.F.R. Parts 401, 431, 435, 441, 441, 447, 483, 488, 489 and 498, as amended effective July 1, 1995. If there are inconsisten- cies between the provisions of this Chapter and federal statutes and/or regulations, including additional or different substantive or procedural requirements, the federal statutes and/or regulations shall control the provisions of this Chapter; and

(ii) The State Operations Manual (SOM). Except as otherwise specified in this Chapter, the procedures and standards of the SOM shall control procedures for the imposition of remedies.

Section 3. General provisions.

(a) The Department may issue Manuals or Bulletins to providers and/or other affected parties to interpret the provisions of this Chapter. Such Manuals and Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Manuals or Bulletins shall be subordinate to the provisions of this Chapter.

(b) The Department may refer suspected abuse or neglect to the appropriate local, state and/ or federal agencies for investigation.

(c) Available remedies. The Department is authorized to impose one or more of the follow- ing remedies for each deficiency:

(i) Directed in-service training;

(ii) Directed plan of correction;

(iii) Appointment of a State monitor;

(iv) Denial of Medicaid payments for new admissions;

(v) Denial of fifty percent of the State share of Medicaid payments;

(vi) Denial of the Federal share of Medicaid payments;

(vii) Reimbursement of resident losses;

(viii) Appointment of a temporary manager;

(ix) Termination of Medicaid provider agreement with transfer of residents and assess- ment of transfer costs; or

(x) Closure of facility with transfer of residents and assessment of transfer costs.

(d) The provisions of 42 C.F.R. § 448.402 are incorporated by this reference.

Section 4. Definitions.

(a) "Abbreviated standard survey." "Abbreviated standard survey" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(b) "Abuse." "Abuse" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(c) "Alternative remedies." The following remedies selected by the Department as alternatives to federally mandated remedies pursuant to 42 C.F.R. § 488.406(a)(8):

(i) Assessment of transfer costs;

(ii) Denial of the Federal share of Medicaid payments;

(iii) Denial of the fifty percent of the State share of Medicaid payments; and

(iv) Reimbursement of resident losses.

(d) "Assessment of transfer costs." The payment by a facility of the actual costs of transferring residents of the facility to other appropriate facilities, selected by the Department, when transfer is part of a remedy.

(e) "Certification of compliance." A determination by the Department, based on the findings and recommendation of the survey agency or the Secretary of HHS, pursuant to 42 C.F.R. Subpart C, that a facility is in substantial compliance with the requirements of participation.

(f) "Certification of noncompliance." A determination by the Department, based on the findings and recommendation of the survey agency or the Secretary of HHS, pursuant to 42 C.F.R. Subpart C, that a facility is in not substantial compliance with the requirements of participation.

(g) "Chapter 1." Chapter 1, Rules for Medicaid Administrative Hearings, of the Wyoming Medicaid Rules.

(h) "Chapter 3." Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.

(i) "Chapter 7." Chapter 7, Wyoming Nursing Home Reimbursement, of the Wyoming Medicaid Rules.

(j) "Closure with transfer of residents." The closure of a facility because of an emergency accompanied by the transfer of all residents to an appropriate facility or facilities.

(k) "Compliance." A facility that meets the requirements of participation.

(l) "Corrective action." The changes or improvements necessary to bring a facility into compli- ance with the applicable requirements of participation.

(m) "Deficiency." "Deficiency" as defined by 42 C.F.R. § 488.301, which definition is incorpo- rated by this reference.

(n) "Denial of fifty percent of the State share of Medicaid payments." The deduction from and retention by the Department of fifty percent (50%) of the State's share of the facility's per diem rate.

The State's share is determined pursuant to 42 U.S.C. § 1396d(b).

(i) If imposed as a category 2 remedy, the Department shall deny the State share of Medicaid payments for those residents affected by the deficiency(ies).

(ii) If imposed as a category 3 remedy, the Department shall deny the State share of Medicaid payments for all Medicaid residents of a facility.

(iii) Payments that are denied shall not be retroactively paid to a facility.

(o) "Denial of the Federal share of Medicaid payments." The deduction from and retention by the Department of the federal share of the facility's per diem rate. The federal share is the federal medi- cal assistance percentage as determined pursuant to 42 U.S.C. § 1396d(b).

(i) If imposed as a category 2 remedy, the Department shall deny the federal share of Medicaid payments for those residents affected by the deficiency(ies).

(ii) If imposed as a category 3 remedy, the Department shall deny the federal share of Medicaid payments for all Medicaid residents of a facility.

(iii) Payments that are denied shall not be retroactively paid to a facility.

(p) "Denial of payment for new admissions." The denial of Medicaid payments for all recipients admitted to a facility after a specified date. Payments that are denied shall not be retroactively paid to a facility.

(q) "Department." The Wyoming Department of Health, its agent, designee or successor. The Department is the single state agency appointed pursuant to 42 U.S.C. § 1396a(a)(5).

(r) "Directed in-service training." Training and education of a facility's staff that is:

(i) Required by the Department;

(ii) In response to a pattern of deficiencies; and

(iii) Is deemed, by the Department, to be likely to correct the pattern of deficiencies.

(s) "Directed plan of correction." A plan of correction developed by the survey agency and implemented pursuant to the supervision of the survey agency.

(t) "Director." The Director of the Department, the Director's agent, designee or successor.

(u) "Division." The Division of Health Care Financing of the Department, its agent, designee or successor.

(v) "Dually participating facility." "Dually participating facility" as defined in 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(w) "Emergency." A situation in which there is a high probability that deficiencies will cause residents immediate serious physical or mental disability, continuation of severe pain or death if not immediately corrected.

(x) "Extended survey." "Extended survey" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(y) "Facility." A nursing facility .

(z) "HCFA." The Health Care Financing Administration of HHS, its agent, designee or succes- sor.

(aa) "HHS." The United States Department of Health and Human Services, its agent, designee or successor.

(bb) "Immediate jeopardy." Immediate jeopardy" as defined in 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(cc) "Informal dispute resolution." A provider's opportunity, upon written request, to dispute the survey findings as set forth in the statement of deficiencies.

(dd) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act and the Wyoming Medical Assistance and Services Act of 1967, as amended.

(ee) "Medicare." The health insurance program for the aged and disabled under Title XVIII of the Social Security Act.

(ff) "Neglect." "Neglect" as defined by 42 C.F.R. § 488.310, which definition is incorporated by this reference.

(gg) "New admission." The admission of a recipient who has never been in a facility or, if previously admitted, ha d been discharged or had voluntarily left the facility. The term does not include:

(i) Residents who were in the facility before the effective date of denial of payment for new admissions, even if they became eligible for Medicaid after that date; or

(ii) Residents who, after a temporary absence, are readmitted to reserved beds.

(hh) "No immediate jeopardy." A situation in which a facility's deficiencies do not pose an imminent threat of serious harm to residents' physical or mental health and safety such that immediate corrective action is necessary.

(ii) "Noncompliance." "Noncompliance" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(jj) "Nursing facility." "Nursing facility" as defined by 42 U.S.C. § 1396r(a), which definition is incorporated by this reference. "Nursing facility" may include a distinct part of a hospital or other institution which is designated to provide nursing facility services.

(kk) "Nursing facility services." "Nursing facility services" as defined by 42 U.S.C. § 1396d(f), which definition is incorporated by this reference.

(ll) "Per diem rate." A facility's per diem rate as established pursuant to Chapter 7.

(mm) "Plan of correction." A written document submitted to and subject to the approval of the survey agency specifying

(i) The corrective action the facility will take to correct deficiencies; and

(ii) A schedule for implementation and completion of the corrective action (the completion date for corrective action may not be more than sixty days after the date of survey, except that if the deficiencies involve substandard quality of care, the completion date for corrective action may not be more than thirty days after the date of survey, unless otherwise agreed to by the survey agency).

(nn) "Provider agreement." "Provider agreement" as defined by Chapter 3, which definition is incorporated by this reference.

(oo)"Recipient." A person who has been determined eligible for Medicaid.

(pp) "Reimbursement of resident losses." The reimbursement by a facility of a resident's per- sonal funds or the value of property owned by a resident when the statement of deficiencies establishes the funds or property have been lost or misplaced as a result of actions by agents or employees of the facility.

(qq) "Remedy." Any of the actions specified in section 3 which the Department may select and impose pursuant to this Chapter to ensure that a facility is in compliance.

(rr) "Requirements of participation." The requirements for long term care facilities as set forth in 42 C.F.R. Subpart B, which requirements are incorporated by this reference.

(ss) "Reserved bed." Beds in a facility reserved for a resident who is temporarily absent when there are no appropriate vacancies in the facility.

(tt) "Resident." A resident of a facility.

(uu) "Standard survey." "Standard survey" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(vv) "Statement of deficiencies." The form, currently HCFA-2567, by which the survey agency notifies a facility of a finding of a deficiency or deficiencies. The statement of deficiencies must include notice of the facility's right to request informal dispute resolution, including the procedures to follow in making such a request.

(ww) "State monitor." An individual, who is an employee or contractor of the survey agency that is appointed by the director, to:

(i) Oversee the implementation of a plan of correction;

(ii) Protect the facility's residents; and

(iii) Report to the survey agency and the Department on whether the facility is operating in compliance with the requirements of participation, properly implementing a plan of correction, or both.

(iv) A monitor shall have no authority to become involved in the actual operation of a facility, except that the monitor may make recommendations to the facility.

(xx) "State Operations Manual (SOM)." The 7000 series of the State Operations Manual as disseminated by HCFA. The SOM is incorporated by this reference. It is available upon request from the survey agency.

(yy) "Submit." To hand-deliver or mail to the Department by certified mail, return receipt requested. If hand-delivered, the date of submission is the date of delivery. If mailed, the date of sub- mission shall be the date of the postmark.

(zz) "Substandard quality of care." Substandard quality of care" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(aaa) "Substantial compliance." "Substantial compliance" as defined by 42 C.F.R. § 488.301, which definition is incorporated by this reference.

(bbb) "Survey." An abbreviated standard survey, an extended survey or a standard survey.

(ccc) "Survey agency." The Office of Health quality of the Department ,its agent, designee or successor.

(ddd) "Temporary absence" or "temporarily absent." "Temporary absence" or "temporarily absent" as defined by Chapter 7, which definition is incorporated by this reference.

(eee) "Temporary manager." An individual appointed to act as temporary nursing home admin- istrator with authority to (except as otherwise specified by the Director):

(i) Hire, terminate or reassign staff;

(ii) Obligate facility funds;

(iii) Alter facility procedures;

(iv) Manage the facility to correct deficiencies; and

(v) Such other duties and responsibilities as assigned by the Director.

(fff) "Termination of Medicaid provider agreement." Making a facility indefinitely ineligible to receive Medicaid reimbursement for providing nursing facility services to recipients.

Section 5. Factors to be considered in selecting remedies. The Director shall consider the factors specified in 42 C.F.R. § 488.404, which is incorporated by this reference, in determining the seriousness of a facility's deficiency(ies) and selecting the appropriate remedy(ies).

Section 6. Available remedies. Remedies are grouped into the following categories pursuant to 42 C.F.R. § 488.408:

(a) Category 1 remedies.

(i) Directed in-service training;

(ii) Directed plan of correction; and/or

(iii) The appointment of a state monitor.

(b) Category 2 remedies.

(i) Denial of Medicaid payments for new admissions;

(ii) Denial of fifty percent of the State share of Medicaid payments for each resident affected by the deficiency(ies);

(iii) Denial of the Federal share of Medicaid payments for each resident affected by the deficiency(ies); and/or

(iv) Reimbursement of resident losses.

(i) Denial of the federal share of Medicaid payments for all Medicaid residents.

(ii) Denial of fifty percent of the State share of Medicaid payments for all Medicaid residents.

(iii) Appointment of a temporary manager.

(iv) Termination of Medicaid provider agreement;

(v) Transfer of residents with assessment of transfer costs; and/or

(vi) Closure of facility and transfer of residents with assessment of transfer costs.

(d) A provider shall not report any costs incurred as any part of a remedy as an allowed cost pursuant to Chapter 7.

Section 7. Selection of remedies.

(a) The Department shall follow the procedures and methods specified in 42 C.F.R. § 488.408, as supplemented by the SOM, both of which is incorporated by this reference, in selecting remedies.

(b) For purposes of selecting remedies, the alternative remedies shall be classified as speci- fied in Section 6, and may be imposed whenever remedies of the specified category are appropriate pursuant to 42 C.F.R. Subpart F, as supplemented by the SOM.

Section 8. Action when there is immediate jeopardy.

(a) When there is immediate jeopardy, the Department shall take action pursuant to 42 C.F.R. § 488.410, as supplemented by the SOM, both of which are incorporated by this reference.

(b) The Department shall follow the procedures specified in 42 C.F.R. § 488.410, as supple- mented by the SOM.

Section 9. Imposition of remedies when there is no immediate jeopardy but the facility is not in substantial compliance.

(a) When there is no immediate jeopardy, but a facility is not in substantial compliance, the Department shall take action pursuant to 42 C.F.R. § 488.412, as supplemented by the SOM, both of which are incorporated by this reference.

(b) The Department shall follow the procedures specified in 42 C.F.R. § 488.412, as supple- mented by the SOM.

Section 10. Imposition of remedies when there is repeated substandard quality of care.

(a) When a facility has been found to have provided substandard quality of care on the last three consecutive standard surveys, the Department shall take action pursuant to 42 C.F.R. § 488.414, as supplemented by the SOM, both of which are incorporated by this reference.

(b) The Department shall follow the procedures specified in 42 C.F.R. § 488.414, as supple- mented by the SOM.

Section 11. Temporary management. The Department adopts the provisions of 42 C.F.R. §488.415, as supplemented by the SOM, both of which are incorporated by this reference, relating to the appointment of a temporary manager.

Section 12. Denial of payments for new admissions. The Department adopts the provisions of 42 C.F.R. § 488.417, as supplemented by the SOM, both of which are incorporated by this reference, relating to the denial of payments for new admissions.

Section 13. State monitoring. The Department adopts the provisions of 42 C.F.R. § 488.422, as supplemented by the SOM, both of which are incorporated by this reference, relating to state monitor- ing.

Section 14. Directed plan of correction. The Department adopts the provisions of 42 C.F.R. § 488.424, as supplemented by the SOM, both of which are incorporated by this reference, relating to directed plans of correction.

Section 15. Directed inservice training. The Department adopts the provisions of 42 C.F.R. § 488.425, as supplemented by the SOM, both of which are incorporated by this reference, relating to directed inservice training.

Section 16. Closure of a facility or transfer of residents, or both. The Department adopts the provisions of 42 C.F.R. § 488.426, as supplemented by the SOM, both of which are incorporated by this reference, relating to the closure of a facility or transfer of residents, or both.

Section 17. Alternative remedies.

(a) The Department has adopted alternative remedies pursuant to 42 C.F.R. § 488.406(a)(8)

(b) Alternative remedies are classified pursuant to Section 6 as category 2 or category 3 remedies.

(i) Alternative remedies classified as category 2 remedies may be imposed whenever the imposition of category 2 remedies is appropriate according to 42 C.F.R. Subpart F. In imposing category 2 alternative remedies, the Department shall follow the procedures of Sections 7510 through 7536 of the SOM.

(ii) Alternative remedies classified as category 3 remedies may be imposed whenever the imposition of category 3 remedies is appropriate according to 42 C.F.R. Subpart F. In imposing category 3 alternative remedies, the Department shall follow the procedures of Sections 7510 through 7536 of the SOM.

Section 18. Duration of remedies.

(a) The Department adopts the provision of 42 C.F.R. § 488.454, which are incorporated by this reference, relating to the duration of remedies.

(b) Alternative remedies. Alternative remedies shall remain in effect until the facility is in substantial compliance as determined by the survey agency, or until the provider agreement is termi- nated.

Section 19. Termination of provider agreement. The Department adopts the provisions of 42 C.F.R. § 488.456, which are incorporated by this reference, relating to the termination of provider agreement.

Section 20. Informal dispute resolution.

(a) Availability. Informal dispute resolution is available whenever the survey agency notifies a facility of noncompliance.

(b) Request. A request for informal dispute resolution shall be made in writing and hand- delivered or mailed by certified mail, return receipt requested, and delivered to the survey agency within ten calendar days after the facility receives a statement of deficiencies.

(c) Conduct of meeting. Informal dispute resolution shall consist of a face-to-face meeting between representatives of the facility and representative of the survey agency.

(d) Scope of informal dispute resolution.

(i) The purpose of informal dispute resolution is to allow a provider an opportunity to demonstrate that deficiencies should not have been cited.

(ii) A facility may not use the informal dispute resolution process to challenge any part of the survey process, including the:

(A) Classification of deficiencies;

(B) Director's choice of remedy(ies) imposed;

(D) Inconsistency of the survey team in citing deficiencies among facilities; or

(E) Inadequacy or inaccuracy of the informal dispute resolution process.

(e) A request for informal dispute resolution shall not delay the imposition of remedies.

Section 21. Readmission.

(a) After termination of Medicaid provider agreement or closure and transfer of residents or voluntary withdrawal, a facility may not participate in Medicaid unless:

(i) The reasons for the termination of Medicaid provider agreement, closure and transfer of residents, or voluntary withdrawal no longer exist;

(ii) There is reasonable assurance that the reasons for the termination of Medicaid provider agreement, closure and transfer of residents, or voluntary withdrawal will not recur; and

(iii) The facility has received a certification of compliance.

(b) Reasonable assurance means, with the exception of physical plant standards, that the facility has demonstrated compliance with the requirements of participation for at least 30 consecutive days immediately prior to readmission. The physical plant standards must be in compliance at the time of readmission.

Section 22. Effect of imposition of Medicare sanctions on dually certified facilities.

(a) Automatic imposition. If a facility is denied participation in, terminated from participa- tion in Medicare, or otherwise sanctioned by Medicare, the Department shall impose the same remedy or remedies for purposes of Medicaid, in accordance with the provisions of 42 C.F.R. § 488.452.

(b) No separate appeal. A remedy imposed pursuant to this Section may not be appealed pursuant to Section 23 of this rule, Chapter I, or any other rules of the Department. The provider's exclusive appeal is pursuant to Medicare procedures in accordance with 42 C.F.R. § 498.

Section 23. Appeal rights.

(a) Request for administrative hearing. A facility may request an administrative hearing at which it may refute the certification of noncompliance upon which the imposition of remedies is based, in accordance with the provisions of 42 C.F.R. § 431, Subpart D. The administrative hearing shall be pursuant to Chapter I and shall be requested by mailing by certified mail, return receipt requested, or personally delivering a written request for hearing to the Department within sixty days of the date the facility receives notice of the imposition of remedies. The request for hearing shall state with specificity the factual basis for the request. The failure to provide such specificity shall result in the denial of the request, with prejudice.

(b) Time of hearing. The administrative hearing shall be held before the effective date of the remedy or within 120 calendar days after the effective date of the remedy.

(c) No stay of remedy. The filing of a request for an administrative hearing shall not stay the effective date of the remedy.

(d) Matters not subject to appeal. A facility may not request an administrative hearing regard- ing:

(i) The scope and severity of noncompliance; or

(ii) The Director's choice of remedy.

(e) Burden of proof. The burden of proof shall be on the facility at an administrative hearing.

Section 24. Superseding effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including Provider Manuals and/or Provider Bulletins, which are inconsistent with this Chapter.

Section 25. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 1995-11-16

Chapter 7 Nursing Facility Payment and Assessment

Wyo. Code R. 048.0037.7.01072026 Nursing Facility Payment and Assessment

CHAPTER 7

NURSING FACILITY PAYMENT AND ASSESSMENT

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter under the Wyoming Medical Assistance and Services Act, Wyoming Statutes §§ 42-4-101 through 42-4-124 and § 42-8-105(b) of the Nursing Care Facility Assessment Act.

Section 2. Purpose and Applicability.

(a) This Chapter applies to payments to and assessments of nursing facilities that provide nursing facility services to clients.

(b) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.

Section 3. Definitions.

(a) Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1 or defined in this Chapter, the terminology used herein has the standard meaning used in healthcare, Medicaid, and Medicare.

(b) "Chapter" - a chapter in the Wyoming Department of Health, Medicaid Rules.

Section 4. General Provisions.

(a) An allowable cost must be reasonable, ordinary, necessary, and related to patient care.

(b) A nursing facility must deliver quality healthcare efficiently and economically.

(c) Except as otherwise specified in this Chapter, the Department determines per diem rates using the methodology set forth in the Medicare Provider Reimbursement Manual ("PRM") and the CMS instructions for administering the PRM. The PRM and the CMS instructions are incorporated by reference and are available from the CMS.

(d) The Department calculates per diem rates for nursing facilities using a combination of a cost-based system and a fixed price system.

Section 5. Cost Report.

(a) Deadline. A certified cost report for each nursing facility must be submitted to the Department by the end of the fifth month following the nursing facility's fiscal year end.

(i) The Department may grant one thirty-day extension of the submission deadline if a nursing facility provides good cause for the extension in writing before its submission deadline.

(ii) A cost report is deemed complete when the Department receives the certified cost report with all of the required documentation.

(iii) If the Department does not receive a nursing facility's complete cost report within ten days after the deadline, the Department shall reduce the nursing facility's per diem rate by 25% until the nursing facility submits its complete cost report or the Department suspends payment to the nursing facility.

(iv) If the Department does not receive a nursing facility's complete cost report within sixty days after the deadline, the Department shall suspend all Medicaid payments to the nursing facility until the Department receives a complete cost report from the nursing facility.

(v) The Department may pay the nursing facility the suspended payments without interest.

(vi) Reduction and suspension of per diem rates do not affect any of the Department's other rights or remedies.

(vii) A nursing facility that closes or changes ownership is not required to submit a cost report if that cost report will not be used to calculate a rate.

(b) Attachments. The nursing facility must attach a copy of each of the following documents in which it is a party to the cost report.

(i) Contracts involving the purchase of a facility or equipment during the last seven years, unless previously submitted;

(ii) Contracts with an owner or other entity related to the nursing facility, unless previously submitted;

(iii) Leases of real or personal property, unless previously submitted;

(iv) Management contracts, unless previously submitted;

(v) Mortgages or loan agreements, unless previously submitted;

(vi) Working trial balance used to prepare the cost report with line number tracing notations or similar identifications;

(vii) Audit, review, or compilation statements prepared by an independent accountant that includes the nursing facility costs or allocation of costs to the nursing facility, including disclosure statements and management letters or SEC 10-K forms;

(viii) Home office cost statements;

(ix) Current Medicare cost report;

(x) Wyoming Financial Report for Long Term Care, a supplemental cost reporting form specific to the Medicaid program; and

(xi) Any other documents requested in writing by the Department that relates to the provision of services, the submission of claims for payment, or a nursing facility's cost reports.

(c) Cost reporting method. A nursing facility may change its cost reporting method only if, prior to the end of the cost reporting period, it requests the change in writing, and the Department approves the change. The Department must not withhold approval if the change can reasonably be expected to result in more accurate reporting.

(d) Fiscal period. A nursing facility must use the same fiscal period as it uses for reporting Medicare costs.

(i) If a nursing facility is not certified by Medicare, it must use the same period it uses for federal income tax reporting.

(ii) A cost reporting period of less than six months must not be used to calculate a nursing facility's rate.

(e) Setting per diem rate. The Department will set a nursing facility's per diem rate within ninety days of the Department's receipt of a complete cost report

(f) Certification of cost reports.

(i) Misrepresentation or falsification of any information contained in a cost report may be punishable by a fine and/or imprisonment under state or federal law.

(ii) Each cost report must include the following certification signed by an authorized agent of the nursing facility:

I certify that I have reviewed the foregoing cost report for the fiscal year beginning ________, 20, and ending ________, 20, including all required documentation and, to the best of my knowledge and belief, it is an accurate and complete report prepared from the books and records of the nursing facility in accordance with standard accounting principles and applicable instructions, except as specifically noted and explained in the cost report. Additionally, an accurate copy of all required documentation is attached to the cost report.

Signature Title Date

Printed name

Section 6. Joint Use of Resources.

(a) Each nursing facility must keep its revenues, expenses, and statistical and financial records separate and clearly identified. If a nursing facility does not comply with this rule, commingled costs are disallowed for purposes of all involved nursing facility's per diem rate.

(b) A nursing facility must allocate pooled costs reasonably and in conformance with GAAP. A pooled cost is allowable only to the extent that the pooled cost is incurred in providing patient-related services and the nursing facility can demonstrate that pooled cost improves efficiency, economy, or quality of care. Allowable pooled costs may be reported as an operating cost.

(c) Direct patient service costs incurred by multiple nursing facility organizations may be reported in the health care component if the service was rendered to the client at the nursing facility and is separately identified, rather than allocated, in the provider's accounting records. Patient service costs which do not meet these criteria must be reported in the operating cost component.

Section 7. Per Diem Rate for New Nursing Facilities and When Ownership Changes.

(a) New nursing facility. A new nursing facility is a newly constructed nursing facility that did not previously exist, a newly designated portion of a hospital which was not previously designated as a nursing facility, or an existing facility which was not previously certified. An addition to a certified nursing facility is not a "new facility." An existing nursing facility that constructs a new building to move into is not a new nursing facility but the new building may be subject to a re-age adjustment.

(i) A new nursing facility per diem rate is calculated as follows:

(A) Healthcare portion of rate. The same starting price as applied to other nursing facilities with a quarterly case mix adjustment using the new nursing facility's case mix scores will be applied. If the nursing facility does not have qualifying case mix data at the time per diem rates are calculated, the healthcare portion is calculated using the statewide Medicaid average case mix score from the prior quarter.

(B) Capital portion of rate. A property rental rate based on the age of the building is applied. If the age cannot be determined at the time of rate setting or if the nursing facility does not supply requested data to calculate the age of the property, a property rental rate based on a 40 year old building is applied. This rate will not be adjusted retrospectively if a nursing facility supplies the requested data after the rate setting period. The rate will be adjusted at the next rate setting quarter if the nursing facility timely supplies the requested data.

(D) Operating portion of rate. The same fixed price applied to other nursing facilities that quarter is applied.

(ii) A new nursing facility's rate will be calculated in this manner until the nursing facility has a qualifying cost report that has been audited. At that time, the qualifying cost report will be used to set its rate effective with the July 1 rate cycle.

(b) Change of Ownership.

(i) When a nursing facility changes ownership, its per diem rate is calculated as follows:

(A) Healthcare rate. The new owner will receive the same starting price as all other facilities with a quarterly case mix adjustment using the new owner's case mix scores. If the new owner does not have the qualifying case mix data at the time per diem rates are calculated, the healthcare costs will be calculated using the prior owner's Medicaid average case mix score from the most recently available quarter.

(B) Capital rate. The new owner assumes the building age used for the property rental rate from the prior owner.

(C) Exempt rate. The new owner will assume the exempt portion of the per diem rate using the most currently available audited data from the prior owner.

(D) Operating rate. The same fixed price applied to other nursing facilities that quarter is applied.

(ii) The rate will be calculated in this manner until the nursing facility has a qualifying cost report that has been audited. At that time, the qualifying cost report will be used to set its rate effective with the July 1 rate cycle.

(iii) Record keeping. The former owner is responsible for maintaining all medical and financial records for one year after the date of the change of ownership. If the nursing facility is involved in an audit or administrative or judicial proceedings which require access to such records, the former owner must maintain the records for one year after completion of all proceedings, including any applicable appeal periods.

(c) Effective dates of per diem rates. Per diem rates are established prospectively and shall remain in effect from the rate effective date until re-determined pursuant to this rule.

Section 8. Reserve Bed Days.

(a) Medicaid will not pay for reserve bed days.

(b) A nursing facility may not bill a client or the client's family for reserved bed days unless the nursing facility informed the client in writing before the period for which payment is sought of the client's option to personally pay to hold the bed.

Section 9. Cost Categories.

(a) General requirements. Costs are allocated among the following categories: (1) healthcare; (2) capital; (3) exempt; and (4) operating. For purposes of this Chapter, labor costs include the cost of employee benefits and taxes. Supplies used in providing patient-related services include, but are not limited to, those specified in Attachment A.

(b) Healthcare costs. Healthcare costs consist of direct costs of patient-related services rendered within a nursing facility. Healthcare costs are subject to a quarterly case mix acuity adjustment. Healthcare costs include, but are not limited to:

(i) Entering and maintaining medical records;

(ii) Providing social services;

(iii) Providing direct nursing healthcare by:

(A) Registered nurses;

(B) Licensed practical nurses;

(D) Contract nurses.

(iv) Payroll taxes and employee benefits associated with the wages above.

(i) Leasehold amortization;

(ii) Rent and lease of real property;

(iii) Depreciation; and

(iv) Interest on loans for real property and personal property.

(d) Exempt costs. Exempt costs include, but are not limited to:

(i) Property taxes. Tax penalties, late fees, and income taxes are not allowable.

(ii) Property insurance. Malpractice, workmen's compensation, and other employee- related insurances are not considered property insurance and are not exempt.

(iii) Fees for CNA classes, texts, and exams.

(e) Operating costs. Operating costs include, but are not limited to:

(i) Administrative and general costs including:

(A) Home office; and

(B) Management fees.

(ii) Physical facility operations;

(iii) Laundry;

(iv) Housekeeping;

(v) Cafeteria;

(vi) Dietary;

(vii) Nurse administration;

(viii) Central services, routine supplies, and non legend drugs;

(ix) Pharmacy consultant;

(x) Activities;

(xi) Payroll taxes and employee benefits associated with the wages above;

(xii) Medical director; and

(xiii) Other costs permitted by federal and state rules and regulations not mentioned in (b), (c), and (d) in this section.

Section 10. Capital Costs.

(a) Depreciation.

(i) The depreciation of a tangible asset is an allowable cost if:

(A) The nursing facility currently uses the asset for patient care;

(B) The asset is available for physical inspection; and

(ii) Basis. The basis used to calculate depreciation is the historical cost of an asset which is the cost incurred by the present owner in acquiring the asset and preparing it for its use. Generally, such cost includes costs that are capitalized under GAAP. For example, in addition to the purchase price, historical cost includes architectural fees, consulting fees, and related legal fees.

(iii) Method. Depreciation must be reported on the straight-line method.

(iv) Useful life. Useful life is determined in accordance with the most recent edition of Estimated Useful Lives of Depreciable Assets, as incorporated by reference and published by the American Hospital Association.

(v) If a single asset or collection of like assets acquired in quantity, including permanent betterment or improvements, has at the time of acquisition an estimated useful life of at least two years and historical cost of at least the minimum amount utilized by Medicare for cost reporting, the cost must be depreciated over the useful life of the asset.

(vi) Assets that do not qualify for depreciation must be included expenses in the year acquired.

(vii) Donated assets.

(A) Definition. An asset is donated to the extent the nursing facility acquired the asset without paying fair market value in cash, property, or services.

(B) Basis. The basis of donated assets, except for donations from an entity related to the nursing facility, is the asset's fair market value minus the value the nursing facility paid for the asset. If the fair market value of the asset is over $2,000.00, the basis is the lesser of the appraised value and the fair market value. If the donor is related to the nursing facility, the basis is the lesser of the donor's net book value and fair market value.

(b) Permanent Financing Interest. Permanent financing interest is financing attendant to the acquisition of patient-related tangible assets.

(i) Allowable cost. Permanent financing interest incurred on patient-related real property, improvements to real property, buildings, building components and equipment is an allowable cost subject to the limitations of this subsection.

(ii) Investment income offset. Allowable interest must be reduced by investment income pursuant to the PRM.

(iii) Cost reporting requirement. Interest expense must be supported by a written loan agreement showing that funds were borrowed, payment of interest and repayment of principal is required, and funds were used to purchase patient-related real property, buildings, building components, or equipment. The lender, purpose, principal amount, terms, and interest rate must be identifiable in the nursing facility's financial records.

(c) Lease and rental expense. Lease and rental expenses incurred on patient-related real property, buildings, building components, or equipment are an allowable cost subject to the limitations of this section.

(d) Related entities. If a nursing facility rents, leases or purchases patient-related real property, buildings, building components, or equipment from an entity related to the nursing facility, the cost must be adjusted to the actual cost incurred by the related entity.

(e) Amortization of leasehold improvements.

(i) Allowable cost. Lease or rental expenses incurred on patient-related real property, buildings, building components, or equipment are an allowable cost subject to the limitations of this section.

(ii) Amortization of leasehold improvements must be calculated and reported in accordance with GAAP and are a capital cost.

(iii) Amortization of organizational cost must be reported as an operating cost.

Section 11. Working Capital Interest. Working capital interest is patient-related financing other than permanent financing.

(a) Interest on a working capital loan is an allowable cost only if the loan was incurred to provide patient-related services.

(b) Interest on a working capital loan must not exceed the actual reported interest less any investment income revenue.

Section 12. Cost of Services and Supplies not Included in the Per Diem.

(a) Services and supplies which are not included in the per diem rate include, but are not limited to:

(i) Ambulance services;

(ii) Audiology services;

(iii) Barber and beauty shop services other than routine personal hygiene items and services;

(iv) Cigarettes, cigars, pipes and tobacco;

(v) Clothing;

(vi) Cosmetics;

(vii) Dental services (unless under purchase for service contract);

(viii) Dry cleaning;

(ix) Eye examinations and other optical supplies and services;

(x) Hearing aids;

(xi) Hospital services;

(xii) Laboratory services;

(xiii) Orthotic services;

(xiv) Physician services;

(xv) Podiatry services;

(xvi) Prosthetic devices; and

(xvii) Customized wheelchairs that are fitted or fabricated to a specific individual and cannot be used by any other person, and electric wheelchairs.

(b) The cost of services and supplies not included in the per diem rate must be removed from patient-related costs.

(c) Costs not related to patient care are costs that are not appropriate or necessary and proper in developing and maintaining the operation of patient care facilities and activities. Costs which are not necessary may include, but are not limited to, costs that are not usual, common, and accepted occurrences in the field of the provider's activity.

(d) The method of removal depends on a provider's accounting and other records. If a provider has adequate segregation in accounting records, such adjustment must be based on the cost of services or supplies not included in the per diem rate. If a provider does not maintain adequate cost segregation or if such accounts cannot reasonably be subjected to normal audit procedures, then the related revenue must be used as an adjustment to patient expense, provided the related revenue amount is reasonably equal to or greater than cost. If these conditions are not met, the entire group of aggregated ancillary or other revenue accounts, or aggregated ancillary or other cost accounts, if greater, must be used as an offset to patient expenses.

Section 13. Per Diem Rate Period.

(a) A nursing facility's per diem rate is effective on July 1 of each year and may be adjusted quarterly in accordance with its acuity case mix.

(b) A per diem rate is in effect until the Department sets a new per diem rate which, in addition to a quarterly acuity case mix adjustment, may be the result of a desk review, field audit, change in federal or state law that causes an increase in healthcare costs, or legislative budget change.

(c) The data used to calculate the per diem rate effective each July 1 is from the cost reporting period that ended two calendar years prior.

(d) The Department will notify nursing facilities of the per diem rate.

(e) If the Department sets an interim per diem rate, any amounts the Department paid which exceed the final per diem rate are overpayments and recoverable by the Department. If the interim per diem rate is less than the final per diem rate, the Department will pay the difference to the nursing facility within sixty days.

(f) For any nursing facility operated under Public Law 93-638 status, payment is solely a per diem rate established and updated annually per the percentage increase from the published OMB rate from the applicable year. Nursing facilities operated under Public Law 93-638 must still submit a cost report unless the Department notifies the nursing facility that it is no longer necessary.

Section 14. Creation of Database.

(a) Each year the Department will create a database from each nursing facility's cost report used to compute the nursing facility's most recent per diem rate.

(b) The database will separate costs from reviewed or audited cost reports into the categories for (1) healthcare costs; (2) capital costs; (3) exempt costs; and (4) operating costs.

(c) Nursing facilities will be grouped by bed range group and into ranges based on the number of licensed beds. Costs will also be grouped by these same ranges.

Section 15. Price and Rate Setting - Legislative Appropriation.

(a) Payment is a combination of a prospective fixed price system and a cost-based system with the healthcare costs subject to an acuity adjustment. The budget will be used to set the cost and price based rates as follows:

(i) Property Price. The first round of legislative allocations will be used to determine the reimbursement necessary to fund the price-based property rental rate system.

(ii) Exempt Cost Per Diem. The second round of allocations will be to determine the amount necessary to fund the exempt costs.

(iii) Healthcare and Operating Prices. The balance of the appropriation will be used to fund healthcare and operating categories. The balance of the appropriation will be allocated between the operating and health care categories based on the statewide total percentage of audited or desk reviewed costs classified to these categories.

(A) The operating price will be the same price for all nursing facilities regardless of their cost.

(B) The healthcare price will begin with the same price to all nursing facilities, regardless of their cost. Each nursing facility's starting price will be further adjusted up or down based on the nursing facility's case mix acuity score for each quarter.

(b) Per diem rates will be further adjusted by bed range group. Each group will receive a percentage adjustment so the resulting cost coverage averages of each group are within a maximum deviation of 5% of each other.

Section 16. HealthCare Case Mix Acuity Adjustment.

(a) Healthcare prices will be paid using a starting fixed price that is the same for all facilities. The fixed price will be adjusted for each individual nursing facility on a quarterly basis based on each nursing facility's Medicaid case mix index to reflect the case mix of that nursing facility's Medicaid residents in a certain quarter. The case mix adjustment will be calculated by taking the fixed starting price times each nursing facility's weighted average Medicaid case mix index divided by the statewide average Medicaid case mix index for each quarter.

(b) Applicable Case Mix Index (CMI). The Medicaid CMI used in establishing each nursing facility's rate is calculated based on the weighted average assessment for each Medicaid resident in the nursing facility in the prior quarter where an MDS assessment was completed and successfully transmitted to the QIES ASAP system.

(i) The CMI is recalculated quarterly and each nursing facility's healthcare component rate is adjusted accordingly.

(ii) In the event that a nursing facility's Medicaid CMI is zero, the nursing facility's average case mix score from the most recent quarter will be used. If there is no data for the previous quarters, they will receive the statewide average Medicaid case mix index score from the prior quarter.

(c) Minimum Data Set (MDS). A set of screening, clinical, and functional status elements, including common definitions and coding categories, that forms the foundation of the comprehensive assessment for all residents of long-term care facilities certified to participate in Medicare or Medicaid. The version of the assessment document used for rate setting is version 3.0. Subsequent versions of the MDS will be evaluated and incorporated into rate setting as necessary.

(d) Case Mix Index (CMI). A numeric score assigned to each nursing facility resident, based on the resident's physical and mental condition that projects the amount of relative resources needed to provide care to the resident.

(i) The Department will use the Patient Driven Payment Methodology (PDPM) case mix classification methodology. The nursing facility case mix classifications will be used to calculate rates.

(ii) For the July 1, 2015 rate quarter, the case mix weight will use the most current MDS assessment for all Medicaid residents as of April 1, 2015. Beginning with the October 1, 2015 quarter and all subsequent quarters, the case mix weight for each resident of a nursing facility for each prior quarter is based on data from MDS assessments completed for the resident and accepted into the QIES ASAP System and weighted by the number of days the resident assessment was in each case mix classification group.

(A) A default case mix group will be established for cases in which the resident dies or is discharged prior to completion of the resident's initial assessment. The default case mix group and case mix weight for these cases will be designated by the Department.

(B) A default case mix group will also be established for cases in which there is an untimely assessment for the resident. The default case mix group and case mix weight for these cases must be designated by the Department.

(iii) The nursing facility Medicaid case mix average will be determined by multiplying the case mix weight of each Medicaid resident by the number of days the resident was at each particular case mix classification group, and then averaging.

(A) The payment source for a resident assessment is considered to be Medicaid if the assessment is a non-PPS assessment where MDS item A0700 Medicaid Number is submitted with a valid Medicaid number.

(B) State-Wide Average Medicaid Case Mix Index. The simple average of all nursing facilities Medicaid case mix indexes used in establishing the reimbursement limitation each quarter.

(e) Nursing Facility: MDS Reviews. The following Minimum Data Set (MDS) reviews will be conducted.

(i) Prior to each rate quarter, the Department will send each nursing facility a preliminary report of its resident roster, a listing of residents' assessments, PDPM Nursing Component classification, number of days for the PDPM classification, case mix index, and payment source. The nursing facility must review the preliminary report and submit missing assessments or corrections to the QIES ASAP system prior to the final rate determination.

(ii) If the Department finds errors in the MDS data that result in an incorrect case mix index, the nursing facility's rate will be retroactively adjusted, for all quarters containing the incorrect assessment, and the Department will determine what amount is due to or from the nursing facility. This does not include residents who received the default classification due to incomplete or inconsistent MDS data.

Section 17. Real Property Rental Rates.

(a) A nursing facility will be paid a rental rate for the building(s) in which it operates. The property rental rate is paid in lieu of payment for capital costs defined in Section 9. The property rental rate does not reimburse for property taxes and property insurance. Property taxes and property insurance will be paid as an exempt cost as defined in Section 9.

(b) A property rental rate is determined using building age as of July 1, 2015. After the building age is determined, the adjustment is applied to the rate calculation based on the table below.

(d) Annually on July 1, the age of each building age will be further adjusted by the percentage change published in the Marshall Swift Index. The percentage change will be determined using in the "Annual Cost Changes" published in the "Current Building Cost Indexes" section of the Marshall Swift Valuation service publication, or its successor. The Annual Cost Changes category used will be for the Western Region, Class D, Nursing Home (convalescent hospital) group in the most recent publication available of the Marshall Swift Index or its successor at the time of rate setting will be used for the annual rate adjustment.

(e) Age of the building. If a building was assigned an age based on the results of a capital cost survey that was conducted in 2013 and updated in 2015, the assigned age as adjusted in accordance with this section will be used to determine the rental rate for the building.

(f) The rental rate for buildings with an adjusted age greater than forty years will be set as a forty year old building.

(g) Age of Building for New Providers.

(i) The age of a building is determined based on reliable documentation the nursing facility submits to the Department that shows the building's historical construction date, square footage, and costs of material capital additions.

(ii) If the nursing facility does not submit reliable documentation thirty days before the beginning of the next rate adjustment quarter, the building age will be set at forty years. If the nursing facility submits reliable documentation of the building's age, the Department will accordingly adjust the building's age at the next rate adjustment quarter.

(h) The effective age of a building may be adjusted based on major repairs, replacement, remodeling, or renovation to the building.

(i) It is the nursing facility's responsibility to notify the Department within one year of completion of any major repairs, replacement, remodeling or renovation of the building. The notification must be in writing with documented costs, square footage, and any other items needed for the review at least 45 days prior to the next rate adjustment quarter.

(ii) Re-age adjustments will be effective on the first day of the next rate adjustment quarter after the re-age calculation was completed. The re-age adjustment shall not apply retroactively.

(iii) A building will not qualify for a re-age adjustment until all of the costs have been capitalized and the changes to the building are in service.

(iv) The re-age adjustment is calculated using the following formula: R = 40 x E / S x C, where

| R = | Re-age adjustment. | The reduction of age of the facility in years. | | --- | --- | --- | | E = | Actual expenses for the construction | Expenses related to capitalized assets for fixed assets including landscaping, sidewalks, egresses, retaining walls, and parking lots. The total costs must have been incurred within twenty-four (24) months of the completion of the construction. For larger construction projects or additions, 36 months may be granted at the State's discretion. | | S = | Total square footage in the building | Gross square feet including common area at the end of the construction. | | C = | The cost of construction for the building in the year the construction was completed. | Source is from costs published by Marshall & Swift Valuation Service or its successor. Costs reflect current construction costs for average Class D Nursing Home (convalescent hospital) using the most current publication. If the publication is late at the time of rate setting, the prior year amount will be inflated forward using the "Annual Cost Changes" figure identified in Section 18 (d). |

(v) If the result of this calculation is "R" is equal to or greater than 1.0, the age of the building in years will be reduced by this number, rounded to the nearest whole number for rate setting purposes. In no case will the age be less than zero.

(vi) The beginning age of a building minus the re-age adjustment is the "re-age adjusted building age." This age is used to select the rental rate based on the age of the building.

(i) If at the time the July 1 rates are being calculated using the base year building adjusted to the current rate year results in total property rental rate that is more than 10% of the total allocated budget, the property rental rates will be rebased to a lower amount to shift more funds to the healthcare costs and operating costs.

Section 18. State-Owned Nursing Facilities. Any state-owned nursing facility is subject to this Chapter with the exception of rate and price setting.

(a) State-owned nursing facility data will not be included in the nursing facilities database.

(b) A state-owned nursing facility per diem rate is calculated using either its desk reviewed or audited cost report. Costs are not subject to any cap or maximum rate.

(c) Per diem rates for state owned nursing facilities are calculated by inflating the audited or desk reviewed costs from the midpoint of the nursing facility's cost reporting year to the midpoint of the rate year. Inflated costs will be divided by total patient days to set the state-owned nursing facility per diem rate.

(d) The inflation factor is the Skilled Nursing Facility (SNF) Market Basket as published quarterly by DRI/Global Resources or its successor.

(e) In times of hiring difficulties where the state must use contract staffing or in periods of low occupancy which cause a nursing facility to operate at a significant budget deficit, the Department can increase the state-owned nursing facility per diem rate in accordance with the distressed nursing facility procedures.

Section 19. Extraordinary Care Clients.

(a) The Department and a nursing facility may negotiate to provide skilled nursing facility services and special equipment and staffing that is medically necessary and preauthorized by the Department, but not included in the services provided by nursing facility's per diem rate. Payment will be the nursing facility's per diem rate, plus the negotiated extraordinary care rate.

(i) The only items that may qualify for an extraordinary care rate are:

(A) Tracheostomy;

(B) Ventilator;

(D) Psychiatric care for clients with significant behaviors that cannot otherwise be safely cared for in a standard nursing facility setting without increased staffing or special accommodations, including clients with significant physical aggression, delirium and/or psychosis; or

(E) Case by case situations where the Department determines a condition requires special care or clinically complex care.

(ii) The Department will negotiate with nursing facilities on a case-by-case basis to determine the extraordinary care rate and billing procedures for an extraordinary care client.

(iii) Prior to negotiations, the nursing facility must submit to the Department:

(A) A treatment plan;

(B) A proposed extraordinary care rate, including relevant financial records and medical records that document the medical necessity for services provided to an extraordinary care client; and

(iv) The Department must reevaluate the condition of an extraordinary care client fifteen days after admission, again thirty days after admission, again ninety days after admission, and every six months thereafter.

(v) The Department must review the extraordinary care client's records annually to determine if renegotiating the extraordinary care rate is necessary to reflect changes in the extraordinary care client's condition.

(b) The extraordinary care rate must not exceed the actual cost of the services provided to the extraordinary care client.

(c) The nursing facility must maintain records of the costs it incurs in furnishing services to each extraordinary care client. Costs related to services furnished to extraordinary care clients, other than nursing facility services, are not allowable costs for purposes of determining the nursing facility's per diem rate.

Section 20. Distressed Facilities.

(a) The Department may pay a contracted rate to a distressed nursing facility. The contracted rate may exceed the nursing facility's per diem rate but must not exceed the lesser of:

(i) The Medicare rate "PDPM Case-Mix Adjusted Federal Rates and Associated Indexes—RURAL" as recorded in the Federal Register; or

(ii) A max percentage cap which must not exceed 200% of the nursing facility's per diem rate.

(b) The Department must consider the criteria below:

(i) Factors:

(A) Financial stability and solvency of the nursing facility;

(B) Occupancy (low occupancy as a percentage of capacity or

drops quickly) of the nursing facility;

(D) Geographic location of the nursing facility.

(ii) Objectives:

(A) Decrease official and unofficial complaints;

(B) Maintenance or improvement of nursing facility survey

results;

(D) Avoidance of client abandonment by the dissolution or insolvency of the distressed nursing facility.

(c) The Department will negotiate with providers determined to be in distress on an individual basis to determine whether a contracted rate is appropriate for that nursing facility, using the Department's distressed facility criteria.

(i) Prior to negotiations, a nursing facility must submit to the Department, in the format prescribed by the Department:

(A) All relevant financial records and medical records which demonstrate the distressed status of the facility;

(B) A proposed method of monitoring and building overall census; and

(C) The additional cost the nursing facility will reasonably and necessarily be incurring to maintain required daily operations in compliance with all State and Federal provisions.

(ii) If the Department requests, the nursing facility must furnish additional information to document the distressed status and added costs.

(iii) The contracted rate will be agreed upon by the nursing facility and the Department for the maintenance of daily operations focused on client health and safety. The contracted rate applies to all Medicaid clients in the nursing facility unless otherwise stated.

(iv) The Department may establish monitoring criteria and procedures to determine whether the nursing facility continues to maintain client health and safety.

(v) If the Department determines that the client's health and safety are not being maintained in accordance with State and Federal standards, the Department must suspend the nursing facility's temporary rate contract and work with the Office of Healthcare Licensing and Survey to take appropriate action. The contracted rate will be the rate set for a new owner of a distressed nursing facility Upon expiration of the contracted rate, the nursing facility may request up to an additional six months at the contract rate. The Department may extend the contract rate for up to six additional months or terminate the contract rate. A provider can only request to be designated as a distressed rate and receive the temporary rate 12 months within a 5-year period.

(d) The contract rate is an all inclusive per diem rate for all services and supplies furnished by the nursing facility, except as otherwise specified in this Chapter or the contracted rate agreement.

(e) The contracted rate must not exceed the nursing facility's actual costs.

(f) The Department's refusal to agree to a contracted rate requested by a nursing facility is not an adverse action for purposes of Wyoming Department of Health, Medicaid Rules.

Section 21. Nursing Care Facility Assessment Act.

(a) Nursing facility adjustment payments to nursing facilities based on the upper payment limit calculation. The Department will make adjustment payments to nursing facilities under the provisions of the Nursing Care Facility Assessment Act, Wyo. Stat. Ann. §§ 42-8-101 through 109.

(i) Adjustment payments will be calculated prospectively on an annual basis to be effective from October 1 through September 30 of each year. The adjustments will be paid quarterly. A new nursing facility opening during that assessment year will not be included in the program until the next assessment year.

(ii) The quarterly adjustment payments will be due to the providers not later than thirty days after the end of each calendar quarter.

(iii) If a nursing facility changes ownership, beginning at the start of the calendar quarter following the date of the change of ownership, the new owner will collect the adjustment payment that was calculated using the prior owner's data. If a nursing facility changes ownership mid quarter, the adjustment payment goes to whoever owns the nursing facility at the end of the quarter.

(iv) Adjustment payments will be calculated based on Medicaid days paid by the Wyoming Medical Assistance Program.

(A) Wyoming Medicaid days will be collected for the dates of service represented in cost reports ended in the calendar year that precedes the assessment effective each October 1. The Medicaid days will be generated by the Department from their MMIS payment system.

(B) For a new nursing facility that opened prior to the October 1 annual calculation that does not have either a full year cost report or a qualifying cost report, resident days will be determined using more current information and will be annualized.

(v) State owned nursing facilities are exempt from this program.

(b) Nursing facility assessment payable to the Department. The Department will collect an assessment from nursing facilities under the provisions of the Nursing Care Facility Assessment Act, W.S. § 42-8-101 through 109.

(i) Assessments will be calculated prospectively on an annual basis to be effective from October 1 through September 30 of each year. The annual assessments will be paid quarterly. A new nursing facility opening during that assessment year will not be included in the program until the next assessment year.

(ii) The quarterly assessments will be due to the Department no later than forty-five days after the end of each calendar quarter.

(iii) If a nursing facility changes ownership, beginning with the quarter following the date of the change of ownership, the new owner will assume the payment schedule calculated using prior owner's data. If it is not clear to the Department which owner is responsible for the assessment, the owner who received the quarterly adjustment payment will be responsible to pay the Department for the assessment related to that same quarter.

(iv) Assessments will be calculated based on a per-resident day basis, exclusive of Medicare resident days.

(A) Resident days will be collected from the Wyoming Nursing Home Reimbursement System, Financial Report for Nursing Homes (cost report) that ended in the calendar year that precedes the assessment effective each October 1. The Department will revise its cost report form to collect the appropriate patient day data. Until the revised cost report forms are in use and have been filed with the Department, the Department will utilize a provider survey to gather the necessary data.

(B) If a new nursing facility opened prior to the October 1 annual calculation that does not have either a full year cost report or a qualifying cost report, resident days will be determined using more current information and will be annualized.

(v) Assessment expenses must be reported on the State of Wyoming Financial Report for Nursing Homes annual cost report. Expenses must be reported on schedule B of this same cost report. For nursing facilities who do not file a Medicare cost report, assessment expenses shall be reported on line 578 of the State of Wyoming Financial Report for Nursing Homes annual cost report.

(vi) State owned facilities are exempt from this program.

Section 22. Medicaid Allowable Payment for Medicaid Program Services.

(a) Any Medicaid program service other than nursing facility services allowable within this Chapter will be paid according to the rules and policies of the Department for that specific program.

(b) The Department will annually pay non-State-owned nursing facilities that qualify for nursing facility gap payments pursuant to Wyoming Medicaid state plan section 4.19-D incorporated herein by reference.

Section 23. Client's Responsibility. If a client has a patient responsibility, the amounts calculated by the Department must be communicated to the nursing facility and the client. Those assigned amounts must be used each month. No additional charges beyond assigned patient responsibility shall be assigned to the client.

Section 24. Change in Provider Status.

(a) If a nursing facility's participation in the Medicaid program is terminated or suspended for any reason, it must submit a cost report for the period ending with the effective date of the termination or suspension if that cost report is needed for rate setting. The cost report is due within forty-five days after the date of termination or suspension, regardless of the nursing facility's tax period. The final month's payment due a nursing facility will be withheld until its cost report is filed and the Department has a reasonable time to perform a desk review and field audit of the cost report and patient funds account.

(b) Change of ownership.

(i) The parties to a transaction involving a change of ownership of a nursing facility must notify the Department in writing of the proposed transaction at least thirty days before the effective date of the change.

(ii) Upon a change of ownership, all parties to the transaction shall have thirty days after the change to complete and sign a representation statement, in written form specified by the Department, which details the persons or entities which have assumed the assets and liabilities of a nursing facility. If a representation statement is not timely submitted, both the original provider and any subsequent provider shall be jointly and severally responsible for all Medicaid liabilities which exist either before or after the change of ownership.

(iii) Once a change of ownership has occurred, the previous owner will no longer be able to bill for dates of service beginning the date of the change in ownership. Rate and assessment letters will not be distributed to a new owner until the new owner completes enrollment, and the Department approves the change.

Section 25. Payment of Out-of-State Provider.

(a) The payment rate for an out-of-state nursing facility providing services to a Wyoming client is the lesser of:

(i) The Medicaid per diem rate the nursing facility receives on July 1 of the rate year for the same or similar services from the most recently available rate for the Medicaid program in the state where the nursing facility is located;

(ii) The average Medicaid day weighted average rate in effect in Wyoming as of July 1 of the rate year that the provider needs a rate calculated; or

(iii) The nursing facility's usual and customary rate.

(b) The average Medicaid day weighted average rate in effect shall be determined by:

(i) Multiplying the number of Medicaid days in each nursing facility by each facility's Medicaid per diem rate;

(ii) Adding the products determined pursuant to (i); and

(iii) Dividing the sum determined pursuant to (ii) by the total number of Medicaid days in the state.

(d) An out-of-state nursing facility must submit with each claim a certification of the nursing facility's per diem rate under the Medicaid program in the state where the nursing facility is located and the nursing facility's usual and customary charge.

(e) The calculated rate will remain in effect until the following July 1. Out of state nursing facilities are not subject to quarterly case mix acuity adjustments.

Section 26. Record Retention.

(a) In the event of a field audit, the nursing facility must have available at the field audit location one or more knowledgeable persons who can explain the nursing facility's financial records, the accounting and control system, and cost report preparation, including attachments and allocations, to the auditors.

(b) A nursing facility that is unable to satisfy any of the requirements of this Section will be given a written notice of deficiency and have sixty days after the date of the written notice to correct the deficiency. If, at the end of the sixty days, the nursing facility has not corrected the deficiency, the Department shall withhold 25% of the nursing facility's per diem rate for services provided after the sixtieth day. If, after 120 days from the mailing of the written notice of deficiency, the nursing facility has still not corrected the deficiency, the Department shall withhold all Medicaid payments for services provided after that date. Payment will not be released until the Department determines that the nursing facility corrected the deficiency.

Section 27. Repayment of Credit Balance.

(a) A nursing facility must report a credit balance on its cost report.

(b) Annual request. The Department may request the repayment of any credit balance annually. Such request will be made in writing; and

(i) Delivered by a method with delivery confirmation; or

(ii) By a secure online portal that provides delivery confirmation. The provider must repay the credit balance within sixty days from the date of delivery confirmation.

(c) A provider must repay any credit balance within sixty days after the date the credit balance is identified by the Department or the provider.

Section 28. Non-Allowable Costs.

(a) If a field audit or desk review discloses non-allowable costs or costs for services and supplies not included in the per diem rate, the Department will adjust the per diem rate retroactively to the beginning of the applicable rate period, recover any overpayments, and adjust the per diem rate for the remainder of the rate period.

(i) Costs which are not reasonably related to services included in the per diem rate or which are against public policy, contractual allowances, courtesy discounts, charity allowances, or similar adjustments are adjustments to revenue and are not an allowable cost. Non-allowable costs include, but are not limited to:

(A) Advertising expense (other than help wanted ads and

telephone directory expense);

(B) Attorney fees and other costs associated with negotiations, administrative proceedings, or litigation involving the Department, except as specified in a settlement;

(D) Cost arising from joint use of resources (including central office and pooled cost) not reasonably related to patient care;

(E) Capital costs due solely to changes in ownership;

(F) Costs incurred in transactions with an entity related to the nursing facility by common ownership or control, to the extent that such costs exceed the price of comparable services, facilities, or supplies that could be purchased elsewhere (42 C.F.R. § 413.17);

(G) Costs incurred as a result of enforcement actions taken by the Department pursuant to Chapter 5 in response to nursing facility deficiencies, including costs of directed in-service training, suspended or denied per diem rate payments, reimbursement expenses, transfer costs, and costs relating to state monitoring and/or the appointment of a temporary manager;

(H) Costs not reasonably related to patient care;

(I) Costs associated with ancillary and other services attributable to Medicare Part A or Medicare Part B, including direct and indirect costs:

(I) Ninety percent of these costs are non-allowable costs;

(II) One hundred percent of Medicare bed days are non-allowable costs, and

(III) When determining the capital costs for nursing facilities with occupancy below 90% Medicare days will be computed to reflect Medicare occupancy.

(J) Costs related to the acquisition, establishment, or operation of an in-house pharmacy, other than the reasonable costs of a pharmacy consultant;

(K) Costs related to extraordinary care clients that exceed the per diem rate;

(L) Costs related to hospice services;

(M) Costs (such as legal fees, accounting and administration costs, travel costs, and the costs of feasibility studies) which are related to the negotiation or settlement of the sale or purchase of any capital asset by acquisition or merger for which any Medicaid payment has been previously made;

(N) Federal income and excess profit taxes;

(O) Fees paid to directors and salaries, wages, and fees paid to non-working officers, employees or consultants;

(P) Fund-raising expenses;

(Q) Interest or penalties on federal or state taxes;

(R) Judgments entered against a nursing facility or settlements entered into by a nursing facility arising out of actions or inactions of the nursing facility's agents or employees, including judgments entered against a nursing facility's agent or employee that a nursing facility pays, or settlements involving the nursing facility's agent or employee that the nursing facility pays;

(S) Life insurance premiums for officers and owners and related parties, except the amount relating to a bona fide nondiscriminatory employee benefits plan;

(T) Meals and lodging provided to guests and employees. If the cost cannot be ascertained, the revenue from meals and lodging furnished to guests and employees must be offset against the appropriate cost;

(U) Prescription drugs;

(V) Public relations expenses;

(W) Resident personal purchases;

(X) Return on equity;

(Y) Self-employment taxes;

(Z) Stockholder relations or stock proxy expenses;

(AA) Taxes and assessments;

(BB) Telephone, television, and radio which are located in patient accommodations and which are furnished solely for the personal comfort of patients;

(CC) Value of services (imputed or actual) rendered by non-paid workers or volunteers; and

(DD) Vending machines and related supplies.

(ii) Costs of services or supplies provided by a related entity are allowable at the actual cost incurred by the related entity. If the actual cost can not be determined, the profit percentage from the related entity's records will be used to calculate the profit percentage adjustment to the related party cost.

(b) Unsubstantiated cost.

(i) Upon written request by the Department, a nursing facility must substantiate costs or other information reported on the nursing facility's cost report. The nursing facility must provide in writing, within thirty days after the date of the request, documentation substantiating the costs or information.

(ii) Any cost which a provider cannot substantiate shall be disallowed.

(iii) Substantiation may include, but is not limited to, home office cost statement, resident census, statistical and related information, cost allocations, account analyses, invoices, stock ownership information, related parties' financial information, or subcontractor's financial information.

Section 29. Incorporation by Reference.

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules.

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference is further identified below:

(i) Referenced in Section 4 of this Chapter is Medicare Provider Reimbursement Manual (PRM) and CMS instructions for administering the PRM, incorporated as of the effective date of this Chapter and found at https://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.html.

(ii) Referenced in Section 10 of this Chapter is the Estimated Useful Lives of Depreciable Assets as published by the American Hospital Association, incorporated as of the effective date of this Chapter and found at https://ams.aha.org/.

(iii) Referenced in Section 17 of this Chapter is Title 42 of the United States Code, Ch. 7, Sub Ch. XIX, Section 1396d, incorporated as of the effective date of this Chapter and found at https://www.gpo.gov.

(iv) Referenced in Section 25 of this Chapter is Wyoming Medicaid State Plan, Section 4.19D, incorporated as of the effective date of this Chapter and found at https://health.wyo.gov/healthcarefin/medicaid/spa/.

(v) Referenced in Section 32 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Sub Ch. B, Pt. 413, Subpart A, incorporated as of the effective date of this Chapter and found at https://www.gpo.gov.

CHAPTER 7

ATTACHMENT A

ABD Pads

Adhesive Tape

Aerosol, other types

Air Mattresses, Air P.R. Mattresses

Airway-Oral

Alcohol Plaster

Alcohol Sponges

Alternating Pressure Pads

Applicators, Cotton-tipped

Applicators, Swab-eez

Aquamatice K Pads (Water-heated Pad)

Arm slings

Asepto Syringes

Baby Powder

Bandages

Bandages, Elastic or Cohesive

Band-Aids

Basins

Bed Frame Equipment (for certain immobilized bed patients)

Bed Rails

Bedpans, all types

Beds: Manual, Electric and Clinitron

Bedside Tissues

Bibs

Blood Infusion Sets

Bottle, Specimen

Canes, all types

Cannual, Nasal

Catheter Indwelling

Catheter Plugs

Catheter Tray

Catheter (any size)

Colostomy Bags

Combs

Commodes, all types

Composite Pads

Cotton Balls

Crutches, all types

Decubitus Ulcer Pads/Dressings

Denture Cleaner/Soak

Denture Cups

Deodorants

Diapers

Disposal Under pads

Donuts

Douche Bags

Drain Tubing

Drainage Bags

Drainage Sets

Drainage Tubes

Dressing Tray

Dressing, all types

Enema Soap

Enema Supplies

Enema Unit

Equipment and Supplies for Diabetic Blood and Urine Testing

Eye Pads

Feeding Tubes

Fingernail Clipping and Cleaning

Flotation Mattress or Biowave Mattress

Flotation Pads and/or Turning Frames

Foot Cradle, all types

Gastric Feeding Unit, including bags

Gauze Sponges

Gloves, Unsterile and Sterile

Gowns, Hospital

Green Soap

Hair Brushes

Hair Care, Basic

Hand Feeding

Heat Cradle

Heating Pads

Heel Protector

Hot Pack Machine

Hydraulic Patient Lifts

Hypothermia Blanket

Ice Bags

Incontinency Care

Incontinency Pads and Pants

Influenza Vaccine

Infusion Arm Boards

Infusion Pumps, Enteral and Parenteral

Inhalation Therapy Supplies

Irrigation Bulbs

Irrigation Trays

I.V. Needles

I.V. Trays

Jelly, Lubricating

Lines, Extra

Lotion, Soap and Oil

Massages (by nursing facility personnel)

Mattresses, all types

Medical Social Services

Medicine Dropper

Medicine Cups

Nasal Catheter

Nasal Catheter, Insertion and Tube

Nasal Gastric Tubes

Nasal Tube Feeding and Feeding Bags

Nebulizer and Replacement Kit

Needles (various sizes)

Needles: Hypodermic, Scalp and Vein

Nursing Services (all) regardless of level, including the administration of oxygen and

restorative nursing care

Nursing Supplies and Dressing

Ostomy Supplies: Adhesive, Appliance, Belts, Face Plates, Flanges, Gaskets, Irrigation

Sets, Night Drains, Protective Dressings, Skin Barriers, Tail Closures

Overhead Trapeze Equipment

Over the counter (OTC) drugs, as designated by the Food and Drug Administration

Oxygen, Gaseous and Liquid

Oxygen Concentrators

Oxygen Delivery Systems, Portable or Stationary

Oxygen Mask

Pads

Pitcher

Plastic Bib

Pump, Aspiration and Suction

Pumps for Alternating Pressure Pads

Respiratory Equipment: Ambu Bags, Cannulas, Compressors, Humidifiers, IPPS Machines and

Circuits, Mouthpieces, Nebulizers, Suction Catheters, Suction Pumps, Tubing, etc.

Restraints

Room and Board (semi-private or private if necessitated by a medical or social condition)

Sand Bags

Scalpel

Shampoo

Shaves

Shaving Cream

Shaving Razors

Sheepskin

Side Rails

Soap

Special Diets

Specimen Cups

Sponges

Steam Vaporizers

Sterile Pads

Sterile Saline for Irrigation

Sterile Water for Irrigation

Stomach Tubes

Suction Catheter

Suction Machines

Suction Tube

Surgical Dressings (including sterile sponges)

Surgical Pads

Surgical Tapes

Suture Removal Kit

Suture Trays

Syringes, all sizes

Syringes, Disposable

Tape, (for laboratory tests)

Tape, Non-allergic or Butterfly

Testing Sets and Refills (S & A)

Therapy Services, including specialized rehabilitative services as set forth in 42 C.F.R.

§483.45

Toenail Clipping and Cleaning

Tongue Depressors

Toothbrushes

Toothpaste

Tracheostomy Sponges

Trapeze Bars

Tray Service

Under pads

Urinals, male and female

Urinary Drainage Tube

Urinary Tube and Bottle

Urological Solutions

Walkers, all types

Water Circulating Pads

Water Pitchers

Wheelchairs: Amputee, Geriatric, Heavy Duty, Hemi, Lightweight, One Arm Drive,

Reclining, Rollabout, Semi-Reclining, Standard

History

Effective 2026-01-07

Chapter 10 Pharmaceutical Services

Wyo. Code R. 048.0037.10.04102025 Pharmaceutical Services

CHAPTER 10

PHARMACEUTICAL SERVICES

Section 1. Authority.

This Chapter is promulgated by the Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through -121.

Section 2. Purpose and Applicability.

(a) This Chapter has been adopted to establish the standards and procedures for the provision of and payment for pharmaceutical services under Medicaid. It shall apply to all pharmaceutical services provided on or after the effective date of this rule.

(b) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

Section 3. Definitions. Except as otherwise specified in Chapter 1 of the Wyoming Medicaid Rules or as defined in this section, the terminology used in this chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

(a) "AB Rated." An "AB rated" generic drug product is one that the FDA has determined to be bioequivalent to a branded drug. A generic drug is considered bioequivalent to a branded drug if it contains the same active pharmaceutical ingredient as the branded drug and there is no significant difference in the formulation, quality, and effectiveness of the two (2) drugs.

(b) "Average wholesale price (AWP)." A national average of list prices charged by wholesalers to pharmacies.

(d) "Brand name." The proprietary or trade name selected by the manufacturer, given to a drug, and placed upon a drug, its container, label, or wrapping at the time of packaging.

(e) "Compound Drug." A drug prepared by a pharmacist who mixes or adjusts drug ingredients to customize a medication to meet a patient's individual needs.

(f) "Device." Any article or healthcare product intended for use in the diagnosis of disease or other condition or for use in the care, treatment, or prevention of disease that does not achieve any of its primary intended purposes by chemical action or by being metabolized.

(g) "Drug Efficacy Study Implementation (DESI) drugs." Drugs determined by the United States Food and Drug Administration (FDA) to be less than effective. This definition applies to all drugs that are similar, related, or identical to these drugs pursuant to FDA designation. Compound formulations which contain a DESI drug are considered to be DESI compounds/DESI drugs.

(h) "Drug Utilization Review (DUR) requirements." The Drug Utilization Review Requirements as set forth in Chapter 9 of the Board of Pharmacy Rules and 42 C.F.R. Part 456. A DUR program shall include prospective drug review, retrospective drug use review, and an educational program.

(i) "Federal Upper Limit (FUL)." The maximum amount the federal government (Centers for Medicare and Medicaid Services) will pay for multiple source drugs.

(j) "Food and Drug Administration (FDA)." The Food and Drug Administration of the United States of America, its agent, designee, or successor.

(k) "Local Trade Area." The geographic area surrounding the client's residence, including portions of states other than Wyoming, commonly used by other persons in the same area to obtain pharmaceutical services.

(l) "Gross Amount Due (GAD)." The sum of the submitted product component cost and the dispensing fee submitted by the pharmacy on a prescription claim.

(m) "Ingredient Cost Submitted." The product cost submitted by the pharmacy on a prescription claim.

(n) "Maintenance drug." A covered prescription drug prescribed for a chronic condition (i.e., diabetes, arthritis, high blood pressure, or heart conditions).

(o) "Multiple source drug." A drug marketed or sold by two (2) or more manufacturers or labelers or a drug marketed or sold by the same manufacturer or labeler under two (2) or more different proprietary names.

(p) "National Average Drug Acquisition Cost (NADAC)." A drug price point that is calculated based on average pharmacy acquisition cost of a particular drug.

(q) "National drug code (NDC)." The code number determined for and assigned to a drug by the FDA.

(r) "One month supply." The quantity of drugs sufficient to last up to thirty-four (34) days.

(s) "Pharmaceutical service." Drugs, devices or medical supplies that are covered services, as defined in this Chapter.

(t) "Pharmacist." A person licensed to practice pharmacy by the Wyoming State Board of Pharmacy or a similar board or agency in another state.

(u) "Pharmacy Therapeutics (P&T) Committee." An advisory committee that shall review evidence based research and provide recommendations to the Department as to the clinical effectiveness of a service or medication within a therapeutic drug class.

(v) "Preferred Drug List (PDL)." A list of preferred pharmaceutical substances for selected pharmacologic or therapeutic classes that is maintained by the Department, is designed to maximize clinical and economic outcomes, and is incorporated herein by reference.

(w) "Prescription drug." A drug that is:

(i) Prescribed by a practitioner acting within the scope of his practice; and

(ii) Dispensed by a provider pursuant to a written prescription that is recorded and maintained in the provider's records.

(x) "Wholesale Acquisition Cost (WAC)." The list price paid by a wholesaler, distributor and other direct accounts for drugs purchased from the wholesaler's supplier not including discounts or rebates.

(y) "Wholesaler." An individual or entity that furnishes drugs, medical supplies, or both, to pharmacies or pharmacists.

Section 4. Provider Participation.

(a) Compliance with Chapter 3. An individual or entity that wishes to receive Medicaid funds for pharmaceutical services furnished to a client shall meet the requirements of Chapter 3 of the Wyoming Medicaid Rules.

(b) Eligible pharmaceutical services providers include non-excluded

(i) Pharmacies;

(ii) Pharmacists; and

(iii) Physicians who practice in a local trade area where pharmacy services are not available from a pharmacy or pharmacist and are enrolled as a Medicaid pharmacy services provider. Except as otherwise specified in this Chapter, such a physician shall meet the standards and follow the procedures established for a pharmacist provider.

Section 5. Provider Records.

(a) Compliance with Chapter 3. A provider of pharmaceutical services shall comply with the record-keeping requirements of Chapter 3 of the Wyoming Medicaid Rules.

(b) Additional requirements. In addition to the requirements of Chapter 3, providers of pharmaceutical services shall retain records that include:

(i) Invoices for drugs;

(A) Pharmacies shall be able to supply all drug invoices in the format requested by the Department. This format may include, but is not limited to, paper, electronic, or a format generated and sent by wholesaler.

(ii) Prescriptions;

(A) All prescriptions shall be reduced to writing. Prescriptions for brand name drugs with multi-source generics that are not considered preferred brand name drugs by the Department shall contain the certification "medically necessary," shall be received and on file within thirty days after the oral prescription, and shall meet the requirements of Section 9 of this Chapter;

(iii) A signature log in the form specified by the Department;

(iv) Client account records; and

(v) Copies of claim forms.

Section 6. Verification of Client Data. A provider of pharmaceutical services shall comply with the verification of client data requirements of Chapter 3 of the Wyoming Medicaid Rules.

Section 7. DUR Requirements. A provider of pharmaceutical services shall comply with the Drug Utilization Review (DUR) requirements of 42 C.F.R. Part 456 and Chapter 9 of the Board of Pharmacy Rules.

Section 8. Covered Services.

(a) Prescription drugs. Prescription drugs are covered in the quantity prescribed by a practitioner, subject to the dispensing limitations of Section 9 and the exclusions of Section 11.

(b) Refill of prescription. In addition to the criteria specified in subsection (a), a refill of a prescription shall:

(i) Be authorized by the practitioner who originally prescribed the drug;

(ii) Conform to State and Federal laws governing prescription refills; and

(iii) Be within one (1) year of the date of the original prescription.

(c) Brand name drugs. Non-preferred brand name drugs with multi-source generics shall be certified in writing by the prescribing practitioner as medically necessary.

(d) Compound drugs. Compound drugs shall be paid per line item if each ingredient is a prescription or Over-the-Counter (OTC) drug covered pursuant to subsections (a) and (e) and is not classified by the FDA as a Drug Efficacy Study Implementation (DESI) drug. One (1) dispensing fee is paid per compound prescription.

(e) OTC drugs and medical supplies. Select OTC drugs and medical supplies are covered pharmacy services if they:

(i) Are dispensed to a client who is not a resident of a nursing facility, not admitted as an inpatient or outpatient in a hospital, and not occupying a swing bed;

(ii) Are prescribed by a practitioner;

(iii) Are rebatable OTC drugs;

(iv) Have been assigned a National Drug Code (NDC) number; and

(v) Are medically necessary.

(A) The Department shall, from time to time, designate OTC drugs and medical supplies as covered services based on their therapeutic value, clinical consultation with practitioners, and applicable Centers for Medicare and Medicaid Services (CMS) guidelines. The Department shall disseminate current lists of covered OTC drugs and medical supplies to providers through manuals, bulletins, facsimiles, designated websites, or other appropriate means.

Section 9. Dispensing Limitations.

(a) Generic drugs. Practitioners shall prescribe generic drugs except in the following circumstances:

(i) When a brand name drug is medically necessary and the appropriate prior authorization criteria has been met,

(ii) When there is not an AB rated generic available, or

(iii) When the brand name drug is listed on the Department's preferred drug list as preferred instead of the generic.

(b) Quantities dispensed.

(i) Maintenance drugs.

(A) Minimum quantities. Except as provided in subparagraph (C), maintenance drugs shall be dispensed in a quantity sufficient for at least a one (1) month supply.

(B) Maximum quantities. Maintenance drugs shall not be dispensed in an amount which exceeds a ninety (90) day supply.

(C) Less than a one (1) month supply of a maintenance drug may be dispensed to allow a client to be stabilized on a new or adjusted maintenance drug.

(ii) Oral contraceptives. The maximum quantity of oral contraceptive which may be dispensed is a ninety (90) day supply.

(iii) All other drugs. The maximum quantity dispensed for all other conditions shall be a one (1) month supply unless the Department has designated a minimum days supply for a specific drug that exceeds a one month supply.

(c) Days supply. A prescription's day supply must equal the quantity of drug dispensed divided by the daily dose prescribed. A prescription claim will be subject to subsequent recovery if:

(i) The days supply submitted is not supported by the dosing directions as prescribed, or

(ii) The dosing directions are given as "take as directed" and the pharmacist has not taken appropriate action to obtain and document on the prescription the actual dosing directions given by the practitioner.

(iii) Extra Doses. The Department does not pre-emptively pay for extra doses in the anticipation of lost or wasted medication.

(d) Tamper resistant prescription pads. Prescriptions written for Medicaid clients shall be written on tamper resistant prescription pads per Section 7002(b) of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007. The law requires that all written, non-electronic prescriptions for Medicaid outpatient drugs shall be executed on tamper resistant pads in order for them to be reimbursable by the federal government. In addition to all current Wyoming Board of Pharmacy requirements for tamper resistant prescription forms, all prescriptions paid for by Wyoming Medicaid shall meet the following requirements to help ensure against tampering:

(i) Written or computer printed prescriptions shall contain all of the following characteristics:

(A) One (1) or more industry recognized features designed to prevent unauthorized copying of a completed or blank prescription or prescription form. In order to meet this requirement, all written or computer printed prescriptions shall contain some type of "void" or "illegal" pantograph that appears if the prescription is copied.

(B) One (1) or more industry recognized features designed to prevent the erasure or modifications of information written on the prescription by the prescriber. This requirement applies only to prescriptions written for controlled substances. In order to meet this requirement, all written or computer printed prescriptions shall contain:

(I) Quantity check-off boxes plus numeric form of quantity values or alpha and numeric forms of quantity values, and

(II) Refill indicator (circle or check number of refills or "NR") plus numeric form of refill values or alpha and numeric forms of refill values.

(C) One (1) or more industry recognized features designed to prevent the use of counterfeit prescription forms. In order to meet this requirement, all written or computer printed prescriptions shall contain security features and descriptions listed on the front and back of the prescription blank.

(ii) In addition to the guidance outlined above, the tamper resistant requirement does not apply when a prescription is communicated by the prescriber to the pharmacy electronically, verbally, or by fax; when a managed care entity pays for the prescription; or, in most situations, when drugs are provided in designated institutional and clinical settings. The guidance also allows emergency fills with a non-compliant written prescription as long as the prescriber provides a verbal, faxed, electronic, or compliant written prescription within seventy-two (72) hours.

(iii) Audits of pharmacies may be performed by the Department to ensure that the above requirements are being followed.

Section 10. Relationship to Other Programs.

(a) This Chapter does not limit the services available to clients under age twenty-one (21) pursuant to Chapter 6 of the Wyoming Medicaid Rules.

(b) This Chapter does not affect services available pursuant to Chapter 29 of the Wyoming Medicaid Rules.

Section 11. Excluded Services. The following prescription drugs are excluded:

(a) Anorexiants, except Amphetamines and derivatives which are prescribed for narcolepsy and hyperkinetic conditions;

(b) Fertility drugs;

(d) Cosmetic agents such as Retin-A, provided to clients age twenty-one (21) years or over;

(e) OTC drugs and medical supplies, except as designated in Section 8(e) of this Chapter;

(f) DESI drugs;

(g) Drugs supplied by a manufacturer that has not entered into and does not have in effect a rebate agreement which meets the requirements of 42 U.S.C. § 1396r-8, including any amendments or updates, except as otherwise specified by that Section; and

(h) Any services and supplies included in the per diem which are furnished to a resident of a nursing home, an individual admitted as an inpatient or an outpatient in a hospital, or an individual in a swing bed.

(i) Any drug, supply or service not designated as a covered service under this Chapter.

Section 12. Pharmacy and Therapeutics (P&T) Committee.

(a) Pharmacy Services shall have a P&T Committee to meet the DUR requirements designated in Section 7 of this Chapter. The P&T Committee shall be made up as follows:

(i) At least one third (1/3), but not more than fifty-one percent (51%) physicians;

(ii) At least one third (1/3), but not more than fifty-one (51%) pharmacists; and

(iii) At least one physician's assistant or nurse practitioner.

(b) The responsibilities of the P&T Committee include:

(i) Prospective Drug Utilization Review, including determination of prior authorization criteria in accordance with Section 13 of this Chapter;

(ii) Retrospective Drug Utilization Review including periodic review of client profiles and claims data in order to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care among physicians, pharmacists, or clients, or associated with specific drugs or groups of drugs;

(iii) Provider education programs to include written or live dissemination of information in group or individual settings;

(iv) Review of literature and providing recommendations to Medicaid Pharmacy Services for the purpose of creating the Preferred Drug List in accordance with Section 15 of this chapter;

(v) Providing recommendations and feedback to Medicaid Pharmacy Services regarding pharmacy policy in general; and

(vi) Other duties as requested by the Department.

Section 13. Prior Authorization.

(a) Procedures. A provider seeking reimbursement for services which require prior authorization shall request prior authorization pursuant to the procedures and in the format specified by the Department and disseminated to providers through manuals or bulletins.

(i) Criteria for review. Prior authorization shall be granted if the proposed services:

(A) Are covered services;

(B) Are consistent with the client's diagnosis;

(D) Are cost-effective;

(E) Meet the criteria established by the rules of the Department; and

(F) Are not reimbursable by any third party payer.

(ii) Denial of prior authorization. The Department shall provide written notice of the denial of prior authorization to the provider and the client.

(A) If a request for prior authorization is denied, the provider may submit a revised request for prior authorization or additional documentation, as necessary, for the Department to reconsider the matter; or

(B) The provider or client may request reconsideration of the denial of prior authorization pursuant to Chapter 4 of the Wyoming Medicaid Rules. If a timely request for reconsideration is made, the services shall be furnished for up to sixty (60) days while the Department reconsiders the denial. The Department shall provide a written notice of its decision on reconsideration.

(C) The denial of prior authorization precludes Medicaid reimbursement for the services in question, except to the extent services are furnished pending reconsideration pursuant to subsection (B).

(iii) Failure to timely request prior authorization. The failure to obtain prior authorization before providing services requiring authorization precludes Medicaid reimbursement for such services.

(iv) Effect of prior authorization. Granting prior authorization shall constitute approval for the provider to receive Medicaid reimbursement for the approved services to be furnished, subject to the other requirements of this and the other Medicaid rules of the Department and post payment review. Prior authorization is not a guarantee of the client's eligibility or a guarantee of Medicaid payment.

(b) Services that require prior authorization.

(i) This and other rules of the Department specify services that require prior authorization. Notice of services requiring prior authorization can be found in manuals, bulletins, faxes, and designated websites published by the Department.

(ii) Designation of additional services. The Department may designate additional services that require prior authorization pursuant to this paragraph.

(A) Request for designation. The Department, the P&T Committee, a provider, a client, an organization of providers or clients, or any other person, may request that the Department consider designating a service as requiring prior authorization. Except when requested by the Department, such a request shall be delivered to the Department in the form and manner specified by the Department.

(B) Referral to the P&T Committee. Any request for designation received by or made by the Department shall be referred to the P&T Committee.

(C) Review by P&T Committee. The P&T Committee may review a referral received from the Department to designate a service as requiring prior authorization. In reviewing any such referral, the P&T Committee may consider the:

(I) Clinical efficacy of the service as demonstrated by:

(1.) peer-reviewed clinical literature;

(2.) nationally recognized practice standards; and

(3.) the consensus of the members of the P&T Committee;

(II) Cost effectiveness of the service;

(III) Potential for over-utilization of the services;

(IV) The availability of lower cost alternatives; and

(V) Comments received from interested parties for services which are under consideration for designation as requiring prior authorization.

(D) Recommendation to the Department. The P&T Committee shall make a recommendation to the Department about whether it should designate a service as requiring prior authorization. Such recommendation shall include the criteria to be used in determining whether to prescribe such services.

(E) Consideration of recommendation. The Department may consider the recommendation of the P&T Committee in determining whether to designate services as requiring prior authorization. The Department may also consider information from CMS and other sources of clinical information which it deems relevant to the determination. The Department shall not be bound by the recommendation of the P&T Committee, but the Department shall not designate a service as requiring prior authorization until it has received the P&T Committee's recommendation.

(iii) Notice of services which require prior authorization.

(A) The Department shall, from time to time, disseminate a current list of services which require prior authorization to providers through manuals, bulletins, facsimiles, designated websites, or other appropriate means.

(B) If additional services are designated pursuant to this section, the Department shall disseminate notice of the additional services which require prior authorization to providers through manuals, bulletins, facsimiles, designated websites, or other appropriate means.

Section 14. Copayment. There is no copayment requirement for services provided under this chapter pursuant to Wyoming Medicaid Rule Chapter 26.

Section 15. Preferred Drug List.

(a) A service may be placed on the Preferred Drug List if the service:

(i) Is a covered service;

(ii) Is cost-effective; and

(iii) Has been reviewed by the P&T Committee.

(b) Services that require listing on the Preferred Drug List.

(i) Review by the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee shall review services of the same therapeutic class in order to determine if one (1) or more services are more clinically effective than others in the same class, or if all services in the class are determined to be clinically equivalent. In reviewing therapeutic classes, the P&T Committee shall consider the clinical efficacy of the services as determined by consensus of the P&T Committee utilizing:

(A) Evidence-based research reports;

(B) Peer-reviewed clinical literature; and

(ii) In order to solicit comments, the P&T Committee may provide notice to interested parties of services which are under consideration for designation on the Preferred Drug List and the criteria applied to such services.

(iii) Recommendation to the Department. The P&T Committee shall make a recommendation to the Department about whether one (1) or more services are more clinically safe or effective than others in the same therapeutic class.

(iv) Consideration of recommendation. The Department may consider the recommendation of the P&T Committee in determining whether to assign services to the Preferred Drug List. The Department may also consider information from CMS and other sources of clinical information which it deems relevant to the determination. The Department shall not be bound by the recommendations of the P&T Committee, but the Department shall not assign services to the Preferred Drug List until it has received and considered the P&T Committee's recommendation.

(c) Once the Department has chosen services for the Preferred Drug List for a therapeutic class, the Department will refer all non-preferred services to the P&T Committee for recommendations on prior authorization, and the criteria to be used for those services.

(i) As new drugs in a therapeutic class are introduced, the Department may change or update prior authorization criteria to include the new services until the P&T Committee can make recommendations to the Department in regard to the services.

(ii) In the event the Department changes the preferred service for a therapeutic class, the Department may ask the P&T Committee to review and update the prior authorization criteria based upon changes to the non-preferred services.

(d) The Department may make changes to the Preferred Drug List for a therapeutic class based upon recommendations from the P&T Committee or changes in pricing.

(e) Notice of services on the Preferred Drug List. If additional services are designated pursuant to this section, the Department shall disseminate notice of the additional services on the Preferred Drug List to providers through bulletins, manuals, or a designated website.

(f) Procedure for requesting other service coverage. A provider seeking reimbursement for services not listed as the Preferred Drug in its therapeutic class may request prior authorization pursuant to the procedures as defined in Section 13.

Section 16. Medicaid Allowable Payment.

(a) Reimbursement Limits. Except as specified in subsection (b) of this section, the Medicaid allowable payment for pharmaceutical services shall be of the calculation below with the lowest reimbursement:

(i) The National Average Drug Acquisition Cost (NADAC) of the ingredient(s) plus the dispensing fee specified in subsection (d);

(ii) When no NADAC is available, Medicaid shall substitute Wholesale Acquisition Cost (WAC) + 0% plus the dispensing fee specified in subsection (d);

(iii) When neither NADAC nor WAC are available, Medicaid shall substitute Average Wholesale Price (AWP) - 11% plus the dispensing fee specified in subsection (d);

(iv) The Federal Upper Limit (FUL) plus the dispensing fee specified in subsection (d);

(v) The Department set maximum allowable cost for specified drugs or drug categories plus the dispensing fee specified in subsection (d);

(vi) The ingredient cost submitted by the pharmacy on the claim plus the dispensing fee specified in subsection (d);

(vii) The gross amount due; or

(viii) The provider's usual and customary charge.

(b) Covered entities purchasing drugs under Section 340B of the Public Health Service Act. Entities that purchase products under Section 340B of the Public Health Service Act shall request, in writing to use these drugs for Wyoming Medicaid clients. 340B entities who are granted such an arrangement shall bill Medicaid no more than their actual acquisition cost (AAC) for the drug and shall be reimbursed no more than the AAC plus the dispensing fee specified in subsection (d). 340B entities that fill Wyoming Medicaid client prescriptions with drugs not purchased under Section 340B of the Public Health Service Act will be reimbursed in accordance with subsection (a).

(c) Pharmacies which are operating as contract pharmacies in the 340B program shall not utilize drugs purchased under Section 340B of the Public Health Service Act for Wyoming Medicaid clients.

(d) Dispensing fee. Except as specified below, the dispensing fee shall be the lower of the provider's usual and customary dispensing fee or the dispensing fee specified in (i) or (ii) below. The dispensing fee shall be adjusted as specified in subsection (f).

(i) Physicians. The dispensing fee for physicians who perform pharmacy services shall be two dollars ($2.00) per prescription.

(ii) Pharmacies. The dispensing fee for pharmacies shall be ten dollars and sixty-five cents ($10.65) per prescription or compound.

(e) Adjustment of dispensing fee. The dispensing fee shall be adjusted pursuant to subsection (f) when necessary to:

(i) Enlist enough providers so that pharmaceutical services are available to clients to the extent that those services are available to the general population; and

(ii) Ensure that payments are consistent with efficiency, economy, and quality of care.

(f) Method of adjusting dispensing fee. The dispensing fee shall be adjusted as follows:

(i) The Department shall conduct a usual and customary survey which may include a review of other insurance payers in-state, and Medicaid pharmacy programs in surrounding areas.

(ii) Using the data collected pursuant to subsection (i), the Department may redetermine the fee.

(iii) The Department may use an appropriate indicator of pharmacy costs to adjust the dispensing fee.

(iv) The Department shall notify providers of any adjustment in the dispensing fee through manuals, bulletins, facsimiles, designated websites, or other appropriate means.

(g) Prescription splitting. If a provider does not have sufficient supplies of a drug to fill a prescription completely, the provider may fill the prescription to the extent possible and claim a dispensing fee. When the balance of the prescription is dispensed, the provider may not seek an additional dispensing fee.

(h) Proof of delivery.

(i) A Provider shall keep a dated log that maintains a record of when a client or client's representative picks up, or takes delivery of, every prescription paid for by the Department. All signatures shall be original at the time each prescription is dispensed; electronic or other methods of reproducing past signatures are not acceptable. The signature log can be either manual or electronic and should comply with all Health Insurance Portability and Accountability Act (HIPAA), State, and Federal regulations.

(ii) Prescriptions that are mailed to clients shall be recorded in a dated log that shall contain the prescription number, date of fill, client's name and address that the prescription is mailed to as well as the name of the person mailing or delivering the mail to the mail carrier. If a single prescription to be mailed has a dollar amount paid by the Department exceeding five hundred dollars ($500.00), a receipt that indicates that the prescription was mailed shall be obtained and attached to the log.

(iii) The above requirements also apply to clients living in nursing or institutional facilities.

Section 17. Submission and Payment of Claims. Except as otherwise specified in this Chapter, submission and payment of claims shall be pursuant to the provisions of Chapter 3 of the Wyoming Medicaid Rules.

Section 18. Recovery of Overpayments. The Department may recover overpayments pursuant to Chapter 16 of the Wyoming Medicaid Rules.

Section 19. Audits. Audits are subject to the provisions of Chapter 16 of the Wyoming Medicaid Rules.

Section 20. Reconsideration. A provider may request reconsideration of the decision to recover overpayments pursuant to Chapter 16 of the Wyoming Medicaid Rules.

Section 21. Disposition of recovered funds. The Department shall dispose of recovered funds pursuant to the provisions of Chapter 16 of the Wyoming Medicaid Rules.

Section 22. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

Section 23. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

Section 24. Severability. If any portion of these rules is found invalid or unenforceable, the remainder shall continue in full force and effect.

Section 25. Incorporation by Reference.

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each rule or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Sections 3 and 7 of this Chapter is Chapter 9 of the Board of Pharmacy Rules, incorporated as of the effective date of this Chapter and can be found at https://rules.wyo.gov/.

(ii) Referenced in Sections 3 and 7 of this Chapter is 42 C.F.R. Part 456, incorporated as of the effective date of this Chapter and can be found at https://ecfr.gov.

(iii) Referenced in Sections 3, 9, 12, and 15 of this Chapter is the Preferred Drug List, incorporated as of the effective date of this Chapter and can be found at www.wymedicaid.org.

(iv) Referenced in Section 9 of this Chapter is Section 7002(b) of the U.S. Troop Readiness, Veterans' Care, Katrina Recovery and Iraq Accountability Appropriations Act of 2007, incorporated as of the effective date of this Chapter and can be found at https://www.congress.gov.

(v) Referenced in Section 11 of this Chapter is 42 U.S.C. § 1396r-8, incorporated as of the effective date of this Chapter and can be found at https://www.gpo.gov.

(vi) Referenced in Section 16 of this Chapter is Section 340B of the Public Health Service Act, incorporated as of the effective date of this chapter and can be found at https://www.federalregister.gov.

History

Effective 2025-04-10

Chapter 11 Medical Supplies, Durable Medical Equipment, and Prosthetics

Wyo. Code R. 048.0037.11.01302023 Medical Supplies, Durable Medical Equipment, and Prosthetics

F:\COMMON\Rules\Health\Medicaid\CH 11.PDF

CHAPTER 11

MEDICAL SUPPLIES, DURABLE MEDICAL EQUIPMENT, AND PROSTHETICS

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute 42-4-101 through -124.

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to govern the standards and procedures for the provision of, and payment for, Medicaid medical supplies, durable medical equipment, orthotics and prosthetics by enrolled providers and suppliers.

(b) This Chapter applies to all clients and providers of any furnished Medicaid medical supplies, durable medical equipment, orthotics, or prosthetics.

Section 3. Definitions.

(a) Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, or as defined herein, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.

(b) "Certification of medical necessity" means a written certification by the prescribing practitioner certifying that the equipment is medically necessary, as required for certain items identified by the Department.

(c) "Misuse" means the intentional utilization of equipment, prosthetic device, or supplies in a manner not prescribed or recommended resulting in the need for repairs or replacement, or the utilization by persons other than the client for whom the use is prescribed or intended according to Department records.

(d) "Practitioner's order" means a written order on the practitioner's personalized prescription pad or letterhead that contains the practitioner's printed name, the practitioner's personal physically-made signature, and the date it was signed.

Section 4. Provider Enrollment and Participation.

(a) No provider or supplier of medical supplies, durable medical equipment, or prosthetics furnished to a client shall receive Medicaid reimbursement unless enrolled with Medicaid pursuant to Wyoming Medicaid Rules Chapter 3.

(b) A provider or supplier of medical supplies, durable medical equipment, or prosthetics furnished to a client shall meet the provider participation requirements of Wyoming Medicaid Rule Chapter 3.

(c) A provider or provider entity shall provide proof of Medicare certification as a durable medical equipment, prosthetics, orthotics, and supplies (DMPOS) supplier prior to Medicaid reimbursement.

Section 5. Eligible providers.

(a) A pharmacy;

(b) A practitioner's office;

(c) A non-pharmacy supplier with a current, valid business license as required by the laws of the State of Wyoming or the state where the business is located.

Section 6. Provider records.

(a) A provider of medical supplies, durable medical equipment, or prosthetics must comply with the record-keeping requirements of Wyoming Medicaid Rules Chapter 3.

(b) The provider's medical records must substantiate the medical necessity of the medical supplies, durable equipment, or prosthetics prescribed for a client, including: the client's diagnosis and prognosis; the estimated duration of the condition which necessitates the medical supplies or durable medical equipment; the nature and extent of the client's functional limitations; other therapeutic interventions which have been tried and their results; and a copy of the certification of medical necessity, and request for prior authorization, if applicable.

Section 7. Verification of Client Data. A provider of medical supplies must comply with the verification of client data requirements of Wyoming Medicaid Rules Chapter 3.

Section 8. General Coverage Provisions.

(a) The medical supplies, durable medical equipment, and prosthetics described in Sections 9 and 10 are a covered service if they are:

(i) Medically necessary, as defined in Wyoming Medicaid Rules Chapter 1;

(ii) Appropriate and effective for the client's medical needs;

(iii) Timely, considering the nature and present medical condition of the client;

(iv) Provided by a provider with appropriate credential;

(v) The least expensive, appropriate alternative available;

(vi) Not considered experimental or investigational;

(vii) An effective and appropriate use of Medicaid funds;

(viii) Suitable for use in the client's home or any non-institutional setting in which normal life activities take place;

(ix) Generally not useful in the absence of an illness, injury, or disability;

(x) Provided to correct or accommodate a physiological disorder of physical condition, or generally used primarily for a medical purpose; and,

(xi) Prescribed using a practitioner's order which:

(A) Includes one or more diagnosis codes, or a statement of the condition which necessitates the medical supplies, durable medical equipment or prosthetics, and an estimate in days, months, or years of the time it will be needed;

(B) If durable medical equipment or a prosthetic device, specifies the additional or optional features which will be separately billed using HCPCS codes;

(C) If medical supplies, specifies the quantity and frequency of use, the frequency of changes, the estimated duration of medical necessity, and is reviewed and re-signed by the practitioner at least once per year.

(b) The Department may designate certain durable medical equipment as requiring a certification of medical necessity in addition to a practitioner's order based on clinical consultation with health professionals, CMS guidelines, and other appropriate sources. The Department shall disseminate to providers a current list of the durable medical equipment which requires a certification of medical necessity through applicable provider manuals and bulletins.

(c) Providers shall be responsible for the delivery of the prescribed medical supplies, durable medical equipment, and prosthetics.

(d) After delivery, if an item is determined to be inappropriate or incorrect, the provider is responsible for retrieving the medical supplies or durable medical equipment within five (5) working days after being notified of the problem by the client or the Department.

(i) Claims for items known to be awaiting pickup by the provider cannot be billed to the Medicaid program.

(ii) If billing occurs prior to notice that pickup is necessary, the provider shall submit an adjustment within twenty (20) working days following the date of pickup.

(e) Providers shall be responsible for confirmation of continued need for disposable supplies by contact with the client or client's caregiver prior to shipment of supplies. Continued need shall be confirmed by a current prescription which contains the duration of medication necessity.

Section 9. Covered services.

(a) The following items are covered services if provided in compliance with the general requirements of Section 8:

(i) Ambulation devices;

(ii) Lactation equipment and supplies;

(iii) Diabetic Supplies, other than insulin and insulin syringes, which may be covered pursuant to Medicaid Rules Chapter 10;

(iv) Enteral and Parenteral Nutrition - other Medical foods;

(v) Home infusion supplies;

(vi) Hospital beds and equipment;

(vii) Infusion pumps and supplies;

(viii) Medication Dispensers or equipment;

(ix) Orthopedic devices;

(x) Ostomy care products;

(xi) Oxygen delivery systems and supplies;

(xii) Pacemaker monitors, self-contained;

(xiii) Paraffin or Sitz baths;

(xiv) Phototherapy light and supplies;

(xv) Pneumatic compressors and appliances;

(xvi) Post-surgery recovery equipment or wound care;

(xvii) Prosthetics;

(xviii) Respiratory care accessories, supplies, and related devices;

(xix) Speech generating devices;

(xx) Stockings and elastic supports;

(xxi) Suction pumps;

(xxii) Syringes and needles;

(xxiii) Traction equipment;

(xxiv) Transfer or lift equipment;

(xxv) Transcutaneous or neuromuscular electrical nerve simulators;

(xxvi) Urinary care products;

(xxvii) Wheelchairs and scooters; and

(xxviii) Other medical equipment and supplies determined to be medically necessary and approved by the Department.

(b) Covered disposable medical supplies are limited to a one-month supply.

(c) A client may request an administrative hearing regarding the termination, reduction, or denial of covered services in accordance with Wyoming Medicaid Rules Chapter 4.

Section 10. Authorization Requests for Non-Covered Services

(a) Authorization may be requested for any piece of durable medical equipment, supply, or prosthetic that is considered a non-covered item as described in the Medicaid Durable Medical Equipment Manual. Documentation must be submitted that demonstrates the item meets the criteria listed in Section 8(a).

(b) Fully completed requests shall be acted upon within 30 days of receipt. Wyoming Medicaid shall notify providers and clients of the grant or denial of the request for coverage. If denied, clients shall be notified of their right to request an administrative hearing pursuant to Wyoming Medicaid Rules Chapter 4.

Section 11. Prior authorization.

(a) The Department may designate medical supplies or durable medical equipment that require prior authorization. The failure to obtain prior authorization shall result in denial of Medicaid payment for the service. Prior authorization of medical supplies and durable medical equipment shall be governed by the prior authorization requirements of Wyoming Medicaid Rules Chapter 3.

(b) In designating medical supplies or durable medical equipment that require prior authorization, the Department shall consider the:

(i) Cost of the service;

(ii) Potential for over-utilization of the medical supplies; and

(iii) Availability of lower cost alternatives.

(c) The Department may disseminate a list of medical supplies and durable medical equipment that require prior authorization to providers through manuals, bulletins or other methods deemed appropriate for provider communication.

Section 12. Medicaid allowable payment. The Medicaid allowable payment for medical supplies, durable medical equipment, and prosthetics shall be pursuant to the Medicaid fee schedule.

Section 13. Submission and Payment of claims. Submission and payment of claims shall be pursuant to the provisions of Wyoming Medicaid Rules Chapter 3.

Section 14. Third-party liability.

(a) Claims for which third-party liability exists shall be submitted in accordance with Wyoming Medicaid Rules Chapter 35.

(b) The Medicaid payment for a claim for which third party liability exists shall be the difference between the Medicaid allowable payment and the third party payment. In no case shall the Medicaid payment exceed the payment otherwise allowable pursuant to this Chapter.

Section 15. Audits. Audits shall be subject to the provisions of Wyoming Medicaid Rules Chapter 16.

Section 16. Overpayments. The Department shall recover overpayments pursuant to Wyoming Medicaid Rules Chapter 16. In addition to using its own internal processes for recovery of overpayments, the Department may refer a matter involving suspected overpayments to the Medicaid Fraud Control Unit at any time.

History

Effective 2023-01-30

Chapter 12 Home Health Services

Wyo. Code R. 048.0037.12.02202026 § 1 Authority

The Wyoming Department of Health promulgates this chapter under the Medical Assistance and Services Act, Wyoming Statutes §§ 42-4-101 through -124.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.12.02202026 § 2 Purposes and Applicability

(a) This Chapter governs home health services covered by Medicaid.

(b) The Department may issue Provider Manuals and Provider Bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.12.02202026 § 3 Definitions

Except as defined in this Section or as defined in Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in accounting, health care, Medicaid, and Medicare.

(a) "Attending physician" m e a n s t he physician who prescribes home health services or reviews and certifies the plan of treatment.

(b) "Encounter" refers to a documented interaction between a patient and a healthcare provider on a specific date of service, where all services are provided, regardless of the duration or number of interactions throughout that day. An exception to billing one encounter per day applies to services that cannot be provided at a single time due to medical necessity or specific practitioner orders regarding frequency or scheduling.

(c) "Home health agency" an agency primarily engaged in arranging and directly providing nursing or other healthcare services to persons at their residence.

(d) "Home health aide" means a person who is certified as a nursing assistant/nurse aide by the Wyoming State Board of Nursing, and employed by a home health agency.

(e) "Home health aide service" m e a n s a covered service provided pursuant to a plan of treatment by a home health aide under the supervision of a registered nurse.

(f) "Intermittent" m e a n s three or fewer encounters per day for home health aide services and skilled nursing services combined.

(g) "Long-term custodial care" means care that has moved beyond the acute phase (has become clinically stable) and is expected to be needed for the rest of the client's life.

(h) "Plan of treatment" m e a n s a plan prepared on CMS Form 485 or other form designated by the Department which is signed and dated by the client's practitioner, and which specifies the:

(i) Client's diagnosis;

(ii) Objectives of the plan;

(iii) Client's prognosis;

(iv) Covered services which are medically necessary for the implementation of the plan; and

(v) Person or persons to provide such services or supplies.

(i) "Practitioner" means attending physician, advanced practice registered nurse, physician's assistant or other licensed practitioner of the healing arts within the scope of their practice.

(j) "Supplies" means medical supplies authorized for Medicaid payments under Wyo. Stat. § 42-4-103 and the Rules and Regulations for Medicaid.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.12.02202026 § 4 Covered Services and Supplies

(a) The services and supplies specified in subsection (b) are covered services if the services are:

(i) Intermittent;

(ii) Medically necessary;

(iii) Ordered by a practitioner;

(iv) Documented in a plan of treatment; and

(v) Expected to last six months or less.

(b) Covered services. The following are covered services:

(i) Skilled nursing services provided by a registered nurse for a client's condition while in the acute phase;

(ii) Home health aide and LPN services supervised by a registered nurse, which must include the following:

(A) A registered nurse shall be available for consultation in person or by telephone;

(B) In-person home visits by a registered nurse:

(1.) At least once every two weeks if the client is receiving skilled nursing care; or

(2.) At least every sixty days if the client only receives home health aide services. The supervisory visits must occur while the aide is furnishing services. Supervisory visits are not a covered service;

(C) Each home health aide encounter must include at least one of the following personal care services in addition to all ordered services that can be provided in one encounter unless medically indicated otherwise:

(1.) Bath (bed, sponge, tub, shower, or shampooing hair);

(2.) Nail or skin care (applying lotion to a client does not constitute personal care);

(3.) Oral hygiene;

(4.) Toileting and elimination;

(5.) Safe transfers and assisted ambulation;

(6.) Assisted dressing;

(7.) Assisted range of motion and positioning; or

(8.) Assisted nutrition or fluid intake (such as meal set-up, meal preparation, feeding assistance, and meal supervision);

(D) Each LPN encounter must include at least one of the following:

(1.) direct patient care;

(2.) monitoring;

(3.) some assessments focus or patient history;

(4.) medication management;

(5.) wound care;

(6.) patient and family education; or

(7.) supervision of home health aides;

(iii) Physical therapy services provided by a licensed physical therapist;

(iv) Speech, hearing, and language services provided by a licensed speech therapist;

(v) Occupational therapy services provided by a licensed occupational therapist;

(vi) Medical social services provided by a licensed social worker; and

(vii) Disposable medical supplies provided by a provider in accordance with a plan of treatment.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.12.02202026 § 5 Excluded Services

(a) The following are not covered services:

(i) Long-term custodial care;

(ii) Homemaker services;

(iii) Respite care;

(iv) Home delivered meals;

(v) Services for clients that are in a hospital or a nursing facility;

(vi) Services that are not cost effective;

(vii) Services where the desired outcome could be better and faster accomplished in another setting; and

(viii) Any other service not included in Section 4 of this Chapter.

(ix) Initial assessment or supervisory visits required at least every sixty days performed by an LPN.

(b) If a service requires a client to comply to achieve measured success and the client does not comply, that service will not be a covered services for that client.

(c) Breaking up personal care into multiple encounters for the convenience of the home health agency staff or due to scheduling issues with home health staff is prohibited and the services provided in that manner will not be covered services.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.12.02202026 § 6 Prior Authorization

(a) All home health services require prior authorization.

(b) To request prior authorization, a provider must submit completed prior authorization forms specified by the Department, including a plan of treatment that includes a statement by a practitioner that the requested home health services are appropriate and medically necessary.

(i) At least once every sixty days, a practitioner must review the plan of treatment to determine if it is still appropriate and medically necessary, and, if it is, sign and date the plan again and resubmit it to the Department.

(ii) All new home health orders must be accompanied by documentation of a face-to-face visit between the client and the ordering practitioner within the ninety days prior to the start of home health services.

(iii) If a client is eligible for both Medicare and Wyoming Medicaid, the client's ordering practitioner must provide documentation that shows the client is not home-bound and would not qualify for home health services under the client's Medicare benefits.

History

Effective 2026-02-20

Chapter 13 Behavioral Health Services

Wyo. Code R. 048.0037.13.08062025 § 1 Authority

The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through -124.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 2 Purpose and Applicability

(a) The Department adopts this Chapter to establish the scope of behavioral health services, such as mental health and substance use treatment services, covered by Medicaid and provided by certified community mental health centers, substance abuse treatment centers, and specific licensed providers. This Chapter also includes the payment and submission of claims by providers of such services.

(b) This Chapter applies to all clients and providers for all furnished Medicaid behavioral health services.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 3 Definitions

(b) "Applied Behavior Analysis (ABA) Treatment" means behavior analysis 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.

(c) "Behavior analysis" means the design, implementation and evaluation of the instructional and environmental modifications based on scientific research and direct and indirect observation and measurement of behavior and environment to produce socially significant improvements in human behavior. It includes the empirical identification of functional relations between behavior and environmental factors. It does not include psychotherapy, cognitive therapy, psychoanalysis, hypnotherapy, counseling, psychological testing, personality or intellectual or neuropsychological assessments, or the diagnosis of psychological disorders.

(d) "Certified center" means a community mental health or substance abuse treatment center that is certified by the Wyoming Department of Health, Behavioral Health Division.

(e) "Clinical Professional" means an individual who is licensed as a:

(i) Licensed Addictions Therapist;

(ii) Licensed Advanced Practitioner of Nursing with a specialty area of psychiatric/mental health (APRN);

(iii) Licensed Clinical Social Worker;

(iv) Licensed Marriage and Family Therapist;

(v) Licensed Physician;

(vi) Licensed Professional Counselor;

(vii) Licensed Psychiatric Nurse (Master level);

(viii) Licensed Psychologist;

(ix) Licensed Board Certified Behavior Analyst - Doctoral (BCBA-D), as defined by the Behavior Analyst Certification Board and the Wyoming Board of Psychology (Wyo. Stat. §§ 33-27-124 and 33-27-125); or

(x) Licensed Board Certified Behavior Analyst (BCBA), as defined by the Behavior Analyst Certification Board and the Wyoming Board of Psychology (Wyo. Stat. §§ 33-27-124 and 33-27-125).

(f) "Clinical staff" means an individual who is a:

(i) Case Manager, who has achieved a bachelor's degree in a human relations discipline, is trained in case management, and who is working under the documented and scheduled supervision of a licensed mental health professional;

(ii) Certified Addictions Practitioner (CAP), who is certified by the Mental Health Professions Licensing Board pursuant to the Wyoming Mental Health Professions Practice Act (Wyo. Stat. §§ 33-38-101 through -113) to practice under the supervision of a licensed and qualified clinical supervisor;

(iii) Certified Addictions Practitioner Assistant (CAPA), who is certified by the Wyoming Mental Health Professions Licensing Board or similar authority in another State to practice under the supervision of a licensed and qualified clinical supervisor;

(iv) Certified Mental Health Worker (CMHW), who has achieved a bachelor's degree in a human relations discipline as specified in the Wyoming Mental Health Professions Licensing Board, Chapter 5-Certified Mental Health Worker and who is working under the documented, scheduled supervision of a licensed mental health professional;

(v) Certified Peer Specialist (CPS), who has a minimum general equivalency diploma (GED) or high school diploma; meets the criteria and supervision requirements of a Mental Health Technician; is certified by the Division of Behavioral Health as a peer specialist; and is working under the documented, scheduled supervision of a licensed mental health professional;

(vi) Certified Social Worker (CSW) or a Certified Mental Health Worker (CMHW), who is certified by the Wyoming Mental Health Professions Licensing Board or similar authority in another State to practice under the supervision of a qualified clinical supervisor licensed in the state of Wyoming;

(vii) Licensed Board Certified Assistant Behavior Analyst (BCaBA), as defined by the Behavior Analyst Certification Board and the Wyoming Board of Psychology (Wyo. Stat. §§ 33-27-124 and 33-27-125);

(viii) Licensed Practical Nurse (LPN), who is performing nursing duties within the scope of practice as defined by the Wyoming Board of Nursing Rules, Chapter 3-Standards of Nursing Practice;

(ix) Mental Health Technician (MHT), who has at minimum a GED or high school diploma, and who is working under the documented, scheduled supervision of a licensed mental health professional;

(x) Provisional Licensee, who is provisionally licensed by the Wyoming Mental Health Professions Licensing Board or similar authority in another state to practice under the supervision of a licensed and qualified clinical supervisor. This includes student interns who meet the qualifications required by their respective Board and are practicing and billing under the direct supervision of a licensed and designated qualified clinical supervisor;

(xi) Registered Behavior Technician (RBT), who has at minimum a GED or high school diploma, is registered with the Behavior Analyst Certification Board and is a paraprofessional in behavior analysis who practices under the close, ongoing supervision of a licensed BCBA or licensed BCaBA and who delivers services that may be assigned to an RBT but shall not include designing assessment or intervention plans or procedures; or

(xii) Registered Nurse (RN) who is performing nursing duties within the scope of practice as defined by the Wyoming Board of Nursing Rules, Chapter 3-Standards of Nursing Practice;

(g) "Clubhouse" is a program defined by Wyo. Stat. § 42-4-124(d).

(h) "Clubhouse Rehabilitation Services" is a term defined by Wyo. Stat. § 42-4-124(d).

(i) "Collateral contact" means an individual involved in the client's care. This individual may be a family member, guardian, healthcare professional, or person who is a knowledgeable source of information about the client's situation and serves to support or corroborate information provided by the client. The individual contributes a direct and exclusive benefit for the covered client.

(j) "DLA-20" means a tool designed to reliably assess twenty areas of daily living activity functioning for adults impacted by a mental illness or disability.

(k) "Evidence-based intervention" means intervention that:

(i) Shows statistically significant effectiveness through empirical research in treating specific problems and populations;

(ii) Is consistent with relevant clinical expertise; and

(iii) Considers client preferences and values.

(l) "Evidence-informed intervention" means programs and practices that use the best available research and practice knowledge to guide their design and implementation.

(m) "Habilitative services" means services that help clients keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age.

(n) "Independent Assessor" means an assessor certified by the Department who:

(i) Has completed DLA-20 assessment training and passed the Department's DLA-20 proficiency exam;

(ii) Is current with all continuing certification requirements;

(iii) Does not have any financial tie to a clubhouse provider; and

(iv) At a minimum has obtained a GED and has two years of lived experience, or a bachelor's degree in a human service-related field.

(o) "Member" means a client receiving Clubhouse Rehabilitation Services.

(p) "Rehabilitative services" means services that help clients keep, get back, or improve skills and functioning for daily living that have been lost or impaired due to the client's illness, injury, or acquired disability.

(q) "Serious mental illness (SMI)" means a long-term illness involving substantial functional impairment over multiple symptom domains. These impairments often lead to an inability to maintain gainful employment, poor social support, repeated psychiatric hospitalizations, homelessness, incarceration, and coexisting substance use disorders. Possible diagnoses include psychotic disorders, bipolar disorder, major depression with psychotic symptoms and treatment-resistant depression. SMI can also include anxiety disorders, eating disorders, and personality disorders if the degree of functional impairment is severe.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 4 Provider Participation

(a) No certified center, licensed psychologist, licensed APRN, licensed mental health professional, licensed behavioral analyst or clubhouse that furnishes services to a client shall receive Medicaid payment unless enrolled with Medicaid.

(b) A certified center, licensed psychologist, licensed APRN, licensed mental health professional, or licensed behavioral analyst that wishes to receive Medicaid payment for services furnished to a client shall meet the provider participation requirements of Medicaid Rules Chapter 3.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 5 Special Requirements for Certified Center Services

(a) To receive Medicaid payment a certified center shall:

(i) Meet Medicaid enrollment requirements pursuant to Medicaid Rules Chapter 3; and

(ii) Be certified by and under contract with the Behavioral Health Division for taxonomies to access both Medicaid and Behavioral Health Center benefit plans.

(A) If a provider's contract with the Behavioral Health Division terminates, as of the date of termination, the provider will only have access to taxonomies for certified centers and can only bill Medicaid benefit plans.

(B) If a provider is not under contract with the Behavioral Health Division, the provider is not considered a behavioral health center as used in this Section.

(b) Each member of a certified center's staff who provides case management services shall:

(i) Be enrolled as a Medicaid provider pursuant to Medicaid Rules Chapter 3;

(ii) Be employed by, or under contract with, a certified center to provide case management services;

(iii) Be a clinical professional or clinical staff member.

(i) Be enrolled as a Medicaid provider pursuant to Medicaid Rules Chapter 3;

(ii) Be eighteen (18) years of age or older;

(iii) Have, at minimum, a GED or a high school diploma;

(iv) Be employed by, or under contract with, a certified center to provide IRS services;

(v) Complete a basic training program which includes non-violent behavior management; and

(vi) Be supervised by the client's primary therapist as evidenced by co-signature of the primary therapist on each IRS progress note.

(d) Each member of a certified center's staff who provides mental health or substance use services shall:

(i) Be employed by, or under contract with, a certified center; and

(ii) Be a clinical professional or clinical staff member who meets the requirements of the specific service and who practices within the scope of their license or certification.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 6 Covered Services

(a) Covered services shall be:

(i) Furnished to a client or collateral contact for the direct and exclusive benefit of the client;

(ii) Furnished by a clinical professional or clinical staff member who meets the requirements of the specific service and who practices within the scope of their license or certification;

(iii) Furnished pursuant to a treatment plan, updated and signed by a clinical professional at least every ninety (90) days. Unless the service is an initial clinical assessment, the treatment plan shall list the type, frequency, and duration of each service provided;

(iv) Documented by providing a legible progress note in the client's medical record. Each progress note shall contain a hand-written or electronic signature and credentials of the provider and shall specify:

(A) Service type and setting (if outside of the office);

(B) Begin and end times (Military or Standard Time); and

(v) Rehabilitative and medically necessary.

(b) The following are covered services when furnished by a certified center:

(i) Clinical assessments;

(ii) Office-based individual and family therapy;

(iii) Community-based individual and family therapy;

(iv) Psychosocial rehabilitation (day treatment);

(v) Intensive outpatient program (IOP);

(vi) Group therapy;

(vii) Comprehensive medication services;

(viii) Individual rehabilitative services (IRS);

(ix) Certified peer specialist services;

(x) Targeted case management provided to clients twenty-one (21) years of age and older; and

(xi) Ongoing case management provided to clients under twenty-one (21) years of age.

(c) The following are covered services when furnished by a licensed psychologist, licensed APRN, or licensed mental health professional:

(i) Clinical assessment;

(ii) Office-based individual and family therapy services;

(iii) Community-based individual and family therapy;

(iv) Group therapy;

(v) Ongoing case management services provided to clients under twenty-one (21) years of age; and

(vi) Additional services as specified in Medicaid policy manuals and provider bulletins. These services provided by licensed psychologists or licensed APRNs may include psychological testing, psychotherapy, and evaluation and management services.

(d) The following are covered services when furnished by an enrolled hospital providing outpatient mental health or substance use services:

(i) Clinical assessments;

(ii) Office-based individual and family therapy;

(iii) Community-based individual and family therapy;

(iv) Intensive outpatient program (IOP);

(v) Group therapy;

(vi) Comprehensive medication services; and

(vii) Ongoing case management provided to clients under twenty-one (21) years of age.

(e) The following are covered services when furnished by a licensed BCBA-D or BCBA:

(i) Behavior identification assessments,

(ii) Observational behavioral follow-up assessments,

(iii) Adaptive behavior treatments, and

(iv) Family adaptive behavior treatment guidance.

(f) Adaptive behavior treatment is a covered service when furnished by a licensed BCaBA or a RBT under the supervision by a BCBA-D or BCBA.

(g) An RBT shall not be assigned duties which include designing assessment or intervention plans or procedures.

(h) Clubhouse Rehabilitation Services are covered when furnished by a provider that is enrolled and accredited by Clubhouse International.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 7 Service Limitations

(a) Medicaid payment for rehabilitative services shall be limited to thirty (30) visits per calendar year, unless pre-approved based on a determination that additional services are medically necessary.

(b) Habilitative services are not covered for clients twenty-one (21) years of age or older.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 8 Excluded Services

(a) The following services are excluded:

(i) Clinical services which are not provided in person or via a telehealth modality, other than collateral contacts necessary to develop or implement a treatment plan;

(ii) Education, public education, public relations, and speaking engagements;

(iii) Day care;

(iv) Driving while under the influence (DUI) classes;

(v) Missed appointments;

(vi) Psychological testing done for the sole purpose of education diagnosis, school or institution admission or placement or Medicaid waiver eligibility assessments;

(vii) Record-keeping time, unless allowed by a specific service code;

(viii) Recreation and socialization without an active clinical treatment component as specified in the individual client's treatment plan;

(ix) Remedial or other formal education;

(x) Residential room, board, or care;

(xi) Substance abuse or mental health disorder prevention services;

(xii) Support groups, such as Alcoholics Anonymous or Narcotics Anonymous;

(xiii) Time spent preparing records or reports, except for up to three (3) hours for a licensed psychologist to prepare a formal report of test findings;

(xiv) Vocational services;

(xv) Services provided to a client with:

(A) Sole Diagnostic and Statistical Manual (DSM) diagnosis of intellectual or cognitive disability;

(B) DSM diagnosis of factitious disorder; or

(C) DSM diagnosis of any ICD-10 "Z" code, unless the client's medical record contains a written statement signed by the affiliated clinical professional explaining why the treatment of a condition that is not classified as a mental disorder is medically necessary;

(xvi) Services provided by a school psychologist, except when provided pursuant to Medicaid Rules Chapter 52 School Based Services.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 9 Clubhouse Rehabilitation Services

Notwithstanding other Wyoming Department of Health Medicaid rules, the following rules apply to Clubhouse Rehabilitation Services:

(a) To become a member, a client must first complete the DLA-20 and have at least the minimum score set forth in the Department's Provider Manual;

(b) The DLA-20 must be performed by an Independent Assessor or a Level of Care Assessor;

(i) Be accredited by Clubhouse International which focuses on non-clinical community-based support services of the work-ordered day;

(ii) Have a Clubhouse Director.

(d) The minimum qualifications for a Clubhouse Director are:

(i) A bachelor's degree in a health and human services field; licensed, certified, or registered by the State or a national organization that provides health care services; and two years experience working at a clubhouse or with the target population of a clubhouse; or

(ii) A master's degree in a health and human services field; licensed, certified, or registered by the State or a national organization that provides health care services; and one year experience working at a clubhouse or with the target population of a clubhouse.

(e) Clubhouse Rehabilitation Services include, but are not limited to, operating (with staff assistance) all aspects of the clubhouse, employment training, housing assistance, educational support, and activities to improve skills related to illness and recovery management, daily living activities, and social interaction.

(f) The rehabilitative service limitation does not apply to Clubhouse Rehabilitation Services.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 10 Limited Services for Nursing Home Residents

(a) Medicaid payment for services provided to a client in a nursing facility is limited to:

(i) Clinical assessment;

(ii) Community-based individual and family therapy; and

(iii) Group therapy.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 11 Prior Authorization

The Department may designate behavioral health services, such as mental health services, and substance use treatment services that require prior authorization. The failure to obtain prior authorization shall result in denial of Medicaid payment for the service. Prior authorization of medical supplies and equipment shall be governed by the prior authorization requirements of Medicaid Rules Chapter 3.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 12 Medicaid Allowable Payment

(a) The Department shall establish and maintain payment rates for behavioral health services to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available, to the extent that such care and services are available to the general population in the geographic area.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 13 Submission and Payment of Claims

Submission and payment of claims shall be pursuant to Medicaid Rules Chapter 3.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 14 Third Party Liability

(a) Claims subject to third party liability shall be submitted in accordance with Medicaid Rules Chapter 35.

(b) The Medicaid payment for a claim for which third party liability exists shall be the difference between the Medicaid allowable payment and the third-party payment. In no case shall the Medicaid payment exceed the payment otherwise allowable pursuant to this Chapter.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 15 Audits

Audits shall be subject to the provisions of Medicaid Rules Chapter 16.

History

Effective 2025-08-06

Wyo. Code R. 048.0037.13.08062025 § 16 Overpayments

The Department shall recover overpayments pursuant to Medicaid Rules Chapter 16. In addition to using its own internal processes for recovery of overpayments, the Department may refer a matter involving suspected overpayments to the Medicaid Fraud Control Unit at any time.

History

Effective 2025-08-06

Chapter 15 Ambulance Services

Wyo. Code R. 048.0037.15.05142018 Ambulance Services

WYOMING MEDICAID RULES

CHAPTER 15

AMBULANCE SERVICES

Section 1. Authority

This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through -306.

Section 2. Purpose and Applicability.

This rule establishes the scope for ambulance services covered by Medicaid and the methods and standards for reimbursing providers for such services.

Section 3. Incorporation By Reference

(a) For any code, standard, rule or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules.

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section.

(iii) The incorporated code, standard, rule or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference in this rule is further identified as follows:

(i) Referenced in Section 7 of this Chapter are Chapters 0 - 15 of the Wyoming Department of Health, Emergency Medical Services Rules, incorporated as of the effective date of this Chapter and found at https://rules.wyo.gov.

Section 4. General Terms

(a) 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 administrative interpretations contained in this rule.

Section 5. Definitions. Except as otherwise specified in Wyoming Medicaid Rule, Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

Section 6. Provider Participation.

(a) Eligible providers. In order to be an eligible provider under this Chapter, an individual or entity shall:

(i) Hold a current ambulance business license pursuant to the Wyoming Emergency Medical Services Act of 1977, found at Wyoming Statues §§ 33-36-101 through 115, or, if the provider is located outside Wyoming, is licensed under applicable provisions of that state's law; and

(ii) Meet all Medicare certification requirements.

(b) Compliance with Wyoming Medicaid Rule, Chapter 3 - Provider Participation. A person or entity that wishes to receive Medicaid reimbursement for covered services furnished to a recipient shall meet the provider participation requirements of Wyoming Medicaid Rule, Chapter 3.

(c) Right of inspection. The Office of Emergency Medical Services may inspect any ambulance at any time or place to determine whether the ambulance is being operated safely and in compliance with these and other applicable laws. An ambulance that does not pass an inspection shall not receive Medicaid reimbursement for furnishing covered services to a client until the ambulance has passed a re-inspection by the Office of Emergency Medical Services.

Section 7. Covered Services.

The terms in this section shall be interpreted under the definitions and classifications established by the Office of Emergency Medical Services Rules.

(a) Emergency ground ambulance transportation is a covered service.

(i) Ground ambulance is any motor vehicle maintained, operated or advertised for the medical care and transportation of patients upon any street, highway or public way, or any motor vehicle owned and operated on a regular basis by the State of Wyoming or any agency, municipality, city, town, county or political subdivision of Wyoming for medical care and transportation of patients upon any street, highway or public way.

(b) Basic Life Support (BLS) or Advanced Life Support (ALS).

(i) Basic Life Support (BLS) is treatment rendered by personnel licensed at the Emergency Medical Responder (EMR) or basic Emergency Medical Technician (EMT) level, including, but not limited to, procedures such as bandaging, splinting, basic first aid, and performing CPR.

(ii) Advanced life support (ALS) is treatment rendered by personnel licensed at the Emergency Medical Responder (EMR) or Emergency Medical Technician (EMT) level, with additional training in accordance with Wyoming Emergency Medical Services Rules certifying them to perform additional procedures including, but not limited, to cardiac monitoring and defibrillation, advanced airway management, intravenous therapy, and the administration of medications.

(A) Advanced Life Support Level 1- Emergency (ALS1- emergency) is transportation by ground ambulance with provision of medically necessary supplies, oxygen, and at least one ALS intervention. The ambulance and its crew shall meet licensure standards for ALS care.

(I) An ALS intervention refers to the provision of care outside the scope of a basic EMT and shall be medically necessary.

(B) Advanced Life Support Level 2 (ALS2) is the provision of medically necessary supplies and services including (1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids); or (2) ground ambulance transport, the provision of medically necessary supplies and services, and at least one of the ALS2 procedures listed below:

(I)Manual defibrillation/cardio version;

(II)Endotracheal intubation;

(III)Central venous line;

(IV)Cardiac pacing;

(V)Chest decompression;

(VI)Surgical airway; or

(VII)Intraosseous line.

(iii) ALS or BLS ground ambulance is a covered service if:

(A) The use of any other method of transportation would endanger the health of the client;

(B) The client is transported to the nearest appropriate facility which offers services sufficient to meet the medical needs of the client;

(D) The service is medically necessary; and

(E) The service was actually rendered to the

(iv) An ALS assessment is an assessment performed by an ALS crew as part of an emergency response that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.

(c) Non-emergency transportation. Non-emergency transportation provided in a ground ambulance is a covered service if any other mode of transportation would endanger the health or life of the individual and the individual is:

(i) Continuously dependent on oxygen;

(ii) Continuously confined to bed;

(iii) Unable to perform any physical activity without discomfort because of a cardiac disease;

(iv) Receiving intravenous treatment;

(v) Heavily sedated;

(vi) Comatose;

(vii) Post pneumo/encephalogram, myelogram, spinal tap, or cardiac catheterization;

(viii) Unable to have flexion at the hip because of hip spicas or other casts;

(ix) In need of isolette in perinatal period; or

(x) Unconscious or semi-conscious.

(d) Advanced Life Support Level 1- Non-Emergent (ALS1- non-emergent) in non-emergent circumstances.

(i) ALS1 - non-emergent is a covered service if the requirements in Section 7(b)(iii) of this Chapter are met.

(e) Air ambulance services are covered when:

(i) Services are provided by a fixed-wing aircraft or helicopter licensed to provide ambulance services, and

(ii) One of the following requirements is met:

(A) The client has a life-threatening condition and the use of any other method of transportation, including ground ambulance, would endanger the health of the client;

(B) The client's location is inaccessible by ground ambulance; or

(f) Community Emergency Medical Services, as described and certified by the Office of Emergency Medical Services (OEMS), includes Community Emergency Medical Services - Technician (CEMS-T) and Community Emergency Medical Services - Clinician (CEMS-C). Community Emergency Medical Services are a covered service if the requirements in this section are met:

(i) Community Emergency Medical Services - Technician (CEMS-T)

(A) Providers (both the agency and the individual) shall have a current endorsement of CEMS-T from the Office of Emergency Medical Services.

(B) Services shall be provided in response to a call for service and include:

(I) Appropriately treating and releasing clients, rather than providing transportation to a hospital or emergency department;

(II)Treating and transporting clients to appropriate destinations other than a hospital or an emergency department;

(III)Treatment and referral to a primary care or urgent care facility; or

(IV)Assessment of the client and reporting to a primary care provider to determine an appropriate course of action.

(C) Provider documentation shall be entered into the electronic reporting system maintained by the OEMS and fully document services provided to the client.

(ii) Community Emergency Medical Services - Clinician (CEMS-C)

(A) Providers (both the agency and the individual) shall have a current endorsement of CEMS-C from the Office of Emergency Medical Services.

(B) Services provided by the CEMS-C certified provider shall be:

(I)Within the scope of practice for the license held by the CEMS-C provider;

(II)Provided under the direct written or verbal order of a physician;

(III)Services that are likely to prevent admission to a hospital, nursing home, or other institutionalized care setting;

(IV)Coordinated with care received by the client from other community providers in order to prevent duplication of services; and

(V)Identified in a written, well documented plan of care, which may include:

(1.) Health assessments;

(2.) Chronic disease monitoring and education;

(3.) Medication compliance;

(4.) Immunizations and vaccinations;

(5.) Laboratory specimen collection;

(6.) Hospital discharge follow-up care; and

(7.) Minor medical procedures.

(C) Services provided, physician's orders, and the plan of care shall be documented in the client's comprehensive medical record maintained by the ambulance agency and supplied to the Department upon request.

Section 8. Excluded Services. The following are not covered services:

(a) Transportation to receive services that are not covered services;

(b) No-load trips and unloaded mileage (when no patient is aboard the ambulance), including transportation of life-support equipment in response to an emergency call;

(c) Transportation of a client who is pronounced dead before an ambulance is called or after the ambulance is called but before transport;

(d) Transportation of a family member or friend to visit a client or consult with the client's physician or other provider of medical services;

(e) Transportation to pick up pharmaceuticals;

(f) A client's return home when ambulance transportation is not medically necessary, including a client's return back to a nursing facility;

(g) Transportation of a resident of a nursing facility to receive services that are available at the nursing facility;

(h) Air ambulance services to transport a client from a hospital capable of treating the client to another hospital at the request of the client or family;

(i) Transportation of a client in response to detention ordered by a court or law enforcement agency;

(j) Transportation based on a physician's standing orders;

(k) Stand-by time;

(l) Special attendants;

(m) Specialty Care Transport (SCT);

(n) Paramedic Intercept (PI);

(o) When a client can be transported by a mode other than ambulance without endangering the client's health, regardless of whether other transportation is available; and

(p) Any other service not included in Section 7 of this Chapter.

Section 9. Prior Authorization.

(a) Services that require prior authorization.

(i) The Department may designate ambulance services that require prior authorization.

(ii) In designating services that require prior authorization, the Department shall consider the:

(A) Cost of the service;

(B) Potential for over-utilization of the service; and

(b) The Department may disseminate a list of ambulance services that require prior authorization to providers through manuals or bulletins.

Section 10. Medicaid Allowable Payment. Medicaid reimbursement shall be the lesser of the provider's usual and customary charges and the Medicaid fee schedule.

Section 11. Submission and Payment of Claims.

(a) An ambulance trip report shall be submitted with all claims. The failure to submit such a report may result in the denial of payment.

(i) An ambulance trip report is a written report, in the form and containing the information specified by the Department, documenting the ambulance services for which Medicaid reimbursement is being sought.

Section 12. Delegation of duties. The Department may delegate any of its duties under this rule to the HHS, any other agency of the federal, state, or local government, or a private entity which is capable of performing such functions, provided that the Department shall retain the authority to impose sanctions, recover overpayments, or take any other final action authorized by this Chapter or another Chapter within this rule.

Section 13. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of various provisions.

Section 14. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

Section 15. Severability. If any portion of this Chapter is found invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2018-05-14

Chapter 16 Medicaid Program Integrity

Wyo. Code R. 048.0037.16.04302020 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at Wyoming Statute § 42-4-101, et seq.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 2 Purpose and Applicability

(a) This Chapter has been adopted to govern the process and procedures pertaining to Medicaid Program Integrity including, but not limited to, the identification and investigation of suspected fraud, waste, or abuse of services, the recovery of overpayments, and the imposition adverse actions against both providers and clients.

(b) The Department may issue manuals, bulletins, or both, to interpret the sections of this Chapter. Such manuals and bulletins shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the sections of this Chapter.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 3 Definitions

Except as otherwise specified in Chapter 1 of the Wyoming Department of Health's Medicaid Rules, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, Medicaid, and Medicare.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 4 Audits

(a) The Department shall be responsible for the detection of suspected fraud, waste, or abuse of services.

(b) The Department shall have the ability to conduct audits of providers or clients.

(d) The Department may perform audits through employees, agents, or through a third party. Audits shall be performed in accordance with Generally Accepted Auditing Standards (GAAS).

(e) If at any time during an audit the Department discovers evidence of an overpayment, that evidence may be referred to the MFCU or the DFS Eligibility Integrity Unit.

(f) Provider self-audit.

(i) A provider may conduct a self-audit at any time. The Department may review or audit the provider's self-audit.

(ii) The Department may require a provider to conduct a self-audit at any time.

(iii) The provider shall notify the Department within sixty (60) business days of the completion of the self-audit.

(g) The Department may require the development of corrective action plans to remediate identified deficiencies.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 5 Random Sample and Extrapolation

(a) The Department shall notify the provider via certified mail of its intent to use extrapolation. The notice shall include:

(i) The nature of the claims;

(ii) The number of claims; and

(iii) The method to be used in extrapolating from the sample.

(b) The amount of overpayments determined pursuant to extrapolation shall be refutably presumed to be correct. The provider may rebut the presumption by providing, at the provider's expense, an audit using GAAS or SAS, or by demonstrating that the method used by the Department failed to comply with the requirements of this Section.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 6 Review of All Claims Submitted by the Provider

The Department may conduct a prepayment or post-payment review of all claims submitted by the provider for six (6) years from the paid date.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 7 Claim Adjustments and Denials

(a) The Department shall make a claim adjustment after Medicaid payment has been made. If there is an adjusted amount, the Department may recover the adjustment amount.

(b) The Department shall deny claims which are improperly submitted or which contain errors of any kind. Such claims may be resubmitted, subject to applicable federal and state requirements.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 8 Repayment of Credit Balance

(a) A provider shall repay any credit balance within thirty (30) business days after the date such credit balance is identified by the Department or the provider.

(b) A provider credit balance may be collected from the same provider under another provider number if that provider number is listed with the same tax identification number.

(d) A provider may not request reconsideration or an administrative hearing regarding a credit balance.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 9 Medicaid allowable payment

(a) Any payment which exceeds the Medicaid allowable payment for the service shall be recovered.

(b) A provider may not request reconsideration or an administrative hearing regarding a recovery of payments which exceeds the Medicaid allowable payment.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 10 Investigation of Suspected Fraud, Waste, or Abuse of Services by Providers

(a) The Department shall be responsible for the detection of suspected fraud, waste, or abuse of services.

(b) The Department is authorized to investigate, or to refer to appropriate agencies the investigation of suspected fraud, waste, or abuse of services identified pursuant to this section. An investigation shall be for the purpose of determining if:

(i) The identified practice is lawful and in compliance with existing rules and regulations and state and federal laws;

(ii) Fraud, waste, or abuse of services exists and can be documented;

(iii) Sufficient evidence can be developed to support the recovery of overpayments, the imposition of an adverse action or any other civil or criminal action permitted by law; or

(iv) The matter should be referred for additional investigation or other action by a law enforcement agency or the Medicaid Fraud Control Unit (MFCU).

(i) Examination of medical, financial, or patient records;

(ii) Interviews of providers, their associates, agents or employees, or contractors;

(iii) Verification of a provider's professional credentials, the credentials of the provider's associates, agents, employees, or contractors;

(iv) Interviews with clients;

(v) Examination of equipment, supplies or other items used in a client's treatment;

(vi) Examination of prescriptions;

(vii) Random sampling and extrapolation; and

(viii) Examination of financial records, including, but not limited to, insurance claims or records, or records of any other source of payment.

(d) For purposes of performing its duties under this Chapter, the Department may use any relevant information necessary to conduct an investigation.

(e) After the completion of an investigation, the Department shall take one or more of the following actions:

(i) Determine that no further action is warranted;

(ii) Take adverse action against the provider; or

(iii) Refer the matter to law enforcement, the Wyoming Attorney General, Health and Human Services (HHS), Department of Family Services (DFS) Eligibility Integrity Unit, the MFCU, or other appropriate authorities for possible civil or criminal action.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 11 Investigation of Suspected Fraud, Waste, or Abuse of Services by Clients

(a) The Department is authorized to identify and investigate, or to refer to appropriate agencies for investigation, suspected fraud, waste, or abuse of services by clients identified pursuant to this section. An investigation shall be for the purpose of determining if:

(i) Fraud, waste, or abuse of services occurred or is occurring and can be documented;

(ii) Sufficient evidence can be developed to support restricting client participation; or

(iii) Sufficient evidence can be developed to support recovery of overpayments.

(b) The Department may, at any time, refer suspected client fraud, waste, or abuse of services, to the DFS Eligibility Integrity Unit or any other appropriate law enforcement agency.

(c) For purposes of its duties under this Chapter, the Department may use any relevant information to conduct an investigation.

(d) After the completion of or during an investigation, the Department shall take one or more of the following actions:

(i) Determine that no further action is warranted; or

(ii) Impose adverse actions against the client.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 12 Adverse Actions for Providers

(a) The Department may impose adverse actions against a provider for:

(i) Suspected or substantiated fraud, waste, or abuse of services in submitting claims;

(ii) A pattern of presenting false or duplicate claims or claims for services not medically necessary;

(iii) A pattern of making false statements of material facts for the purpose of obtaining overpayments;

(iv) Failure to comply with the provisions of the provider agreement;

(v) Civil Remedies imposed by Centers for Medicare and Medicaid Services (CMS);

(vi) Failure to render requested documentation;

(vii) Situations that pose a threat to the health, safety, or welfare of the clients or general public;

(viii) Suspension, termination, or expiration of state licensure or any certification required to provide services;

(ix) Lack of or repeated failure to provide documentation of Medicaid services;

(x) Provider's inability to repay overpayments;

(xi) Failure to maintain current contact information;

(xii) Exclusion by the Office of Inspector General;

(xiii) Termination/exclusion under Medicare, Children's Health Insurance Program (CHIP) or another State's Medicaid program;

(xiv) Failure to maintain records;

(xv) Refusal to grant access to records;

(xvi) Refusing to complete education;

(xvii) Pending the completion of an on-going investigation conducted by the MFCU or another law enforcement agency;

(xviii) Failure to notify the Department of the completion of a self-audit within sixty (60) days;

(xix) Prosecution by the MFCU or another law enforcement agency and found guilty of healthcare fraud;

(xx) Failure to submit any paid claims for over one (1) year;

(xxi) Failure to submit an acceptable corrective action/quality improvement plan, or has failed to implement the corrective action/quality improvement plan approved by the Department;

(xxii) The chronic failure to provide services pursuant to the individual plan of care;

(xxiii) Providing services that fail to meet the applicable standard of care for the profession/service involved;

(xxiv) There is a continuing condition creating serious detriment to the health, safety, or welfare of recipients of home and community-based waiver services; or

(xxv) Violation of Medicaid, Department, or other State or Federal statute, rule, or law relating to provisions of services.

(b) When making a decision to impose adverse actions, the State Medicaid Agent, or the Agent's designee shall consider:

(i) The nature and extent of the provider's violations;

(ii) The provider's history of previous violations;

(iii) Actions taken or recommended by other State regulatory or licensing agencies; and

(iv) The steps taken by the provider to reduce the possibility of future violations.

(i) Educational intervention;

(ii) Recovery of overpayments;

(iii) Suspension of payments;

(iv) Suspension of provider agreement;

(v) Termination of provider agreement;

(vi) Place conditions on the provider;

(vii) Impose a monitor;

(viii) Impose civil monetary penalties;

(ix) Impose an immediate suspension; or

(x) Impose an additional appropriate adverse action.

(d) The Department shall send written notice of the adverse action, to the provider, via certified mail, return receipt requested. The notice shall include:

(i) A statement of the intended action;

(ii) The effective date of the intended action;

(iii) The reason(s) for the intended action;

(iv) The specific regulations that support, or the change in federal or state law that requires the action;

(v) The provider's right to request reconsideration of the adverse action;

(vi) The right to representation by a lawyer admitted to practice in Wyoming; and

(vii) A statement that the failure to request reconsideration shall preclude any further appeal of the adverse actions.

(e) If a provider agreement has been terminated, and all appeal periods have been exhausted, the Department shall send written notice of the adverse action to the public, known beneficiaries, known entities where the Provider was receiving payment for services, MFCU, Utilization and Quality Control Quality Improvement Organizations, the appropriate professional society, the appropriate state licensing agency, CMS, Office of Inspector General (OIG), and any other appropriate authority. Such notice shall include the adverse action, the findings of fact which led to the adverse action and the results of any appeals pursuant to 42 CFR 1001.2005 and 2006 and 42 CFR 1002.212.

(f) Effective date of adverse action.

(i) Adverse actions shall be effective on the date specified in the notice of adverse actions.

(ii) Suspension or termination of a provider shall be effective immediately in the following instances:

(A) When the Department determines there is an imminent threat to the health, safety, or welfare of clients the general public; or

(B) When the Department receives notice that a provider's state license, any certification required to provide services has been suspended or revoked, or when the provided has been terminated from another State Medicaid agency.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 13 Adverse Actions for Clients

(a) The Department may impose or refer a client to the appropriate agency for adverse actions for instances including, but not limited to:

(i) Fraud, waste, or abuse in obtaining services;

(ii) Alteration or duplication of the client's Medicaid identification card;

(iii) Permitting, authorizing or assisting a non-client to use the client's Medicaid identification card to obtain services;

(iv) Using another client's Medicaid identification card to obtain services;

(v) Alteration or duplication of a prescription;

(vi) Knowingly misrepresenting material facts regarding the client's physical or mental condition for the purpose of obtaining services;

(vii) Knowingly furnishing incorrect information regarding eligibility to a provider;

(viii) Knowingly furnishing incorrect information to a provider to obtain services which are not medically necessary;

(ix) Pending the completion of an on-going investigation conducted by the MFCU, Eligibility Integrity Unit or another law enforcement agency;

(x) Refusing to complete education; or

(xi) Obtaining services by any false or incorrect pretenses.

(b) The decision to take action pursuant to this Section shall be made by the State Medicaid Agent, or the Agent's designee, who shall consider, among other things:

(i) The nature and extent of the client's violations; and

(ii) The client's history of previous violations.

(i) Refer the client to educational intervention to correct inappropriate or dangerous utilization of services;

(ii) Recover overpayments from the client, to the extent permitted by law;

(iii) Restrict the client's future participation in Medicaid to receiving services from the provider or providers designated by the Department. Medicaid payments shall be limited to the designated provider, except for payments for emergency care; or

(iv) Any other action allowed by state or federal law.

(d) The Department shall send written notice of the adverse action, to the client, via certified mail, return receipt requested. The notice shall include:

(i) An explanation of:

(A) The individual's right to request a hearing; or

(B) An explanation of circumstances where a hearing will be granted based on a change in the law.

(ii) The method for requesting a hearing;

(iii) The individual's right to be represented by a legally authorized representative, including a lawyer admitted to practice in Wyoming, a relative, friend or other spokesperson;

(iv) Notice that the individual shall notify the Department in writing that they will be represented;

(v) The intended action;

(vi) The effective date of the intended action;

(vii) The reason(s) for the intended action;

(viii) The specific regulations that support, or the change in federal or state law that requires the action;

(ix) Where applicable, an explanation of the circumstances under which benefits may be continued if a hearing is requested pursuant to 42 C.F.R. § 431.231; and

(x) The client's right to request a reconsideration of the adverse action.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 14 Educational Intervention

(a) If the adverse action includes educational intervention, the Department will inform the provider or client:

(i) The reason(s) for the educational intervention,

(ii) The education required,

(iii) The time and date of the education, and

(iv) That the continued participation as a provider or client in Medicaid is contingent on complete of the education by the specified date.

(b) If the education is refused, the provider or the client shall be suspended from participation in Medicaid until the education is completed.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 15 Recovery of Overpayments from Providers or Clients

(a) The Department shall recover overpayments from providers. The Department may recover overpayments from a clinic, group, corporation, professional association, or other organization of any current or former member of that practice. The Department may also recover overpayments from an individual provider that was formerly part of a clinic, group, corporation, professional association or other organization. The Department shall recover overpayments from a client that has engaged in abuse of services, fraud, or waste resulting in an overpayment.

(b) After determining that a provider or client has received overpayments, the Department shall send written notice, via certified mail, return receipt requested, to the provider or client. In addition to any additional notice requirements, the notice shall include:

(i) The amount of the overpayments; and

(ii) The basis for the determination of overpayments.

(c) A provider or client shall reimburse the Department for overpayments within thirty (30) business days after the provider or client receives written notice from the Department of the overpayments. Neither the filing of a request for reconsideration nor a request for an administrative hearing shall stay the effective date of the adverse action.

(d) If a provider or client does not timely reimburse the Department, following final administrative action, the Department shall recover the overpayments by:

(i) Withholding all or part of future Medicaid payments:

(A) Payments shall be withheld at one hundred percent (100%);

(B) Payment arrangements may be entered into if the provider or client can demonstrate that one hundred percent (100%) withholding will result in an undue hardship, with the approval of the State Medicaid Agent or the Agent's designee;

(ii) Initiating a civil lawsuit against the provider or client; or

(iii) Any other method of collecting a debt or obligation permitted by law.

(e) If the provider is bankrupt or out of business, the Department shall notify the provider that an overpayment exists and take reasonable action to recover the overpayment during the three hundred and sixty-five (365) day recovery period in accordance with 42 CFR § 433.318. The Department shall take action to be listed as a creditor in the bankrupt proceedings.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 16 Suspension and Termination of Provider

(a) A suspension or termination under this section shall be the same and shall run contemporaneously with the period of the provider's suspension from a licensing entity, Medicare, another State Medicaid Agency or any period of voluntary non-participation.

(b) A suspended or terminated provider shall not submit any claims, either personally or through a third party payer, clinic, group or other association, for any services provided after the effective date of the suspension;

(c) No clinic, group, corporation, professional association or other organization shall submit any claim for services provided by an individual provider within such organization after the effective date of the individual provider's suspension or termination; and

(d) The Department shall not pay any claims submitted by a provider for services provided to a client during any period of suspension or after a provider has been terminated.

(e) The Department may suspend any and all provider numbers that have the same tax identification number as the provider number that has been suspended or terminated.

(f) This section does not preclude the filing of claims prior to a termination. Any filed claims may be held in suspense until a final decision is rendered on the termination.

(g) The Department may reinstate or reenroll a suspended or terminated provider if:

(i) The Department has been reimbursed for all overpayments or a payment agreement is in effect;

(ii) The Department is satisfied that sufficient safeguards have been implemented to insure that fraud, waste, or abuse of services, or other factors which led the suspension or termination, will not recur; and

(iii) For terminated providers, an approved new provider agreement is signed by all parties.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 17 Conditions on Providers

(a) The Department may place the following condition(s) on the provider's certification or Medicaid enrollment:

(i) Requiring a physician's or appropriate medical specialist's statement verifying the ability to perform service duties as required;

(ii) Restricting the provider's certification or participation to a specific service;

(iii) Restricting the provider's certification or participation to a specific geographic area or location; and

(iv) Requiring the provider to deny new admissions.

(b) The provider shall be notified via certified mail that a condition is being place on their certification or participation and shall have fifteen (15) business days to abate all areas of noncompliance that warrant the condition(s), or to submit an acceptable corrective action/quality improvement plan.

(i) If the provider fails to abate all areas of noncompliance or submit an acceptable corrective action/quality improvement plan within fifteen (15) business days of the notice, then the condition(s) shall go into effect and continue until removed.

(A) If all areas of noncompliance are successfully abated or an acceptable corrective action/quality improvement plan is received by the Department, within fifteen (15) business days of receipt of the notice then the condition(s) shall not be imposed.

(B) If the provider does not implement the corrective action/quality improvement plan accepted by the Department, than the provider shall be notified via certified mail that condition(s) shall be effective immediately.

(ii) Once in place, a condition(s) shall not be removed until the provider submits the following:

(A) Evidence that the areas of non-compliance have been abated;

(B) An acceptable corrective action/quality improvement plan and;

(C) Verification that the corrective action/quality improvement plan has been implemented for each area of non-compliance, within thirty (30) days of placement of the condition.

(c) Failure to comply with this section may result in revocation of the provider's certification or other applicable adverse action.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 18 Impose a Monitor

(a) The state monitor shall have access to all of the provider's financial and health records, service delivery settings, staff and participant information that is otherwise available to the Department.

(b) The state monitor shall be removed when the provider has abated the areas of non-compliance and has submitted and implemented an acceptable corrective action / quality improvement plan.

(c) The state shall pay the costs and expenses of the state monitor if the provider fails to do so. The monitor shall continue to monitor the provider until payment in full is received from the provider.

(d) The Department shall make a reasonable effort to assure that there is not a potential conflict of interest between the state monitor and the provider.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 19 Civil Monetary Penalties

(a) When determining the amount of any proposed penalty, the Department shall consider the following factors:

(i) The size of the provider's operation, including number of clients served;

(ii) The gravity and extent of any potential or actual health, safety, or welfare risk to a participant;

(iii) The degree of fault of the provider in causing or failing to correct the violation either through act or omission, ranging from inadvertent action causing an event which was unavoidable by the exercise of reasonable care to reckless, knowing, or intentional conduct;

(iv) Whether economic benefit resulted from the provider's failure to comply;

(v) The appropriateness of any action or inaction to mitigate a health, safety, or welfare risk to a participant;

(vi) The provider's history of previous substantiated violations; and

(vii) Any other relevant information submitted to the Department between the initial adverse action and the decision to impose civil monetary penalty.

(b) A finding that civil monetary penalty is warranted shall:

(i) Be submitted to the provider, in writing, via certified mail;

(ii) Include reference to specific factors relevant to the determination of the penalty as supported by substantial evidence; and

(iii) Begin upon the provider's receipt of the notice of penalties, except that a provider's bad faith attempts to avoid notice shall cause the penalties to begin to run immediately.

(c) For each day of continuing violation, the civil monetary penalty shall not exceed one thousand dollars ($1,000.00) or one percent (1%) of the amount paid to the provider during the previous twelve (12) months, whichever is greater.

(i) The provider may request that the Department reduce the penalty imposed.

(A) The Department may reduce the penalty upon a finding that the financial impact may negatively impact the provider's ability to provide services that meet participants' health and safety needs.

(B) Such a reduction shall be requested by the provider, in writing, and must be accompanied by relevant evidence to support the requested reduction within twenty (20) business days of receiving notice of the penalty

(C) The Department's findings with regard to the reduction must be supported by substantial evidence and shall be sent to the provider via certified mail.

(d) The civil monetary penalty shall continue until the provider submits evidence that the areas of non-compliance are abated, or the provider submits and implements an acceptable quality improvement plan.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 20 Immediate suspensions

(a) If a substantial and immediate threat to the health or safety of clients exists, the Department may immediately suspend the certification or enrollment of the provider and take action necessary to protect the health and safety of participants

(b) Notice of the immediate suspension shall be in writing provided to the provider at the time of the suspension.

(c) The provider shall be afforded an opportunity for a hearing within ten (10) business days after the effective date of the immediate suspension.

(i) A request for hearing shall be provided to the Department within two (2) business days after the receipt of notice.

(ii) The Department shall notify the provider that the hearing has been accepted or denied within one (1) business day of receipt of the request.

(iii) Providers shall not be afforded the opportunity to request reconsideration for suspensions under this section.

(iv) All other procedures for immediate suspension hearings shall be as specified by Chapter 4 of the Wyoming Department of Health's Medicaid Rules.

(d) The immediate suspension of the provider shall remain in place until the conclusion of the Administrative Hearing process or the provider submits:

(i) Evidence that the substantial and immediate threat to the health or safety of participants has been abated;

(ii) An approved corrective action or quality improvement plan for each area of non-compliance; and

(iii) Evidence that the corrective action or quality improvement plan for each area of non-compliance has been implemented.

(e) In addition to suspending the provider the Department make take action necessary to protect the health and safety of participants. The action may include:

(i) Removing the person or persons deemed to be at significant risk;

(ii) Making a report of abuse or neglect to the appropriate investigative agency as may be required by law; or

(iii) Other actions deemed necessary to protect the health or safety of participants.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 21 Reconsideration

(a) Request for reconsideration.

(i) A provider may request that the Department reconsider an adverse action. Such request shall be mailed to the Department via certified mail within twenty (20) business days after the mailing of the notice of the adverse action.

(A) The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice.

(B) A provider shall submit any additional relevant information at the time of the request.

(ii) A client may request that the Department reconsider a decision to recover overpayments. Such request must be submitted electronically via email to Department, made verbally to the Department, or mailed to the Department via certified mail, return receipt requested, within twenty (20) business days after the mailing of the notice of the adverse action.

(A) The request must state with specificity the reasons for the request. Failure to provide such a statement shall result in the dismissal of the request with prejudice.

(B) A client may submit any additional relevant information at the time of the request.

(b) The Department may request additional information from the party requesting reconsideration as part of the reconsideration process. Such a request shall be made in writing by certified mail, return receipt requested.

(i) The party to whom the request is directed must provide the requested information within thirty (30) business days after the date of the request.

(ii) Failure to provide the requested information shall result in the dismissal of the request for reconsideration with prejudice.

(c) The Department shall review the decision and send written notice of its final decision via certified mail, return receipt requested, to the party requesting reconsideration.

(i) The Department shall send its final decision within forty-five (45) business days after the Department receives the request for reconsideration or after the receipt of any additional information requested, whichever is later.

(d) Reconsideration shall be limited to whether the Department has complied with this Chapter or other applicable rules of the Department.

(e) The party requesting reconsideration or the Department may request an informal meeting before the final decision is made to determine whether the matter may be resolved.

(i) The substance of the discussions and/or settlement offers made pursuant to an attempt at informal resolution shall not be admissible as part of a subsequent administrative hearing or judicial proceeding.

(f) Failure to Request Reconsideration.

(i) A provider that fails to request reconsideration pursuant to this section may not subsequently request an administrative hearing regarding the adverse action.

(ii) A client may elect not to request reconsideration and may request an administrative hearing regarding the adverse action.

(A) Such a request for hearing shall be submitted electronically via email to Department, made verbally to the Department, mailed via certified mail, return receipt requested, or personally delivering a request for hearing to the Department within thirty (30) business days of the date of the notice of the adverse action.

(B) Failure to request reconsideration or an administrative hearing within the required time shall preclude the client's right to contest the adverse action.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 22 Suspending or Withholding Payments Pending Reconsideration or Administrative Hearing

(a) The Department may suspend a provider or withhold all payments for services furnished by a provider pending reconsideration or administrative hearing if the State Medicaid Agent or his or her designee determines in writing and notifies the provider that:

(i) There is a substantial likelihood the Department will prevail in an action to recover overpayments;

(ii) There is a substantial likelihood the provider's pattern or practice which prompted the investigation will continue; or

(iii) There is reasonable cause to doubt the provider's financial ability to refund any overpayments.

(b) The decision to suspend or withhold payments pursuant to this section may be subject to an administrative hearing.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 23 Remedies Cumulative

. The remedies provided by this Chapter are cumulative. The Department may seek multiple adverse actions simultaneously, and pursue any additional remedies permitted by law.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 24 Effect of Fraud, Waste, or Abuse of Services of Medicare

(a) The Department shall suspend or terminate any provider who has been suspended or terminated from participation in Medicare, or any provider which voluntarily withdraws from Medicare when Medicare certification is a prerequisite to enrollment in Medicaid.

(b) The duration of the provider's suspension, termination, or withdrawal from participation in Medicaid shall be the same as and shall run contemporaneously with the provider's suspension, termination, or withdrawal from participation in Medicare.

(c) A provider suspended or terminated from participation in Medicaid pursuant to this section shall not be entitled to reconsideration or an administrative hearing pursuant to this rule or any other rules of the Department. The provider's remedies are limited to those provided by Medicare.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 25 Disposition of Recovered Funds

(a) The Department shall, in accordance with the Social Security Act and applicable HHS regulations, repay all recovered federal Medicaid funds to CMS.

(b) The Department shall retain the state Medicaid percentage of all recovered Medicaid funds as a state general fund reduction.

History

Effective 2020-04-30

Wyo. Code R. 048.0037.16.04302020 § 26 Delegation of Duties

The Department may delegate any of its duties under this rule to the Wyoming Attorney General, HHS, any other agency of the Federal, State or local government, or a private entity which is capable of performing such functions, provided that the Department shall retain the authority to impose adverse actions, recover overpayments or take any other final action authorized by this Chapter.

History

Effective 2020-04-30

Chapter 17 Nursing Facility Resident Trust Accounts

Wyo. Code R. 048.0037.17.05292012 Nursing Facility Resident Trust Accounts

CHAPTER 17

Rules and Regulations for Medicaid

Nursing Facility Resident Trust Accounts

Section 1. Authority. This rule is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. § 42-4-101, et seq., and the Wyoming Administrative Procedure Act at W.S. § 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) This Chapter has been adopted to establish the standards and procedures for all resident trust accounts maintained by nursing facilities.

(b) The Department may issue manuals, bulletins, or both to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

(c) 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.

Section 3. Definitions. Except as otherwise specified in the Rules and Regulations of Wyoming Medicaid, Chapter 1, Definitions, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

Section 4. Notice to Residents. Notice of covered services. At the time of admission, the nursing facility shall provide the resident and the resident's representative with a written notice that contains the information specified in subsections (a) through

(g) . Such notice shall also be given at least once every year after admission, and within sixty (60) days after there is any change in the services available to residents, the charges for such services or the services included in the Medicaid reimbursement rate. The notice shall contain:

(a) An itemized statement of the services provided by the nursing facility as part of the nursing facility's Medicaid reimbursement rate;

(b) An itemized statement of the services provided by the nursing facility that are not covered by the nursing facility's Medicaid reimbursement rate or Medicare and that may be charged to the resident, including the charge for each such service;

(i) Personal funds account. For purposes of this Chapter, personal funds are all funds which belong to a resident, from whatever source, including the resident's personal care allowance.

(ii) Resident trust account. For purposes of this Chapter, the resident trust account is an account maintained by a facility in which a facility resident's personal funds are deposited and held in trust by the facility for the use and benefit of the resident.

(d) A description of the resident's right to select one (1) of the following alternatives for the management of personal funds:

(i) The resident may receive, retain and manage personal funds directly or through a legal guardian;

(ii) The resident may apply to the Social Security Administration for the designation of a representative payee to receive and manage personal funds; or

(iii) The resident may designate, in writing, another person to receive and manage personal funds.

(e) A statement that any charge for the nursing facility managing the resident's trust account is included in the Medicaid reimbursement rate;

(f) A statement that the resident is entitled to one (1) accounting per calendar month of the resident's trust account upon the written request of the resident, the resident's legal guardian, the resident's representative payee or such other person as has been designated to manage the resident's trust account;

(g) A statement that if the resident is or becomes incapable of managing personal funds and has not designated another person to do so, the nursing facility shall arrange for the management of the resident's personal funds pursuant to the provisions of this Chapter; and

(h) Notice of potential ineligibility for Medicaid or SSI. In addition to the notice described above, the nursing facility shall notify a client when the balance of the resident's trust account is within two hundred dollars ($200.00) of the amount determined under 42 U.S.C 1382(a)(3)(B). The notice shall be in writing and shall inform the client that if the amount in the account plus the client's other nonexempt resources reaches the amount determined under 42 U.S.C. 1382(a)(3)(B), the client may lose eligibility for Medicaid, SSI or both.

Section 5. Charges to Residents.

(a) No charges for services included in per diem rate or covered by Medicare. A nursing facility may charge a resident only for services which are not included in the nursing facility's per diem rate for that resident and which are not covered by Medicare.

(b) Charges to personal care allowance. A nursing facility may seek reimbursement from a resident's personal care allowance only for services directly related to the resident's personal needs, including, but not limited to:

(i) Commissary items, such as books, magazines and candy; or

(ii) Premiums on life insurance policies or burial expense policies.

Section 6. Nursing Facility's Fiduciary Responsibilities.

(a) Upon written authorization from the resident, or any individual designated pursuant to Section 4 of this Chapter, the nursing facility shall accept responsibility for:

(i) Receiving personal funds;

(ii) Depositing personal funds in the resident's trust account;

(iii) Safeguarding the resident's personal funds; and

(iv) Managing the resident's trust account, including accounting for all personal funds received by the nursing facility.

(b) Management. The nursing facility may perform the duties specified in this Chapter directly or through a bank, which is a federally or state chartered bank, savings and loan or credit union which is insured by an agency of the United States Government. The delegation of such duties to a bank shall not affect the nursing facility's ultimate responsibility for ensuring that the requirements of this Chapter are met.

(c) Interest. The nursing facility may deposit personal funds in a non-interest bearing account if such funds do not exceed fifty dollars ($50.00). Funds in excess of fifty dollars ($50.00) shall be transferred to an interest bearing account within fifteen (15) days after the date a client's trust account exceeds fifty dollars ($50.00). All such interest shall accrue to the resident's trust account.

(d) Pooled funds. Resident trust accounts may be pooled. If the nursing facility uses a pooled account, it must:

(i) Maintain records adequate to clearly disclose the amount of each resident's trust account and each transaction involving such account;

(ii) Indicate on the account that the nursing facility does not have an ownership interest in the funds; and

(iii) Establish a written policy for the attribution of accrued interest among the pooled accounts. Interest may be prorated by:

(A) End of quarter balance;

(B) End of month balance;

(D) Average daily balance.

(e) Record keeping requirements. The nursing facility shall maintain current, written records of each transaction involving each resident's trust account for which the nursing facility is responsible. The records shall include:

(i) The resident's name;

(ii) The name of the resident's representative;

(iii) The date of the resident's admission;

(iv) The date and amount of each deposit and withdrawal, the name of the person who accepted the withdrawn funds, the purpose for which funds were withdrawn, and the balance after each transaction;

(v) Receipts indicating the expenditure of the funds;

(vi) All accrued interest; and

(vii) If applicable, the date of discharge, the date the resident's trust account was closed and final disposition of the resident's trust account.

(f) Resident unable to manage funds. When a resident is not capable of managing personal funds for any reason, the nursing facility shall, in addition to the record-keeping required by subsection (e), maintain prenumbered voucher slips which:

(i) Indicate the item(s) purchased with the resident's personal funds; and

(ii) Contain two (2) signatures for each withdrawal, one (1) of which shall be that of a supervisory employee of the nursing facility. If the withdrawal is to reimburse another person for the expenditure of funds on behalf of the resident, that person's signature shall appear on the voucher.

(g) Quarterly reports. Within thirty (30) days after the end of each calendar quarter, the nursing facility shall issue a written accounting to each resident or resident representative for whom the facility maintains a resident trust account. The written accounting shall include:

(i) The balance at the beginning of the quarter;

(ii) Total deposits and withdrawals;

(iii) Interest earned;

(iv) The balance at the end of the quarter; and

(v) The location of the resident's trust account and the account's identification number.

(h) Access to resident trust accounts. The nursing facility shall provide access to resident trust accounts:

(i) For at least two (2) hours during normal business hours each working day; and

(ii) For a reasonable time on Saturdays and Sundays.

(i) Commingling of resident trust accounts. The nursing facility shall not commingle resident trust accounts with any of the nursing facility's funds. Each resident trust account shall state that the nursing facility has no ownership rights in the account and that the funds are held in trust.

(j) Return of personal funds. The nursing facility shall, upon written request by a resident or the person designated pursuant to subsection 4(d) of this Chapter:

(i) Return the balance of the resident's trust account to the requesting party within five (5) days after receipt of such request; and

(ii) Provide a written accounting, including all transactions from the date of the last quarterly report.

(k) Death of resident. Upon the death of a resident for whom the nursing facility is maintaining a resident trust account, the nursing facility shall:

(i) Provide the personal representative of the estate of the resident, or any other person entitled to distribution pursuant to W.S. § 2-4-101, et seq., with a full, written accounting of the resident's trust account within thirty (30) days after the date of the resident's death; or

(ii) If there is no person entitled to an accounting pursuant to paragraph (i), provide a full, written accounting of the resident's trust account to the person designated pursuant to subsection 4(d) of this Chapter or the resident's representative.

(iii) If the funds in a deceased resident's trust account are not claimed within six (6) months after the resident's death, the funds shall be handled according to the Wyoming Probate Code.

(l) Change of ownership. A nursing facility shall, within sixty (60) days before a change of ownership:

(i) Provide a written accounting of all resident trust accounts to the new owner; and

(ii) Provide a written accounting to each resident or resident representative of all transactions from the date of the last quarterly report and the balance in the account on the date of the accounting.

(iii) On or before the effective date of the change of ownership, the nursing facility shall surrender all resident trust accounts to the new ownership, obtain a written receipt for such funds, and otherwise comply with the provisions of the Rules and Regulations of Wyoming Medicaid, Chapter 7, Nursing Home Reimbursement System.

(iv) Failure to comply with the provisions of this subsection shall result in the nursing facility transferring ownership and the new ownership remaining jointly liable for all resident trust accounts entrusted to the nursing facility at or before the time of the change of ownership.

(m) Accounting principles. All accountings required by this Chapter shall be performed in accordance with generally accepted accounting principles (GAAP).

Section 7. Audits of Resident Trust Accounts.

(a) Audits are subject to the requirements of the Rules and Regulations of Wyoming Medicaid, Chapter 16, Medicaid Program Integrity.

(b) Repayment of missing funds. The nursing facility shall, within ten (10) days after receipt of notice of missing funds, replace such funds and provide a written accounting of such replacement to the Department, even if the nursing facility has requested reconsideration or requested an administrative hearing regarding the determination of missing funds. Missing funds are personal funds for which a facility is responsible, which are determined after an audit to be missing or otherwise unaccounted for. If the nursing facility does not replace the missing funds, the Department may recover such funds from the facility subject to the requirements of the Rules and Regulations of Wyoming Medicaid, Chapter 16, Medicaid Program Integrity.

Section 8. Delegation of Duties. The Department may delegate any of its duties under this rule to the Wyoming Attorney General, HHS, any other agency of the Federal, State or local government, or a private entity which is capable of performing such functions, provided that the Department shall retain the authority to impose sanctions, recover overpayments or take any other final action authorized by this Chapter.

Section 9. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

Section 10. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and/or bulletins, which are inconsistent with this Chapter.

Section 11. Severability. If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2012-05-29

Chapter 18 Medicaid Eligibility

Wyo. Code R. 048.0037.18.05232025 § 1 Authority

. The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute § 42-4-101 through -124.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 2 Purpose and Applicability

(a) The Department adopts this Chapter to govern Medicaid eligibility and enrollment including an individual's rights and responsibilities, establishing uniform application and renewal procedures and defining eligibility groups.

(b) This Chapter applies to all applicants and clients for all eligibility determinations.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 3 Definitions

(b) "Relative" means a parent, child, stepchild, grandparent, grandchild, brother, sister, stepbrother, stepsister, aunt, uncle, niece, nephew, whether by birth or adoption, and whether by whole or half-blood, of the individual or individual's current or former spouse.

(c) "Fiduciary" means an individual's attorney-in-fact, guardian, conservator, legal custodian, caretaker, trustee, attorney, accountant, or agent.

(d) A "Personal Care Contract" means an agreement between a caregiver and an aged, blind or disabled individual to provide caregiver services for fair market value.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 4 Application Process, Applicant/Client Rights and Responsibilities

(a) Application Process.

(i) Applicants shall submit an application in the manner and form prescribed by the Department. The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant.

(ii) Applications shall be processed within the following time frames:

(A) Aged, Blind and Disabled programs:

(I) Forty-five (45) days from the date of application, or

(II) Sixty (60) days from the date of application when waiting on documentation from a third party for use in determining eligibility, or

(III) Ninety (90) days from the date of application when waiting for a disability determination to be completed by the Department or designee. If future medical evidence is required to assess the applicant's duration of disability, a medical deferment of up to ninety (90) additional days for processing is authorized.

(B) Family and Children's programs:

(I) Forty-five (45) days from the date of application, or

(II) Sixty (60) days from the date of application when waiting on documentation from a third party for use in determining eligibility.

(iii) Applicants shall be notified in writing of the reasons for the approval, denial or closure, the specific regulation supporting the action, and an explanation of the right to request a hearing, as specified in 42 C.F.R. § 431.210 and Wyo. Stat. § 42-4-108.

(iv) Any individual who has been determined eligible by the Social Security Administration (SSA) for Supplemental Security Income (SSI) is not required to complete an application.

(v) Applicants shall be allowed to receive retroactive Medicaid benefits not to exceed three (3) calendar months prior to the application if the individual received Medicaid covered services at any time during that period, and would have been eligible for Medicaid had they applied, unless restricted by other federal and state laws and regulations.

(b) Applicant Rights.

(i) Applicants shall be allowed the opportunity to apply for Medicaid without delay.

(ii) Applicants may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process.

(iii) Applicants may request assistance completing the applications or obtaining required verification.

(iv) Applicants shall be informed of the following information in writing and verbally as appropriate:

(A) The eligibility requirements;

(B) Available Medicaid services; and

(v) If an administrative hearing is requested, it shall be conducted in accordance with Wyoming Medicaid Rules Chapter 4, Medicaid Administrative Hearings.

(i) Applicants shall cooperate in the eligibility process by providing all information and documentation requested by the Department, including, but not limited to, income, resources, and trusts.

(ii) Applicants who fail to cooperate or provide the information requested by the Department shall be denied eligibility.

(iii) Applicants, clients, and their representatives shall report changes in any of the following circumstances to the Department within ten (10) days:

(A) Income;

(B) Resources, if applicable to their program;

(D) Health insurance coverage; and

(E) Address.

(d) Eligibility Period and Redeterminations.

(i) Medicaid eligibility begins the first day of the month in which the individual is eligible, except for eligibility under the Presumptive Programs, when eligibility begins the day the application is submitted and approved.

(ii) Individuals under age nineteen (19) and women on the Family Planning waiver are deemed to be continuously eligible for Medicaid for twelve (12) months from the effective date of eligibility or for twelve (12) months from the last review.

(iii) The Department shall redetermine client's eligibility every twelve (12) months.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 5 General Eligibility Requirements

(a) In addition to meeting the requirements of this Chapter, applicants shall meet the following requirements to be eligible for Medicaid:

(i) Applicants shall be citizens or nationals of the United States, and shall provide a social security number and provide proof of identity. Pregnant women considered to be lawfully present satisfy the citizenship and alienage eligibility requirements.

(ii) Applicants shall be a Wyoming resident or meet the criteria specified in the Wyoming Medicaid State Plan. An individual who intends to return to their home in another state shall not be considered a Wyoming resident.

(b) Individuals eligible for Wyoming Medicaid who are incarcerated will be reviewed for continued coverage at the time of notification of incarceration. If the incarcerated individual remains eligible for Wyoming Medicaid, benefits will be suspended. Renewals and applications received for incarcerated individuals will be processed and, if approved, benefits will be authorized but suspended until release from the public institution.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 6 Family and Children's Eligibility

(a) The following are Medicaid-eligible categories:

(i) Children born to a Medicaid eligible woman are deemed to have applied for medical assistance and to have been found eligible on the date of birth and to remain eligible for a period of thirteen (13) months.

(ii) Children birth through age five (5), whose countable family income does not exceed one hundred fifty-four percent (154%) of the Federal Poverty Level (FPL).

(iii) Children age six (6) through age eighteen (18), whose countable family income does not exceed one hundred thirty-three percent (133%) of the FPL.

(iv) Foster care children who are eligible for Medicaid under Title IV-E of the Social Security Act.

(v) Foster care children who are not eligible under Title IV-E of the Social Security Act and are in the custody of the Wyoming Department of Family Services (DFS).

(vi) Adopted children who live in Wyoming and are under a Wyoming Subsidized Adoption Agreement remain eligible for Medicaid until age twenty-one (21).

(vii) Children who were in DFS or Tribal custody under a Federally Funded Foster Care Medicaid program at the time of their eighteenth (18th) birthday and are released from custody at that time or later are eligible for Medicaid until age twenty-six (26).

(viii) Children who were in any State's or Tribal custody under a Federally Funded Foster Care Medicaid program at the time of their eighteenth (18th) birthday and are released from custody at that time or later are eligible for Medicaid until age twenty-six (26), if the child turned eighteen (18) on or after January 1, 2023.

(ix) A woman who is pregnant and whose family income does not exceed one hundred fifty-four percent (154%) of the FPL is eligible for Medicaid during the pregnancy and through a twelve (12) month postpartum period beginning on the last day of the pregnancy.

(x) A woman who is pregnant and whose family income does not exceed the income eligibility levels specified in the Wyoming Medicaid State Plan under Title XIX of the Social Security Act shall be eligible for Medicaid during the pregnancy and through a twelve (12) month postpartum period beginning on the last day of the pregnancy.

(xi) A woman who is at least age nineteen (19) but under the age of forty-five (45) whose family income does not exceed one hundred fifty-nine percent (159%) and is transitioning from the Pregnant Women Program shall be eligible for Medicaid coverage for certain family planning services.

(xii) Caretaker relatives of a dependent child, as specified in 42 C.F.R. 435.110, whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan shall be eligible for Medicaid. Adults must cooperate in establishing paternity and obtaining medical support.

(xiii) Caretaker relatives of a dependent child under the age of eighteen (18) whose family income exceeds the Family Care income eligibility levels due to the receipt of spousal support, and who have received Family Care benefits for three (3) of the last six (6) months shall be eligible for an extension of Medicaid benefits for four (4) months.

(xiv) Caretaker relatives of a dependent child under the age of eighteen (18) whose family income exceeds the Family Care income eligibility levels due to an increase in earning of the caretaker, and who have received Family Care benefits for three (3) of the last six (6) months shall be eligible for an extension of Medicaid benefits for twelve (12) months.

(xv) Medicaid benefits shall be available to individuals who are infected with tuberculosis.

(b) For all eligibility categories described in this Section which include an income requirement, income shall be calculated using the modified adjusted gross income of the household.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 7 Presumptive Eligibility

(a) Eligibility shall begin on the date on which a qualified provider or qualified hospital determines that an individual is eligible for presumptive eligibility and ends with the earlier of:

(i) The day on which Medicaid eligibility is determined; or

(ii) The last day of the month following the month in which the determination of presumptive eligibility was made if no full Medicaid application is received.

(b) Presumptive eligibility determinations may be conducted by a:

(i) Qualified provider; or

(ii) Qualified hospital

(i) Pregnant women whose family income does not exceed one hundred fifty-four percent (154%) of FPL shall be eligible for temporary outpatient services. A pregnant woman shall be eligible for one (1) presumptive eligibility period per pregnancy.

(ii) Children under age six (6) whose family income does not exceed one-hundred fifty-four percent (154%) of FPL and children age six (6) through eighteen (18) whose family income does not exceed one-hundred thirty-three percent (133%) of FPL shall be eligible for all services covered under the Wyoming Medicaid State Plan. A child shall be eligible for one (1) presumptive eligibility period every twelve (12) months.

(iii) Parents and other caretaker relatives of a dependent child, whose family income does not exceed the income eligibility levels specified in the Medicaid State Plan shall be eligible for all services covered under the Wyoming Medicaid State Plan for this group. The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months.

(iv) Certain individuals needing treatment for breast or cervical cancer whose household income does not exceed two hundred fifty percent (250%) of FPL shall be eligible for all services covered under the Wyoming Medicaid State Plan for this group. The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months.

(v) Children who were in any State's or Tribal custody under a Federally Funded Foster Care Medicaid program at the time of their eighteenth (18th) birthday and are released from custody at that time or later, are eligible for Medicaid until age twenty-six (26). The individual shall be eligible for one (1) presumptive eligibility period every twelve (12) months.

(d) Status as a qualified provider or qualified hospital may be terminated if a staff member of the provider or hospital knowingly provides false information to influence a presumptive eligibility determination. Providers may request reconsideration of the disqualification in accordance with Wyoming Medicaid Rules Chapter 4.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 8 Aged, Blind or Disabled Eligibility

(a) The following are Medicaid-eligible categories:

(i) Age sixty-five (65) or over;

(ii) Determined disabled according to Social Security guidelines by the SSA or the Department

(iii) Entitled to or receiving SSI, or SSI-related programs; or

(iv) Individuals who receive hospice services in accordance with a voluntary election, and provider statement of terminal condition when:

(A) The individual has received hospice services, or resided in a medical institution, for thirty (30) or more consecutive days; or

(B) The individual is not an SSI recipient and dies before completion of the thirty (30) consecutive days' requirement.

(v) Individuals who qualify for Home and Community Based Services (HCBS) under a Medicaid waiver pursuant to Medicaid Rules Chapters 34 and 46.

(b) In order to qualify for an Aged Blind or Disabled (ABD) program, the individual must also meet established level of care requirements, and income and resource guidelines applicable to the client's program as detailed in the Medicaid Eligibility Online Manual.

(i) Income of a spouse is not available to the other spouse when applying for Inpatient Hospital Care, the Employed Individuals with Disabilities (EID) program, Nursing Home Care, Hospice Care, or HCBS under a waiver, pursuant to Section 1915(c) of the Social Security Act.

(ii) A parent's income is available to a child until the month after the child attains age eighteen (18) if the child lives in the parent's home. A parent's income is not available to a child if the child is married, institutionalized for more than thirty (30) consecutive days, or if the child applies for assistance under a HCBS waiver or the EID program.

(iii) Income within a valid income trust may qualify for an income trust exemption, pursuant to Section 1917(d)(4)(B) of the Social Security Act. An income trust cannot be used to qualify an applicant/client for inpatient hospital or hospice Medicaid programs. Penalties for transferred resources shall not apply to resources transferred into an income trust. To qualify as a valid income trust, the trust must:

(A) Be established using standards provided by the Department;

(B) Be irrevocable;

(C) Be composed only of pension, Social Security, and other income to the individual and accumulated income in the trust;

(D) Provide that the Department will receive all amounts remaining in the trust upon the death of the individual up to the amount equal to the total amount of medical assistance paid on behalf of the beneficiary;

(E) Allow a monthly distribution of three hundred percent (300%) of the SSI payment standard for programs with no patient contribution, reasonable costs of administering the trust, and a Community Spouse allowance;

(F) Allow a monthly distribution to pay towards the cost of nursing facility services, less allowable deductions. Deductions shall be allocated as specified in 42 C.F.R. § 435.725, except the trust may provide that the trustee pay any reasonable costs of administering the trust; and

(G) Prohibit any portion of the trust principal to be available to the beneficiary.

(d) Treatment of Resources.

(i) Resources belonging to an applicant or their spouse are considered available determining Medicaid eligibility if either has the legal right, authority, or power to liquidate them. At renewal, only resources available to the client are considered when redetermining eligibility as specified in 20 C.F.R. 416.1201 et seq.

(ii) Resources belonging to an applicant or their spouse are considered unavailable when determining Medicaid eligibility if there is a legal barrier that prevents the access or right to dispose of the resource. The applicant/client shall pursue reasonable steps to overcome the legal barrier unless it is determined by the Department that the cost of pursuing legal action would exceed the value of the resource or that it is unlikely the legal action would be successful.

(iii) A home, as defined by Chapter 1 of the Wyoming Medicaid Rules, is an excluded resource. If the applicant/client resides in an institution and does not have a community spouse, their intent to return home must be established by execution of the Department's intent to return home form.

(iv) Real property shall be considered unavailable to the individual for purposes of determining resources when the individual has executed:

(A) The Department's conditional benefits agreement form when the individual has been eligible for Medicaid for less than six (6) months; or

(B) The Department's bona fide effort to sell agreement when the individual has been eligible for Medicaid for six (6) months or more.

(v) Medicaid may disregard any resources claimed by an individual in an amount equal to or less than the benefits paid on behalf of the individual by a Qualified Long-Term Care Partnership Policy as defined by Wyo. Stat. § 42-7-102(a)(v).

(vi) Resources shall not exceed the SSI resource limits, except as specified in 20 C.F.R. § 416.1205. Individuals who are ABD and reside in a medical institution, receive Hospice Services, or receive HCBS under a waiver shall receive an additional Community Spouse Resource Maintenance Allowance (CSRMA) as specified in Section 1924 of the of the Social Security Act.

(e) Treatment of Trusts.

(i) Revocable and irrevocable trusts shall be treated in accordance with Wyo. Stat. §§ 42-2-402, 42-2-403, and the Social Security Act, 42 U.S.C. 1396p.

(ii) All trust distributions to or for the benefit of the beneficiary client, unless paid directly to a third party, shall be income to the client in the month received and a client resource the first of the month following.

(iii) Special needs trusts established in accordance with Wyo. Stat. §§ 42-2-402, 42-2-403, and the Social Security Act, 42 U.S.C. 1396p shall be considered an excluded resource when the following conditions are met:

(A) The individual trust account holder must be under age sixty-five (65) and determined disabled according to the criteria set forth in 42 U.S.C. § 1382(c)(a)(3) when the trust is established;

(B) The trust is irrevocable;

(D) Trust resources from a third party are considered an irrevocable gift. The third party shall not be able to redirect resources transferred to the trust, or otherwise exert any interest or control over the resources in the trust;

(E) The trust includes a valid "spendthrift clause" that complies with the laws of every state in which the individual has received Medicaid benefits;

(F) The trust lists the Department as a Qualified Beneficiary as defined in Wyo. Stat. § 4-10-103(a)(xv)(E);

(G) Trust distributions shall be for the sole benefit of the disabled beneficiary and shall be used to provide for the beneficiary's special needs; and

(H) Trust distributions shall be allowed for the beneficiary's basic needs only when the trustee has proven to the Department that the beneficiary's basic needs are not adequately met by government assistance programs.

(iv) Administrative requirements for a special needs trust are as follows:

(A) When a special needs trust has or will receive annuity payments, structured settlement payments, or any other periodic payments, the payments shall be titled in the name of the trust.

(B) The trustee shall provide an annual accounting of the trust income and expenditures to the Department. The Department may request more frequent accountings at its discretion.

(C) Trust distributions for funeral expenses shall not be paid after the beneficiary's death until the Department and all other state Medicaid agencies are fully reimbursed;

(D) The trustee shall obtain the consent of the Department prior to early termination of a special needs trust pursuant to Wyo. Stat. § 4-10-412. The Department shall consent to termination of a special needs trust prior to the beneficiary's death when a court order is entered providing that the Department shall be fully reimbursed from the trust. The Department shall be joined as a party to any such proceedings and served with a copy of all pleadings; and

(E) When the beneficiary dies or the trust is terminated, the trustee shall notify the Department and provide a sworn affidavit with an accounting within sixty (60) days after the beneficiary's death.

(v) Assets of an individual deposited into a Department-approved pooled trust account established in accordance with Wyo. Stat. § 42-2-403(f)(iii) and 42 U.S.C. § 1396p shall be considered an excluded resource when the following conditions are met:

(A) The individual trust account holder must be determined disabled according to the criteria set forth in 42 U.S.C. § 1382(c)(a)(3) when the account is established;

(B) The trust is established and managed by a nonprofit association;

(C) A separate account is maintained for each beneficiary of the trust but is pooled for the purposes of investment and management of funds;

(D) Accounts in the trust are established solely for the benefit of disabled individuals as defined by 42 U.S.C. § 1382(c)(a)(3), by the disabled individual, parent, grandparent, legal guardian, or by a court; and

(E) Pooled trust distributions shall be for the sole benefit of the disabled beneficiary and shall be used to provide for the beneficiary's special needs.

(vi) Administrative requirements for a pooled trust are as follows:

(A) Any distribution from the trust paid directly to the beneficiary shall be considered income available to the beneficiary in the month received and a resource the first of the month following;

(B) The trustee shall obtain the consent of the Department prior to early termination of a special needs trust pursuant to Wyo. Stat. § 4-10-412. The Department shall consent to termination of a special needs trust prior to the beneficiary's death when a court order is entered providing that the Department shall be fully reimbursed from the trust. The Department shall be joined as a party to any such proceedings and served with a copy of all pleadings;

(C) When the beneficiary dies or the trust is terminated, the trustee shall notify the Department and provide a sworn affidavit with an accounting within sixty (60) days after the beneficiary's death;

(D) To the extent that amounts remaining in the beneficiary's account upon the death of the beneficiary, or termination of the pooled trust, are not retained by the trust, the trust pays to the state from the remaining amounts in the account an amount equal to the total amount of medical assistance paid on behalf of the beneficiary, except for reasonable administrative fees and expenses agreed upon by the Department;

(E) Distributions for funeral expenses shall not be paid after the beneficiary's death until the Department and all other Medicaid agencies in other states are fully reimbursed;

(f) Personal Care Contracts

(i) Payments made to family members through a personal care contract (PCC) to delay or prevent Medicaid long term services or support are authorized, but shall be considered a transfer of resources for less than fair market value unless the agreement meets the requirements in this Section and documentation is provided to the Department upon request.

(ii) The PCC shall be in writing and must include:

(A) The date the care begins;

(B) A detailed description of the services to be provided;

(D) How much the caregiver will be compensated;

(E) When the caregiver will be compensated;

(F) How long the agreement is to be in effect;

(G) A statement that the terms of the agreement can be modified only by mutual agreement of the parties and approved by the Department;

(H) The location where services will be provided; and

(I) The notarized signature of both parties.

(iii) The following services may be provided under a PCC when the individual is receiving unduplicated services at home and are not in a facility: preparing meals, shopping, medication management, transportation to medical appointments, paying bills, light housekeeping, and assistance with activities of daily living.

(iv) No services shall be provided under a PCC while an individual resides in a long term care facility or receives services under a waiver program. A caregiver shall not duplicate services provided by a home health aide, nurse, medical professional, or other care provider hired to assist the individual regardless of whether the individual resides in a long term care facility or receives services within their home.

(v) "Advocating for services" shall not be an allowable service under a PCC.

(vi) The Department shall verify the fair market value of these services through the use of the U.S. Department of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook see https://www.bls.gov/ooh/healthcare/home-health-aides-and-personal-care-aides.htm?view_full.

(vii) Caregivers shall not receive payment in advance of services performed. Prepayments made to caregivers shall be considered a transfer for less than fair market value.

(viii) A retroactive PCC shall be considered a transfer for less than fair market value in accordance with subsection (i) of this Section.

(g) Patient Contribution for Institutional Care.

(i) The patient contribution is the monthly amount a Medicaid eligible individual must pay toward their cost of care or services and is based upon their gross income.

(ii) Deductions from the individual's gross income shall be allowed in determining the amount of the individual's monthly patient contribution to be paid toward the cost of care in a medical facility.

(iii) Allowable deductions shall be applied in accordance with Title XIX of the Social Security Act, 42 C.F.R. § 435.725 and the Wyoming Medicaid State Plan.

(iv) Deductions for a spouse who lives in the community when the married client lives in a medical institution, shall be applied in accordance with Title XIX of the Social Security Act, 42 C.F.R. § 435.725 and the Wyoming Medicaid State Plan.

(v) An individual temporarily in an institution shall be allowed a maintenance deduction, not to exceed one hundred fifty dollars ($150.00) per month for up to six (6) months, to maintain their home as defined in Medicaid Rules Chapter 1, when:

(A) A physician verifies the individual can return to their home within six (6) months; and

(B) The client's spouse is not institutionalized.

(h) Medicaid benefits are authorized:

(i) After completion of thirty (30) consecutive days in a medical institution, thirty (30) days after a hospice election, or upon the client's death in the facility or while receiving services under a hospice election before the thirty (30) consecutive days has been met.

(ii) The first day of the month during which all eligibility requirements are met and the client's individual plan of care is approved by the Department for an HCBS waiver program.

(i) Transfer of Resources:

(i) It is presumed that a transfer of an individual's resource for less than fair market value was made for the purpose of qualifying for Medicaid. Unless convincing evidence is submitted to the Department that the resource was transferred exclusively for some other reason. The burden of rebutting the presumption that a resource was transferred to establish Medicaid eligibility rests with the individual.

(ii) The fair market value of real property shall be based on an appraisal or a comparative market analysis of the property at the time of the sale or transfer of the property. The individual has the obligation to provide the Department with an appraisal or comparative market analysis. Failure to provide the requested documentation shall result in a denial of eligibility.

(iii) For a resource to be considered transferred for fair market value or to be considered to be transferred for valuable consideration, the compensation received for the resource shall be in a tangible form with intrinsic value. A transfer for love and consideration is not considered a transfer at fair market value.

(iv) Services provided for free at the time performed were intended to be provided without compensation. A retroactive transfer of a resource for care provided in the past without compensation is presumed a transfer for less than fair market value. An individual can rebut this presumption with tangible evidence that is acceptable to the Department as described in subsection (e) of this Section. Such evidence shall be in writing at the time services were provided to be considered by the Department.

(v) A transfer penalty shall not be imposed if the transferred resource is returned to the individual. A one-time return, or one-time partial return, of the transferred resource, can be made to the individual or paid directly to a provider during the transfer penalty period in order to reduce or eliminate the transfer penalty. The value of returned resources shall be determined using fair market value.

(A) A return of resources to pay for attorney's fees during a contested case shall not reduce the penalty period for the individual. Attorney's fees are the sole responsibility of the individual.

(vi) The Department shall waive a transfer penalty if imposing the penalty would result in undue hardship as determined by the Department. The Department shall consider a waiver of the transfer penalty for undue hardship when requested by an individual using the Department's hardship request form with supporting documentation and a physician statement, as applicable.

(A) Undue hardship exists when a transfer penalty would deprive the individual of food, clothing, shelter, or other necessities of life, or deprive the individual of medical care such that the individual's health or life would be endangered and one of the following:

(I) It is determined that the person who received the transferred resource cannot be located by the individual, the individual's spouse, the individual's fiduciary, or an agent of the nursing facility, after all attempts to locate the person have been exhausted; or

(II) The resource transferred was due to theft, fraud, or financial exploitation of the individual or their spouse, which has been reported and pursued through Adult Protective Services or law enforcement; or

(III) The individual or their fiduciary has exhausted all reasonable legal means to recover or regain possession or obtain fair market value of the transferred resource or income. "Exhausting all reasonable legal means to recover" may include seeking the advice of an attorney and pursuing legal or equitable remedies, such as asset freezing, assignment, or injunction; seeking modification, avoidance, or nullification of a financial instrument, promissory note, mortgage, or other transfer agreement; cooperating with any attempt to recover the transferred asset.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 9 Breast and Cervical Cancer Program

(a) Eligibility Requirements:

(i) Referral to the Medicaid Breast and Cervical Cancer Program by the

Department's Public Health Division Breast and Cervical Cancer Early Detection Program;

(ii) Countable family income less than or equal to two hundred and fifty percent (250%) of the FPL. Income shall be calculated using the modified adjusted gross income of the household, as specified in 42 C.F.R. § 435.603 and the Wyoming Medicaid State Plan;

(iii) Individuals shall be under the age of sixty-five (65); and

(iv) Individuals shall not be eligible for other full Medicaid programs, or have health insurance.

(b) Eligibility shall be reviewed by the Department for continued eligibility every twelve (12) months.

(c) Individuals shall be responsible for reporting to the Department any changes as outlined in Section 4(c)(iii), as well as the conclusion of their treatment.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 10 Employed Individuals with Disabilities Program

(a) Medicaid benefits are available to individuals with disabilities who work and pay a monthly premium for their healthcare coverage under the Employed Individuals with Disabilities (EID) program.

(b) Eligibility Requirements:

(i) Countable unearned income shall be less than or equal to three hundred percent (300%) of the SSI payment standard.

(ii) Resource tests do not apply for this eligibility group.

(iii) Individuals shall be age sixteen (16) through sixty-four (64).

(iv) An individual shall be employed part-time or full-time during a specified payroll period. The individual will be considered employed while on a temporary absence from work due to documented medical leave.

(v) The individual shall pay a monthly premium, as calculated according to Wyo. Stat. §§ 42-4-115 and 42-4-116.

(c) An individual who meets the EID eligibility requirements may receive waiver services through the EID Comprehensive or Supports waiver if they meet other HCBS criteria for the Comprehensive or Supports waivers.

(d) Individuals shall be responsible for reporting to the Department any changes as outlined in Section 4(c)(iii), as well as any changes to employment.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 11 Medicare Savings Programs

(a) Medicaid shall assist individuals eligible for the Qualified Medicare Beneficiary (QMB) program with paying their Medicare premiums, cost sharing and deductibles, as specified in Sections 1902(a)(10)(E)(i) and 1905(p)(1) of the Social Security Act. Individuals shall meet the following eligibility requirements:

(i) Entitled to Medicare;

(ii) Countable income shall be equal to or less than one hundred percent (100%) of the FPL; and,

(iii) Countable resources shall not exceed the resource limit established by the SSA adjusted annually by the increase in the consumer price index.

(b) Medicaid shall assist individuals eligible for the Specified Low-Income Medicare Beneficiary (SLMB) program with paying their Medicare Part B premium, as specified in Section 1902(a)(10)(E)(iii) of the Social Security Act. Individuals shall meet the following eligibility requirements:

(i) Entitled to Medicare;

(ii) Countable income shall be more than one hundred percent (100%) of the FPL but less than equal to one hundred twenty percent (120%) of the FPL.

(iii) Countable resources shall not exceed the resource limit established by the SSA, adjusted annually by the increase in the consumer price index.

(c) Medicaid shall assist individuals eligible for the Qualified Individual (QI) program with paying their Medicare premiums, as specified in Section 1902(a)(10)(E)(iv) of the Social Security Act. Individuals shall meet the following eligibility requirements:

(i) Entitled to Medicare;

(ii) Countable income shall be more than one hundred twenty percent (120%) of the FPL, but less than or equal to one hundred thirty-five percent (135%) of the FPL; and,

(iii) Countable resources shall not exceed the resource limit established by the Social Security Administration adjusted annually by the increase in the consumer price index.

(d) Medicaid shall assist individuals eligible for the Qualified Disabled Working Individual (QDWI) program with paying their Medicare Part A premiums, as specified in Section 1902(a)(10)(E)(ii) of the Social Security Act. Individuals shall meet the following eligibility requirements:

(i) Be disabled according to Social Security guidelines, are ineligible for Social Security Disability Income (SSDI) and premium-free Medicare Part A benefits due to returning to work;

(ii) Countable income shall be at or below two hundred percent (200%) of the FPL;

(iii) Countable resources shall not exceed twice the limit of the SSI resource limit; and,

(iv) Not otherwise eligible for another Medicaid program.

(e) Eligibility shall be redetermined by the Department every twelve (12) months for all groups within this section.

(f) Individuals shall be responsible for reporting to the Department any changes described in Section 4(c)(iii).

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 12 Emergency Services Program

Applicants who are not citizens or nationals of the United States, but otherwise meet the eligibility requirements of the following Medicaid programs, are eligible for limited emergency services as specified in 42 C.F.R. § 440.255: Modified Adjusted Gross Income-Based (MAGI) programs; the Inpatient Hospital program; and, the SSI program solely for retroactive months.

History

Effective 2025-05-23

Wyo. Code R. 048.0037.18.05232025 § 13 Delegation of Duties

. The Department may delegate any of its duties under this rule to the Wyoming Attorney General, Health and Human Services, any other agency of the federal, state or local government, or a private entity which is capable of performing such functions, provided that the Department shall retain the authority to impose sanctions, recover overpayments or take any other final action authorized by this Chapter.

History

Effective 2025-05-23

Chapter 19 Nursing Facility Preadmission Screening and Annual Resident Review for Mental Illness and Intellectual Disability

Wyo. Code R. 048.0037.19.10232025 Nursing Facility Preadmission Screening and Annual Resident Review for Mental Illness and Intellectual Disability

Microsoft Word - 2025-04-01 Ch. 19 S&U Track-Changes (car) (1)

CHAPTER 19

Nursing Facility Preadmission Screening and Annual Resident Review for Mental Illness and Intellectual Disability

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter under the Wyoming Medical Assistance and Services Act, Wyoming Statutes §§ 42-4-101 through -124.

Section 2. Purpose and Applicability

(a) This Chapter governs nursing facility preadmission screening and annual resident review for mental illness and intellectual disability and related conditions.

(b) This Chapter applies to all individuals applying for admission into a nursing facility and all residents of a nursing facility regardless of the individual or resident's source of payment for nursing facility services.

(c) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.

Section 3. Definitions.

(a) Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1 or defined in this Chapter, the terminology used in this Chapter has the standard meaning used in healthcare, Medicaid, and Medicare.

(b) "Chapter" - a chapter in the Wyoming Department of Health, Medicaid Rules.

(d) "Intellectual disability" - includes "related condition".

(e) "PASRR" - preadmission screening and annual resident review.

(f) "SIDA" - state intellectual disability authority.

(g) "SMHA" - state mental health authority.

Section 4. Screening for Mental Illness and Intellectual Disability.

(a) Mental Illness.

(i) A nursing facility must not admit an individual with a mental illness unless before admission, the SMHA determines, based on a physical and mental evaluation performed by an entity other than SMHA, that the individual requires nursing facility services because of the individual's physical and mental condition.

(ii) If an individual requires nursing facility services, the SMHA must also determine whether the individual requires specialized services.

(b) Intellectual disability.

(i) A nursing facility must not admit an individual with an intellectual disability unless, before admission, the SIDA determines, based on a physical and mental evaluation performed by an entity other than the SIDA, that the individual requires nursing facility services because of the individual's physical and mental condition.

(ii) If an individual requires nursing facility services, the SIDA must also determine whether the individual requires specialized services.

(c) A nursing facility that admits an individual with a mental illness or an individual with an intellectual disability before a determination of appropriate placement is subject to:

(i) Denial of Medicaid payment for an otherwise Medicaid-eligible individual; and

(ii) Regardless of the individual's source of payment for nursing facility services, the Department may impose any of the remedies specified in Chapter 5

Section 5. Level I Screening.

(a) Level I screening must be performed by qualified staff of a nursing facility or hospital to determine whether an individual seeking admission to or residing in a nursing facility needs further evaluation because of a suspected mental illness or an intellectual disability.

(b) Level I screening includes reviewing the individual's medical records, observing presenting evidence, or reviewing documentation from other reliable sources. A screener must use the following criteria:

(i) Mental illness. The screener must consider:

(A) Has the individual been diagnosed with a serious mental illness as defined by 42 C.F.R. § 483.102;

(B) An individual experiencing temporary anxiety or depressive reactions to a terminal or chronic debilitating condition for which specialized services would not be appropriate, but for which mental health services of a lesser intensity may be required does not qualify as a mental illness for nursing facility screening purposes;

(C) Does the individual have a history of mental illness requiring treatment more intensive than outpatient treatment; and

(D) Is there presenting evidence of a serious mental illness, including possible disturbances in orientation, affect, or mood that is not attributable to dementia or another medical diagnosis or treatment.

(ii) Intellectual Disability. The screener must consider:

(A) Has the individual been diagnosed by a physician or other qualified intellectual disability professional of having a primary or secondary diagnosis of intellectual disability as defined by 42 C.F.R. § 483.102;

(B) Does the individual have a history of an intellectual disability;

(D) Was the individual referred by an agency that serves persons with an intellectual disability, and the individual was eligible for that agency's services.

(c) Upon completion of the Level I screening, the screener will determine whether to refer the individual for a Level II screening.

(i) If the determination is that a Level II screening is not necessary, the individual may be admitted to the nursing facility; the individual does not need to be screened again unless there is a significant change in the individual's condition that indicates a Level II screening is then necessary.

(ii) If the determination is that a Level II screening is necessary, the individual must undergo Level II screening.

(d) The nursing facility must provide written notice to the individual or his or her legal representative if Level II screening is required. This notice is only required for the first Level II screening.

(e) The nursing facility must complete documentation in the format specified by the Department.

Section 6. Level II Screening.

(a) A nursing facility must not admit an individual whom the level I screening determined a Level II screening was required until the Level II screening is completed and the determination is that a nursing facility is an appropriate placement.

(b) If there has been a previous Level II screening and the residents physical or mental functioning has significantly changed, the nursing facility must request a new Level II screening promptly by completing and submitting a new Level I form. The nursing facility must indicate on the Level I form that a new Level II screening is being requested because of a significant change in the person's physical or mental functioning.

(i) The Department will not pay for nursing facility services furnished to an individual before the Level II screening is completed and the proper authority determines placement of the individual in a nursing facility is appropriate.

(ii) The Department may impose any of the remedies in Chapter 5 for failure to timely comply with PASRR requirements for non-Medicaid eligible individuals.

(d) A categorical determination takes into account that certain diagnoses, levels of severity of illness, or need for a particular service clearly indicate that admission to or residence in a nursing facility is appropriate without a Level II screening. An individual with a mental illness or an intellectual disability who meets the criteria for any category in this section is deemed appropriate for nursing facility placement. The individual must still be evaluated for a specialized services determination.

(i) Terminal illness. A diagnosis of terminal illness constitutes a Level II determination of appropriate placement and specialized services are not required.

(ii) Severe medical condition. A diagnosis of a severe medical condition constitutes a Level II determination of appropriate placement if an individual who has a mental illness or has an intellectual disability meets the criteria for severe medical condition if the individual or resident is comatose, ventilator dependent, or functioning at the brain stem level or has chronic obstructive pulmonary disease, severe Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, congestive heart failure, severe cardiovascular accident, quadriplegia, advanced multiple sclerosis, end stage renal disease, severe diabetic neuropathy, or refractory anemia that is so severe that the individual could not be expected to benefit from specialized services for a mental illness or an intellectual disability.

(iii) Convalescent care. An individual who has a mental illness or an intellectual disability and requires nursing facility services of no more than 120 days constitutes a Level II determination of appropriate placement. Thirty days before the end of the 120 days, the nursing facility must refer the individual for a Level II screening to determine if the individual has a mental illness or an intellectual disability and has an acute physical illness which:

(A) Requires hospitalization; and

(B) Does not meet the criteria for an exempt hospital discharge as defined in 42 C.F.R. § 483.106.

(iv) Provisional placement. An individual who requires a nursing facility stay of no more than fourteen days. Before the end of the fourteen days, the nursing facility must refer the individual for a Level II screening to determine if the individual has a mental illness or intellectual disability and requires admission for:

(A) Delirium, where an accurate diagnosis cannot be made until

the delirium clears; or

(B) Respite care.

(v) Emergency admissions. The individual has a mental illness, or an intellectual disability and requires a nursing facility stay of no more than seven days for his or her protection. Before the end of the seven days, the nursing facility must refer the individual for a Level II screening.

(e) Criteria for Level II screening.

(i) Each individual referred for a Level II screening, regardless of payment source, must be evaluated for medical necessity pursuant to Chapter 22.

(ii) Level II screening must be performed using the minimum criteria specified by CMS in §§ 4251 through 4253 of the State Medicaid Manual appropriate for the specific individual. The State Medicaid Manual is published by CMS and is available from CMS or the Department.

(iii) SMHA and SIDA must review the mental and physical evaluations and the determinations of medical necessity and determine whether, based on the individual's physical and mental condition, he or she requires the level of services provided by a nursing facility.

(iv) Determination of need for specialized services.

(A) The need for specialized services for an individual with a mental illness must be determined using the procedures and protocols of the SMHA. The procedures and protocols of the SMHA are available from the SMHA or the Department.

(B) The need for specialized services for persons with an intellectual disability must be determined using the procedures and protocols of the SIDA. The procedures and protocols are available from SIDA or the Department.

(f) Level II screening determines the appropriateness of nursing facility placement and the need for specialized services. Following are the possible determinations.

(i) Individual requires nursing facility services but does not require specialized services:

(A) Nursing facility placement is appropriate; and

(B) Mental health services of a lesser intensity than specialized services may be recommended.

(ii) Individual requires nursing facility services and specialized services:

(A) Nursing facility placement is appropriate; and

(B) Specialized services are appropriate.

(iii) Individual does not require nursing facility services but requires specialized services and chooses to remain in the nursing facility under the thirty month rule, defined in 42 C.F.R. § 483.130:

(A) Nursing facility services are deemed appropriate; and

(B) Specialized services are appropriate.

(iv) Individual does not require nursing facility services or specialized

services:

(A) Nursing facility placement is not appropriate and admission is denied; or

(B) If the individual is already admitted, the nursing facility must arrange an orderly discharge including preparation and orientation for discharge.

(v) Individual does not require nursing facility services but does require specialized services that cannot be provided in the nursing facility:

(A) Nursing facility placement is not appropriate and admission is denied; or

(B) If the individual is already admitted, the nursing facility must arrange an orderly discharge including preparation and orientation for discharge.

(vi) There is no evidence of a serious mental illness or of an intellectual disability:

(A) Nursing facility placement is appropriate; but

(B) Specialized services are not appropriate.

(vii) Individual has a primary or secondary diagnosis of dementia without a diagnosis of an intellectual disability:

(A) Nursing facility placement is appropriate; but

(B) Specialized services are not appropriate.

(viii) Evaluation not completed due to death or discharge:

(A) PASRR not complete; and

(B) Medicaid payment for nursing facility services will not be authorized.

(g) Notice of Level II determination.

(i) The Department must notify the nursing facility in writing of the results of each Level II determination; and

(ii) The Department must notify the individual in writing of the Level II determination.

Section 7. Medicaid Payment.

(a) The Department shall not pay for nursing facility services furnished to an individual until:

(i) The completion of the Level I screening which determines Level II screening is not required; or

(ii) If the Level I screening determines Level II screening is required, the completion of the Level II screening and a determination that nursing facility placement is appropriate; and

(iii) The completion of the evaluation of medical necessity pursuant to Chapter 22 which determined that nursing facility services are medically necessary.

(b) Retroactive payments.

(i) For individuals that do not require Level II screening, Medicaid payment commences upon the Department's receipt of the Level I screening results if the Department has an evaluation and finding of medical necessity pursuant to Chapter 22.

(ii) For individuals who require Level II screening, Medicaid payment commences upon the completion of the Level II screening which indicates that nursing facility services are appropriate, except as otherwise specified in this Chapter. Payment is retroactive to the date of the completion of the Level II screening, provided there was an evaluation of medical necessity pursuant to Chapter 22. Payments for residents permitted to continue to reside in a nursing facility pursuant to the thirty month rule defined in 42 C.F.R. § 483.130, are contingent upon completion of a Level II screening, regardless of whether the screening determines that nursing facility services are appropriate.

Section 8. Incorporation. Incorporation by reference incorporates the version, edition, or standard existing at the effective date of this Chapter.

History

Effective 2025-10-23

Chapter 20 Reimbursement of Intermediate Care Facilities for Individuals with Intellectual Disabilitites (ICFs/IID)

Wyo. Code R. 048.0037.20.06142017 Reimbursement of Intermediate Care Facilities for Individuals with Intellectual Disabilitites (ICFs/IID)

1128

CHAPTER 20

REIMBURSEMENT OF INTERMEDIATE CARE FACILITIES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES (ICFs/IID)

Section 1. Authority.

This rule is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. §§ 42-4-101 through 42-4-306.

Section 2. Applicability.

This rule shall apply to and govern the reimbursement of the Wyoming Life Resource Center State Operated Facility and other ICFs/IID.

Section 3. General Terms.

These rules are intended to implement and be read in conjunction with the provisions of W.S. §§ 42-4-101 through 42-4-306.

Section 4. Definitions.

(a) "Certified." Approved by the Department to provide ICF/IID services.

(b) "Excess payments." Medicaid funds received by a provider:

(i) That exceed the provider's per diem rate;

(ii) Pursuant to a per diem rate which is subsequently determined to be erroneous or based on erroneous information; or

(iii) Pursuant to an interim payment rate that is based on projected costs which exceed the facility's actual costs for the interim payment rate period.

(d) "Infirmary services." Sub-acute hospital services provided on the premises of a facility.

(e) "Interim payments." Payments to a new facility or a newly certified facility pursuant to subsection 5(c) during the time between the effective date of the new facility's provider agreement and the determination of a per diem rate pursuant to this rule.

(f) "Intermediate care facility for individuals with Intellectual Disabilities (ICF/IID)." An intermediate care facility as defined by 42 U.S.C. 1396d(d) that has at least fifteen certified beds. "ICF/IID" includes that portion of the Wyoming Life Resource Center which is certified to provide intermediate care facility services for those with intellectual disabilities.

(g) "Per diem rate." The Medicaid reimbursement rate determined pursuant to this rule.

(h) "Provider." An ICF/IID that has a provider agreement with the Department and that is certified to provide services to recipients.

(i) "Provider agreement." A formal written agreement between the Department and an ICF/IID that is certified to provide services to recipients.

(j) "Services." Intermediate care facility services for those with intellectual disabilities as defined in 42 U.S.C. 1396d(d).

(k) "Services and supplies included in the per diem rate." In addition to those services and supplies specified in Chapter 7, Attachment A.

(l) "Services and supplies not included in the per diem rate." Services and supplies which are not included in the per diem rate include, but are not limited to:

(i) Barber and beauty shop services;

(ii) Clothing;

(iii) Cigarettes, cigars, pipes and tobacco;

(iv) Cosmetics;

(v) Hospital services;

(vi) Prosthetic devices;

(vii) Ventilators; and

(viii) Customized wheelchairs that are fitted or fabricated to a specific individual and cannot be used by any other person, and electric wheelchairs, including batteries.

(m) "Temporary absence." When a recipient is out of a facility for hospitalization or therapeutic home visits. Temporary absences for hospitalization:

(i) Shall not exceed fifteen (15) days per year, and

(ii) The recipient must intend to and have a reasonable expectation of returning to the facility.

(iii) Temporary absences for therapeutic home visits shall:

(A) Be part of the recipient's plan of care, and

(B) Be limited to fifteen (15) days in duration no more than once per month, not to exceed thirty (30) days per calendar year. A recipient receiving infirmary services is not absent from the facility.

(n) "Unique costs." The following services and supplies are unique costs and shall be included in the per diem rate if they are provided by the facility or by a third party under contract to the facility to or for the benefit of a recipient:

(i) Audiology services;

(ii) Case management services;

(iii) Dental services;

(iv) Dietary services and adaptive equipment;

(v) Dry cleaning expenses incurred on behalf of residents;

(vi) Habilitation services,

(vii) Hearing aids;

(viii) Infirmary services;

(ix) Laboratory services;

(x) Music therapy services;

(xi) Occupational therapy services;

(xii) Optical services;

(xiii) Orthotic services;

(xiv) Physical therapy services;

(xv) Physician services;

(xvi) Podiatry services;

(xvii) Prescription drugs;

(xviii)Pre-vocational training services and supplies;

(xix) Psychological services;

(xx) Recreational therapy services;

(xxi) Social services;

(xxii) Speech therapy services; and

(xiii) Transportation services

(o) "Wyoming Life Resource Center." The Wyoming state training school as established pursuant to W.S. §§ 25-5-101 through 25-5-135.

Section 5. General methodology.

(a) ICFs/IID shall be reimbursed using a per diem rate calculated in accordance with the methodology established below. In addition, ICFs/IID shall be subject to the rules in Chapter 7, Wyoming Nursing Home Reimbursement System, except as otherwise specified by this rule. ICFs/IID shall not be subject to the Chapter 7 rate and price setting Sections 7, 13(d), 14, 15, 16, 17(c), 18, and 19.

(b) Calculation of per diem rates for ICFs/IID. The per diem rate for ICFs/IID shall be calculated independently from the calculation of rates for facilities as defined in Chapter 7. The provider's per diem rate shall be determined utilizing either a desk reviewed or audited cost report. Costs shall not be subject to any form of cap or maximum rate for the Wyoming Life Resource Center.

(i) Effective date. The rates calculated each July 1 shall remain in effect until the following July 1.

(ii) Per diem rates are established prospectively and shall remain in effect from the rate effective date until re-determined pursuant to this rule.

(iii) Applicable cost report data. The data used in establishing the rate calculation is from the cost reports which ended two (2) calendar years ago (for example, cost reports ending during the period from January 1, 2013 to December 31, 2013, shall be used to set rates effective July 1, 2015).

(iv) Cost reports submitted by ICFs/IID shall not be used in any way to calculate per diem rates for facilities as defined in Chapter 7.

(v) Rates shall be established by inflating adjusted / reviewed costs from the midpoint of the provider's cost reporting year to the midpoint of the rate year. Inflated costs shall be divided by total patient days to arrive at the allowed per diem rate.

(c) Reimbursement of new facilities. A new facility or a newly certified facility shall receive interim payments for services provided to recipients as determined pursuant to this subsection.

(i) Submission of projected costs. A new facility shall, before receiving Medicaid funds for services provided to recipients, submit a cost report to the Department containing projected costs for the facility's first six months of operation.

(ii) Time of submission of cost report. A new facility shall submit a cost report containing the information specified in paragraph (i) within sixty (60) days after the facility notifies the Department in writing that it wishes to participate in the Medicaid program as a provider and has been certified.

(iii) Review of projected costs. The Department shall desk audit the cost report submitted pursuant to paragraph (i) to determine the reasonableness of the facility's allowable projected costs. An interim payment rate shall be established using the facility's reasonable, allowable costs. The interim payment rate shall not exceed the lower of the rate determined pursuant to this subsection and seventy-five percent (75%) of the Wyoming Life Resource Center rate in effect.

(iv) Period of interim payments. Interim payments shall be effective upon the effective date of the facility's provider agreement, and shall remain in effect until a qualifying cost report has been submitted and subjected to audit and used to calculate a rate. No payments shall be made to a new facility until an interim payment rate has been determined pursuant to this subsection.

(v) Audits of interim payments. Upon receipt of the qualifying cost report, the Department may audit a facility to determine the accuracy and reasonableness of cost reports submitted by the facility. If the audit discloses that the interim payments included non-allowable costs, costs for services and supplies not included in the per diem rate or that budgeted costs exceeded actual costs, the Department shall adjust the per diem rate retroactively to the beginning of the interim rate period and recover any excess payments.

(vi) Audits shall be conducted in accordance with Section 5(b). Providers other than Wyoming Life Resource Center shall have rates limited to the lower of the provider's audited cost in accordance with Section 5(b) or seventy-five percent (75%) of the Wyoming Life Resource Center rate.

Section 6. ICFs/IID are subject to the requirements of Chapter 17, Nursing Facility Resident Trust Accounts.

Section 7. Superseding Effect. This chapter supersedes all prior rules or policy statements issued by the Department, including manuals and/or bulletins, which are inconsistent with this Chapter.

Section 8. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 9. Incorporation by Reference

(a) For any code, standard, rule or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference is further identified as follows:

(i) Referenced in Sections 4 and 5 is Chapter 7 - Rules and Regulations for Medicaid - Wyoming Nursing Home Reimbursement System, adopted by the Department of Health and effective on May 29, 2012, found at http://soswy.state.wy.us/Rules/RULES/8611.pdf

(ii) Referenced in Section 6 is Chapter 17, Rules and Regulations for Medicaid - Nursing Facility Resident Trust Accounts, adopted by the Office of Medicaid and effective on May 29, 2012, found at http://soswy.state.wy.us/Rules/RULES/8612.pdf.

History

Effective 2017-06-14

Chapter 22 Determination of Nursing Facility Level of Care

Wyo. Code R. 048.0037.22.10052021 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-104(a)(iv).

History

Effective 2021-10-05

Wyo. Code R. 048.0037.22.10052021 § 2 Purpose and Applicability

(a) The methods and standards established in this Chapter shall be used to determine whether an individual requires, or continues to require the level of care provided, in a nursing facility or in consideration of eligibility for applicable home and community-based waiver programs.

History

Effective 2021-10-05

Wyo. Code R. 048.0037.22.10052021 § 3 Definitions

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

(a) "Nursing Facility Level of Care Determination." A determination as to whether an individual requires or continues to require the level of care provided in a nursing facility.

(b) "Level of Care Assessment." An assessment of an individual's current functional status used by the Department in making nursing facility level of care determinations.

(c) "Level of Care Assessor." A registered nurse licensed to practice in the State of Wyoming and qualified by the Department or its agent as having successfully completed all requisite education and training to conduct a level of care assessment.

History

Effective 2021-10-05

Wyo. Code R. 048.0037.22.10052021 § 4 General Provisions

(a) A determination indicating a need for nursing facility level of care shall not constitute a determination of eligibility or a guarantee of reimbursement for Wyoming Medicaid services. Individuals shall meet any additional eligibility criteria for the applicable Wyoming Medicaid services and programs.

(b) The level of care assessment conducted pursuant to this Chapter is not intended to serve as an instrument for the identification, diagnosis, or treatment of any disease or medical condition.

(c) The Department is the sole entity authorized to make nursing facility level of care determinations for the purposes established by this Chapter.

(d) The Department shall establish the procedures, instruments, methods, and criteria by which a level of care assessment is conducted.

(i) The Department shall make nursing facility level of care determinations based solely on the results of a level of care assessment conducted by a qualified level of care assessor.

(ii) The Department shall make nursing facility level of care determinations and provide notification in accordance with its established timelines and procedures.

History

Effective 2021-10-05

Wyo. Code R. 048.0037.22.10052021 § 5 Requests for Determination of Nursing Facility Level of Care

(a) Any individual may request a nursing facility level of care determination on his or her own behalf.

(b) A guardian or legal representative may request a nursing facility level of care determination on behalf of an individual for whom legal decision-making authority has been conferred.

(c) Employees of a nursing facility, hospital, or any other such healthcare or social services provider may request a nursing facility level of care determination on behalf of any individual for whom that organization has the responsibility for the provision or coordination of healthcare services.

(d) The Department shall approve only those requests for a nursing facility level of care determination which meet all of the following criteria:

(i) The request is complete and is submitted in accordance with the Department's established procedures;

(ii) The individual to be assessed is a resident of, or intends to reside in, the State of Wyoming;

(iii) The individual to be assessed demonstrates a reasonable indication of need for long-term care services as determined by any initial screening criteria established by the Department;

(iv) The individual to be assessed is currently receiving, or has expressed interest in, a long-term care service or program which requires a nursing facility level of care determination; and

(v) The individual to be assessed is a current Wyoming Medicaid recipient, has submitted an application for Wyoming Medicaid, or has been identified by a Preadmission Screening and Resident Review (PASRR) Level I Screening to require a PASRR Level II screening pursuant to Chapter 19.

History

Effective 2021-10-05

Wyo. Code R. 048.0037.22.10052021 § 6 Requests for Reconsideration and Administrative Hearings

(a) The individual for whom the determination was made, or his or her guardian or legal representative, if applicable, may request reconsideration of the Department's nursing facility level of care determination.

(i) Reconsideration requests are an opportunity for alternative dispute resolution, are not a prerequisite to request an administrative hearing, and shall not impede the individual's right to request an administrative hearing in accordance with Chapter 4.

(b) The Department shall approve only those reconsideration requests which are submitted in writing within twenty (20) business days of the notice of adverse action and in accordance with the Department's established procedures.

(c) For approved reconsideration requests, the Department or its agent shall review the level of care assessment results to determine whether its procedures, instruments, methods, and criteria were applied appropriately, and the Department shall:

(i) Require a second level of care assessment be conducted by a different level of care assessor; or

(ii) Affirm the Department's nursing facility level of care determination and provide the individual a notice of adverse action and the right to request an administrative hearing in accordance with Chapter 4.

(d) When a second level of care assessment is required, the Department shall make a reconsideration determination based solely upon the results of the second level of care assessment.

(e) In accordance with Chapter 4, the Department shall provide notice of adverse action and the right to request an administrative hearing to any individual whose Medicaid service coverage or eligibility is denied, reduced, terminated, or suspended as a result of its reconsideration determination.

History

Effective 2021-10-05

Chapter 26 Covered Services

Wyo. Code R. 048.0037.26.01182025 § 1 Authority

This Chapter is promulgated by the Wyoming Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through -124.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 2 Purpose and Applicability

This Chapter has been adopted to establish the scope of covered services, except as otherwise specified by the Wyoming Department of Health, and shall apply to all clients and providers for all services furnished on or after the Chapter's effective date.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 3 Definitions

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 inpatient hospital care.

(d) "Dental Services." Professional services and dental appliances furnished by a dentist within the scope of their 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, multidisciplinary evaluation of a child five years of age or under, that:

(i) Is performed after a written referral from a physician, nurse practitioner or physician's assistant 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;

(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 indicated 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 radiographic instruments 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.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 4 Covered Services

(a) The services and supplies specified in subsection (b) are covered services if medically necessary, subject to any exclusions or limitations contained in this Chapter and the Wyoming Department of Health.

(b) Covered services:

(i) Applied Behavior Analysis (ABA) Treatment, for individuals between the ages of 0-20 with a diagnosis of autism spectrum disorder;

(ii) Administrative Transportation;

(iii) Advanced Practitioner of Nursing (APN) services

(iv) Ambulance Services including Ground and Air;

(v) Ambulatory Surgical Center (ASC) Services;

(vi) Audiology Services and hearing aids;

(vii) Certified Registered Nurse Anesthetist (CRNA) services;

(viii) Certified Community Mental Health Center Services (CMHC);

(ix) Chiropractic Services

(x) Clubhouse Rehabilitation Services;

(xi) Certified Community Substance Abuse Treatment Center (SATC) Services

(xii) Comprehensive Outpatient Rehabilitation Facility (CORF) Services;

(xiii) Dental Services;

(xiv) Dietician Services;

(xv) Developmental Center Services;

(xvi) Durable Medical Equipment and Supplies;

(xvii) Emergency Hospital Services;

(xviii) Early and Periodic Screening, Diagnosis and Treatment (EPSDT)

Services;

(xix) End Stage Renal Disease (ESRD) services;

(xx) Family Planning Clinic Services;

(xxi) Federally Qualified Health Center (FQHC) services;

(xxii) Home and Community Based Services (HCBS);

(xxiii) Home Health Services;

(xxiv) Hospice Services;

(xxv) Hospital Services (inpatient and outpatient);

(xxvi) Indian Health Service (IHS) and 638 Tribal Facilities;

(xxvii) Intermediate Care Facility for People with Intellectual Disabilities (ICF/ID) Services;

(xxviii) Institution for Mental Disease (IMD) Services furnished to individuals under twenty-two years of age and sixty-five years of age and older;

(xxix) Interpretation Services;

(xxx) Laboratory Services;

(xxxi) Mental Health Professional Services as defined in § 42-4-103 a (xx);

(xxxii) Midwife Services;

(xxxiii) Nurse Midwife (Certified) Services;

(xxxiv) Nursing Facility Services;

(xxxv) Nurse Practitioner Services

(xxxvi) Occupational Therapy Services;

(xxxvii) Pharmaceutical Services;

(xxxviii) Pharmacist Services;

(xxxix) Physical Therapy Services;

(xl) Physician Assistant Services;

(xli) Physician Services;

(xlii) Podiatry Services;

(xliii) Psychiatric Residential Treatment Facility (PRTF) Services;

(xliv) Psychology Services;

(xlv) Radiology Services;

(xlvi) Rural Health Clinic (RHC) Services;

(xlvii) School-Based Services as defined in Chapter 52;

(xlviii) Solid organ transplants and bone marrow transplants;

(A) For clients over the age of 21, transplants are limited to bone marrow, kidney, and liver;

(xlix) Speech Therapy Services; (l) Swing bed Services;

(li) Targeted case management; (lii) Vision Services and

(liii) Weight reduction treatment, including intestinal bypass surgery, gastric bypass surgery, and gastric stapling.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 5 Services Not Covered

(a) The Wyoming Department of Health shall not cover the following services and supplies:

(i) Except in an emergency, services furnished without the consent of the client or the client's legal guardian;

(ii) Experimental procedures which are not generally accepted or used by a provider's peer group as current or standard practice;

(iii) Examinations or reports required for legal purposes or other purposes not specifically related to medical care;

(iv) Services furnished outside the United States;

(v) Services furnished to an individual who is an inmate of a public institution, or an individual that is in the custody of a state, local, or federal law enforcement agency except as allowed by Federal law;

(vi) Services provided to an individual during the first seventy-two (72) hours of emergency detention;

(vii) Services provided to clients age 22 - 64 in an Institute for Mental Diseases (IMD), including Medicare secondary claims;

(viii) Unless pre-approved, services which exceed the service limitations;

(ix) Services provided pursuant to a court order if such services:

(A) Are not covered services;

(B) Exceed service limitations;

(D) Have not received prior authorization, if applicable; or

(E) Have not received admission certification, if applicable.

(x) Abortions, except to the extent required by 42 C.F.R. § 441.200 - 441.208;

(xi) Acupuncture;

(xii) Alcohol and chemical rehabilitation furnished to an inpatient, except for purposes of detoxification or stabilization of acute conditions;

(xiii) Autopsies;

(xiv) Biofeedback therapies and equipment;

(xv) Chronic pain rehabilitation;

(xvi) Community mental health services and community substance abuse treatment center services furnished outside Wyoming;

(xvii) Cosmetic procedures;

(xviii) Custodial care including but not limited to non-skilled, personal care. Personal care would include help with activities of daily living, such as bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom;

(xix) Gender reassignment surgery;

(xx) Hormone therapy for gender dysphoria for a person who is younger than eighteen (18) years of age;

(xxi) Infertility services, includes but is not limited to counseling, sterilization reversal and artificial insemination;

(xxii) Missed or canceled appointments;

(xxiii) Personal comfort items;

(xxiv) Private-duty nursing services;

(xxv) Puberty blockers for gender dysphoria for a person who is younger than eighteen (18) years of age;

(xxvi) Sterilizations, unless the requirements of 42 C.F.R. § 441.250 - 441.259 are satisfied; and

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 6 Ambulatory Surgical Services (ASC) Services

(a) Eligible providers. A facility or distinct portion of a facility certified under Medicare to provide ASC services.

(b) Covered services.

(i) All surgical procedures covered by Medicare; and

(ii) Additional surgical procedures pre-authorized and which may be provided as outpatient hospital services.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 7 Audiology Services and Hearing Aids

(a) Eligible providers. Physicians, independently practicing licensed Audiologists, and hearing aid equipment providers.

(b) Covered services.

(i) Audiological function tests;

(ii) Hearing aid examinations; and

(iii) Hearing aid equipment.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 8 Certified Registered Nurse Anesthetist (CRNA) Services

(a) Eligible providers. Hospitals and physicians that employ a CRNA or independently practicing CRNAs.

(b) Covered services. Anesthesia services, except as otherwise specified by the Wyoming Department of Health.

(i) Is not a covered service;

(ii) Requires prior authorization that has not been obtained; or

(iii) Requires informed consent by the client that has not been obtained.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 9 Comprehensive Outpatient Rehabilitation Facility (CORF) Services

(a) Eligible providers. Facilities certified by Medicare as a CORF.

(b) CORF services are limited to:

(i) Drugs and biologicals that cannot be self-administered;

(ii) Medical supplies and equipment;

(iii) Nursing services;

(iv) Occupational therapy;

(v) Orthotics and prosthetics;

(vi) Physician Services;

(vii) Physical therapy;

(viii) Respiratory therapy;

(ix) Social or psychological services; and

(x) Speech therapy.

(i) Services directed at general conditioning or maintenance; and

(ii) Services that exceed the limitations imposed by the Wyoming Department

of Health.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 10 Dental Services

(a) Covered services for clients under the age of twenty-one (21):

(i) Preventive visits;

(ii) Restorative fillings, crowns, and tooth replacement;

(iii) Extractions;

(iv) Partial or complete dentures;

(v) Root canal therapy;

(vi) Periodontal treatment;

(vii) Oral and maxillofacial surgery;

(viii) Orthodontic treatment for severe malocclusions; and

(ix) Palliative treatment.

(b) Covered services for clients age twenty-one (21) and older:

(i) Preventive visits;

(ii) Extractions;

(iii) Palliative treatment; and

(iv) Oral and maxillofacial surgery.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 11 Dietitian Services

(a) Eligible providers. Dietitians.

(b) Covered services.

(i) Medically necessary professional services furnished by a dietitian, as prescribed by a physician, nurse practitioner or physician assistant.

(i) Medicaid reimbursement for Dietitian service(s) shall be limited to a total of twenty (20) visits per calendar year, unless pre-approved.

(ii) The limitations of this subsection shall not apply to:

(A) A client who is under age twenty-one (21); or

(B) A pregnant woman.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 12 Developmental Center Services

(a) Eligible providers. Developmental Centers certified by the Developmental Disabilities Section and under contract with that office to provide such services.

(b) Covered services. Diagnostic assessment and evaluation, behavioral health, speech, physical therapy services, occupational therapy services, and case management services.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 13 Emergency Hospital Services

(a) Emergency Hospital Services are covered at the most accessible enrolled hospital available that is equipped to furnish appropriate Emergency Hospital Services.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 14 End Stage Renal Disease (ESRD) Services

(a) Eligible Providers. Free-standing or hospital-based facilities certified by Medicare to provide ESRD services.

(b) Covered services. ESRD services for outpatient dialysis and other treatment for persons with end-stage renal disease.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 15 Family Planning Clinic Services

(a) Eligible Providers. A clinic, which is neither located on the premises of a hospital nor owned by a hospital and meets the minimum requirements for routine contraceptive management as specified by the state Public Health Division. A laboratory in a clinic shall be licensed by the State of Wyoming.

(b) Covered Services. The following services are covered when furnished under the supervision of a physician, nurse practitioner or physician assistant who is directly affiliated with the clinic. A provider is directly affiliated with the clinic if there is a contract between the provider and the clinic under which the provider is obligated to supervise the following care furnished to the clinic's patients:

(i) Office visits;

(ii) Contraceptive supplies and devices;

(iii) Laboratory tests; and

(iv) Counseling.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 16 Hospice Services

(a) Eligible providers. Hospice providers certified by Medicare and located within the State of Wyoming. Services provided by a hospice provider located outside the State of Wyoming shall not be eligible for Medicaid reimbursement unless the services are pre-approved.

(b) Covered services. The following services shall be covered if provided pursuant to a written plan of care established by the hospice provider and approved by the client's attending physician:

(i) Routine home care;

(ii) Continuous home care;

(iii) Inpatient respite care;

(iv) General inpatient care;

(v) Hospice, nursing facility room and board; and

(vi) Hospice, inpatient hospice facility room and board.

(c) Limitations. During the time a client elects to receive hospice services, the client shall waive all rights to Medicaid payments for the following services:

(i) Hospice Services provided by a provider other than the hospice provider designated by the client (unless provided under arrangements by the designated hospice); and

(ii) Any Medicaid services that are related to the treatment of the terminal illness (or a related condition) for which hospice services were elected, or services that are equivalent to hospice services, except for services:

(A) Provided by the designated hospice, either directly or by arrangement with another provider;

(B) Provided by the client's attending physician if that physician is neither an employee of the designated hospice nor receiving compensation from the hospice for furnishing such services;

(D) Provided by a Home and Community Based Waiver; or

(E) Delivered to a client under the age of twenty-one (21) years. Clients under the age of twenty-one (21) shall be eligible for curative services as well as terminal illness hospice care.

(d) Medicaid allowable payment. The Medicaid allowable payment shall be determined as follows:

(i) The Medicaid allowable payment to the hospice provider for room and board furnished in a nursing facility shall be ninety-five percent (95%) of the nursing facility's per diem rate. The hospice provider shall be responsible for paying the nursing facility for the room and board services furnished to a client of hospice services.

(ii) Providers providing hospice services in an inpatient hospice facility that does not meet eligibility criteria for inpatient hospice care billing may receive room and board payments from Wyoming Medicaid. Payments for room and board shall follow the method established in Section 16, (d)(i) and pay one hundred percent (100%) of the rates establish by that method. This is intended to ensure client choice of setting does not cause a difference between nursing home and standalone hospice settings.

(iii) Total Medicaid payments to a hospice provider for inpatient care furnished to clients of hospice services shall not exceed twenty percent (20%) of the aggregate number of days of hospice care provided by the hospice provider to all Medicaid clients during the applicable twelve-month period. The limit shall be applied as follows:

(A) For each twelve-month period beginning on November 1, the Department shall determine the aggregate number of days of inpatient care furnished by each hospice provider to clients of hospice services (the number of days of inpatient care shall include general inpatient care and inpatient respite care); and

(B) If payments for inpatient services exceed twenty percent (20%) of the total days of Medicaid services, the Medicaid payments for such services shall be considered overpayments and shall be recovered.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 17 Hospital Services

(a) Hospital Services (including ancillary services provided in a hospital) shall be covered services if provided:

(i) Pursuant to the written orders of a licensed physician; and

(ii) By or under the supervision of a licensed physician.

(b) Inpatient Hospital Psychiatric Services. Psychiatric services are limited to stabilization of acute conditions. Such services shall only be covered services when:

(i) The client is evaluated by a multidisciplinary team within forty-eight (48) hours after admission;

(ii) The multidisciplinary team prepares an individualized treatment plan; and

(iii) The medical record documents a plan of active treatment and individual, group, or family therapy directed to achieve the goals specified in the individualized treatment plan.

(i) Medicaid reimbursement for outpatient hospital services shall be limited to a total of twelve (12) visits per calendar year to a hospital clinic, a hospital emergency room (for non-emergency services), and a physician's office, unless additional visits are pre-approved.

(ii) Exceptions. The limitations of subsection (c)(i) shall not apply to:

(A) An individual seeking emergency services who is diagnosed with an emergent condition;

(B) An individual seeking family planning clinic services;

(D) A pregnant woman;

(E) Items and services furnished directly by the Indian Health Services, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or through a referral under a purchase order contract health service (as described in 42 C.F.R., Ch. I, Subch. M, Pt. 136, Subpart C) to an American Indian or Alaskan Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of "Indian" at Section 4 of the Indian Healthcare Improvement Act (25 U.S.C. § 1608);

(F) A resident of a nursing facility; or

(G) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 18 Interpretation Services

(a) Interpreters shall adhere to national standards developed by the National Council on Interpreting in Healthcare (NCIHC), to include accuracy, confidentiality, impartiality, role boundaries, professionalism, professional development, and advocacy.

(b) Covered Services. The interpretation provider shall only bill for time spent with the client.

(i) Excluded services. Interpreter services in conjunction with the following

services:

(A) Inpatient and outpatient hospital services;

(B) Services in an Intermediate Care Facility for persons with Intellectual Disabilities (ICF/ID);

(D) Ambulance Services by public providers;

(E) PRTF services;

(F) Comprehensive Inpatient and Outpatient Rehabilitation Facility

Services;

(G) Services provided by other agencies and organizations receiving

federal funding;

(H) Interpreter services provided by a family member, volunteer, associate, or friend; and

(I) Reimbursement for interpreter travel to and from the appointment.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 19 Laboratory Services

(a) Eligible providers. Independent laboratories certified by Medicare, hospitals laboratories, and physician offices with a laboratory licensed by the state in which the laboratory is located.

(b) Covered services. Professional or technical laboratory services ordered by a licensed provider under their scope of practice. Services shall be directly related to the diagnosis and treatment of the patient as specified in the ordering provider's treatment plan.

(i) Handling charges where a specimen is referred by one (1) laboratory to

another;

(ii) Post-mortem examinations;

(iii) Fees charged to obtain immediate results;

(iv) Technician callback fees; and

(v) Services that are not FDA approved.

(d) Limited services:

(i) Specimen collection fees shall be paid only to the provider that collects the specimen from the client.

(ii) Only one collection fee shall be allowed for each type of specimen for each client encounter, regardless of the number of specimens extracted.

(iii) Clinical laboratory services routinely performed by non-physicians shall not be entitled to a professional component.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 20 Nurse Midwife Services

(a) Covered services. Professional services furnished by a licensed nurse midwife that are:

(i) Throughout the maternity period; and

(ii) Within the scope of the nurse midwife's practice as permitted by the Wyoming Nursing Practice Act.

(b) Excluded and limited services. Services furnished in a hospital or a clinic shall be covered only to the extent the facility permits such services.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 21 Occupational Therapy Services

(a) Eligible providers. Licensed independent occupational therapists, hospitals, physicians, PRTFs, and developmental centers that employ licensed occupational therapists.

(b) Covered services.

(i) Prescribed rehabilitative occupational therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness;

(ii) Occupational therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;

(iii) Occupational therapy services furnished in a developmental center or PRTF to a client pursuant to:

(A) An individualized education plan (IEP) developed by the school

system or PRTF; or

(B) An individualized family services plan developed by a

developmental center.

(i) Unless pre-approved, Medicaid reimbursement for client occupational therapy visits shall be limited to twenty (20) visits per calendar year.

(ii) Habilitative services are not covered for clients 21 years of age or older.

(iii) Except as otherwise specified in this Chapter, occupational therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts every one hundred eighty (180) days.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 22 Physical Therapy Services

(a) Eligible providers Licensed independent physical therapists, physicians, hospitals, PRTFs, and developmental centers that employ licensed physical therapists.

(b) Covered services.

(i) Prescribed rehabilitative physical therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness as prescribed by a physician;

(ii) Physical therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;

(iii) Physical therapy services prescribed as a direct result of outpatient surgery required as a result of an injury; and

(iv) Physical therapy services provided to a client under age twenty-one (21) with chronic disabilities when furnished by a developmental center or PRTF pursuant to an:

(A) Individualized education plan developed by the school system or

PRTF; or

(B) Individualized family services plan developed by a developmental

center.

(i) Unless pre-approved, Medicaid reimbursement for client physical therapy visits shall be limited to a total of twenty (20) visits per calendar year.

(ii) Habilitative services are not covered for clients 21 years of age or older.

(iii) Except as otherwise specified in this Chapter, physical therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts every one hundred eighty (180) days.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 23 Physician Services

(a) Covered services. Medically necessary professional services furnished by or under the supervision of a licensed physician, except as otherwise specified by this Chapter.

(b) Excluded or limited services.

(i) Anesthesia services shall be limited as follows:

(A) An anesthesiologist shall not receive Medicaid reimbursement for a consultation in addition to any other anesthesia services for the same surgery.

(B) Anesthesia services shall not be covered when performed in

conjunction with:

(I) A non-covered surgical procedure; or

(II) A procedure requiring client consent if proper consent was

not obtained not withstanding emergency procedures where consent cannot reasonably be obtained.

(ii) The following allergy and clinical immunotherapy services are excluded:

(A) Sublingual, intracutaneous and subcutaneous provocative and neutralization testing; and

(B) Neutralization therapy for food allergies.

(iii) Cosmetic surgery:

(A) Services intended solely to improve an individual's physical appearance and which do not restore bodily function or correct a physical deformity are excluded.

(B) Reconstructive surgery procedures which are intended to improve bodily functions and the appearance of a body area which has been altered by disease, trauma, congenital or developmental anomalies, or previous surgical procedures shall be covered only if authorized prior to the procedure.

(iv) Dermatology. The following shall be excluded:

(A) Removal of lesions not suspected to be precancerous, unless medically necessary to restore a bodily function; and

(B) Services performed primarily for cosmetic reasons.

(v) Medical supplies. Expendable medical supplies normally used in a physician's office shall be included in the Medicaid payment for the office visit or test performed. The actual cost of special expendable supplies prescribed for home use by a client may be separately billed to Medicaid.

(vi) Prolonged care shall be limited to a total of three (3) hours per day unless there is documentation in the medical records that additional prolonged care was medically necessary.

(vii) Sterilizations shall not be covered unless the requirements of 42 C.F.R.

§ 441 are satisfied.

(viii) Therapeutic injections shall not be covered unless:

(A) The drug cannot be administered orally;

(B) The drug cannot be self-administered; and

(c) Service Limitations. Unless pre-approved, Medicaid reimbursement for client visits to a physician, ophthalmologist, physician assistant, nurse practitioner, optometrist and to the outpatient department of a hospital shall be limited to a total of twelve (12) visits per calendar year. The limitations of this subsection shall not apply to:

(i) A client seeking emergency services who is diagnosed with an emergent

condition;

(ii) A client seeking family planning clinic services;

(iii) A client who is under age twenty-one (21);

(iv) A pregnant woman;

(v) Items and services furnished directly by the Indian Health Services, an Indian Tribe, Tribal Organization, or Urban Indian Organization, or through a referral under a purchase order contract health service (as described in 42 C.F.R., Ch. I, Subch. M, Pt. 136, Subpart C) to an American Indian or Alaskan Native who is enrolled as a member of a Federally- Recognized Tribe or otherwise meets the definition of a "Indian" as Section 4 of the Indian Healthcare Improvement Act (25 U.S.C. § 1608);

(vi) A resident of a nursing facility; or

(vii) A client who is also eligible for Medicare and where Medicare has reimbursed the provider for the claim.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 24 Radiology Services

(a) Eligible providers. Licensed independent radiology practices, hospitals, and physician practices.

(b) Excluded services:

(i) Unordered radiological studies; and

(ii) Separate consultations procedures unless ordered by the attending

physician, nurse practitioner or physician's assistant.

(i) Routine mammography is limited as follows:

(A) One mammography between the ages of thirty-five (35) and thirty-

nine (39); and

(B) One mammography per year at age forty (40) and after.

(ii) Services performed in a physician's office shall be covered only if performed by or under the direct supervision of the physician.

(iii) Services performed in a hospital using equipment owned by the provider. The provider may bill for the total procedure if the technical component is not billed by the hospital.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 25 Speech Therapy Services

(a) Eligible Providers. Independent licensed speech therapists, physicians, hospitals, PRTFs, and developmental centers that employ licensed speech therapists.

(b) Covered Services.

(i) Prescribed rehabilitative speech therapy services furnished in response to physical debilitation caused by acute physical trauma or physical illness as prescribed by a physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts;

(ii) Speech therapy services prescribed while the client was an inpatient and continuing on an outpatient basis;

(iii) Speech therapy prescribed as a direct result of outpatient surgery required as a result of an injury; and

(iv) Speech therapy services provided to a client under age twenty-one (21) with chronic disabilities when furnished by a developmental center or a PRTF pursuant to an:

(A) Individualized Education Plan (IEP) developed by the school

system or PRTF; or

(B) Individualized family services plan developed by a developmental

center.

(i) Medicaid reimbursement for client speech therapy visits shall be limited to thirty (30) visits per calendar year, unless pre-approved.

(ii) Habilitative services are not covered for clients 21 years of age or older.

(iii) Except as otherwise specified in this Chapter, speech therapy services shall be prescribed by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts and re-certified by the attending physician, advanced practice registered nurse, physician's assistant, or other practitioner of the healing arts every one hundred eighty (180) days.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 26 Targeted Case Management Services

(a) Eligible providers. Case managers.

(b) Covered services. Case management services provided only to target groups.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 27 Vision Services

(a) Eligible providers. Optometrist, opticians and licensed ophthalmologists.

(b) Covered services. Medical treatment for clients:

(i) At risk of eye diseases, including eye disease secondary to chronic

illness; or

(ii) With eye injuries.

(i) Medically necessary contact lenses;

(ii) Eyeglasses;

(iii) Medically necessary photosensitive lenses;

(iv) Routine eye examinations; and

(v) Vision therapy.

History

Effective 2025-01-18

Wyo. Code R. 048.0037.26.01182025 § 28 Client Co-Payments

(a) Clients who receive the following services shall make a co-payment:

(i) Federally Qualified Health Centers (FQHC) services;

(ii) Physician office visits;

(iii) Physician home visits;

(iv) Psychiatric services;

(v) Rural Health Centers services;

(b) Co-payment amounts. Co-payment dollar amounts shall be assigned as specified in State Plan Amendment 4.18-A.

(i) Emergency services;

(ii) Family planning clinic services;

(iii) Clients under the age of twenty-one (21);

(iv) Pregnant women;

(v) Residents of a nursing facility or swing bed facility;

(vi) A client who is also eligible for Medicare and where Medicare has

reimbursed the provider for the claim;

(vii) Items and services furnished directly to an American Indian or Alaska Native who is enrolled as a member of a Federally-Recognized Tribe or otherwise meets the definition of an "Indian" at Section 4 of the Indian HealthCare Improvement Act (25 U.S.C.

§ 1608);

(viii) Hospice Services; and

(ix) Inpatient hospital stays.

(x) Any individual or service where cost sharing is prohibited by Federal law or State law as specifically delineated in State Plan Amendment 4.18-A.

(d) Providers shall be responsible for collecting the co-payment. The amount of the co-payment shall be automatically deducted by the Wyoming Department of Health from the Medicaid allowable payment, regardless of whether the co-payment is actually paid. For purposes of this section, a provider shall not deny service to a client due to a client's inability to make the co-payment, unless a client regularly refuses to make co-payments.

History

Effective 2025-01-18

Chapter 28 Payment for Swing Bed Services

Wyo. Code R. 048.0037.28.10152025 § 1 Authority

. The Wyoming Department of Health (Department) promulgates this Chapter under the Medical Assistance and Services Act, Wyoming Statute §§ 42-4-101 through 124.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 2 Purpose and Applicability

. This Chapter governs the provision of and payment for swing bed services.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 3 Definitions

(a) Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1 or as otherwise defined in this Chapter, the terminology used herein has the standard meaning used in healthcare, Medicaid, and Medicare.

(b) "Chapter" refers to the specified chapter in the Wyoming Department of Health, Medicaid Rules.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 4 General Provision

. Medicaid reimbursement for swing bed services and services provided to extraordinary care clients is limited to services furnished to individuals that are nursing facility eligible.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 5 Hospital Participation

. A hospital that wishes to receive Medicaid payment for swing bed services furnished to a client must meet the requirements of applicable federal regulations, including 42 C.F.R. § 482.58 and 483.1 through 483.95.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 6 Minimum Data Set (MDS)

(a) The MDS requirements for nursing facility services required by 42 C.F.R. § 483.20 also apply to swing bed services. Each hospital must comply with the MDS requirements for nursing facility services.

(b) The MDS must be completed on or before the day specified by HHS regulations.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 7 Determination of Medical Eligibility

Each applicant and client must undergo an evaluation of medical necessity pursuant to Chapter 22 before a hospital may receive Medicaid payment for swing bed services provided to that individual.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 8 Medicaid Allowable Payment for Swing Bed Services

(a) The per diem rate for swing bed services is the lesser of:

(i) The hospital's usual and customary charges for swing bed services; or

(ii) The lowest per diem rate currently in effect for nursing facility services furnished in a nursing facility in the community where the hospital is located, as determined pursuant to Chapter 7.

(b) The per diem rate includes payment for all services and supplies furnished to a client except as otherwise specified in this Chapter.

(i) The client was admitted to the hospital from a nursing facility which has available an appropriate bed to which the client could return;

(ii) There is an available bed in a nursing facility within the hospital's geographic region, as defined in 42 C.F.R. § 413.114(b), and the client has not been transferred as required by Section 13.

(A) "Available bed." A certified bed in a nursing facility that is:

(I) Not occupied by an individual;

(II) Not a reserved bed for which the facility has received or will

receive payment; and

(III) In a nursing facility willing and able to provide the services required by the client.

(iii) The hospital is located outside the State of Wyoming; or

(iv) As otherwise prohibited by 42 C.F.R. § 413.114(d).

(d) The facility must maintain records of the costs it incurs in furnishing swing bed services. Costs related to swing bed services must not be cost settled by Medicaid and must not be used to rebase inpatient hospital rates pursuant to Chapter 30.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 9 Transfer to Nursing Facility

(a) Except as provided in subsection (c) an applicant or client receiving swing bed services must be transferred to the first available, appropriate nursing facility bed in the hospital's geographic region upon the availability date, as defined in 42 C.F.R. § 413.114(b). Medicaid payment to the hospital for swing bed services will terminate after the date of the transfer.

(b) The facility must maintain records of its efforts to transfer each client, including the facility or facilities contacted and any response. Such records must be maintained as part of the client's medical records kept pursuant to Chapter 3.

(c) The requirements of subsection (a) do not apply if the client's physician certifies, in writing, that transfer is not medically appropriate.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 10 Payment of Claims

Each claim must contain a certification by the hospital that the service was medically necessary, that it was provided on the date specified, that third party liability has been paid or, if third party liability has been denied, documentation of that denial is attached, and that the payment sought is not in excess of the hospital's usual and customary charge for the service.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 11 Inpatient Services

Medicaid will not pay for inpatient services furnished to an extraordinary care client unless the client is discharged from the swing bed and admitted to a hospital as an inpatient.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 12 Medicaid Payment for Reserve Bed Days

(a) Reserve bed days.

(i) Medicaid will not pay for reserve bed days.

(ii) A hospital must not bill a client or the client's family for reserved bed days that are not paid pursuant to this section unless the nursing facility has informed the client in writing before the period for which payment is sought of the client's option to make payments to hold the bed.

History

Effective 2025-10-15

Wyo. Code R. 048.0037.28.10152025 § 13 Incorporation by Reference

(a) For any code, standard, rule or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of these rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference is further identified as follows:

(i) Referenced in Section 5 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. G, Pt. 482, Subpart D, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.

(ii) Referenced in Section 5 and 9 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. G, Pt. 483, Subpart B, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.

(iii) Referenced in Section 11 and 13 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. B, Pt. 413, Subpart F, incorporated as of the effective date of this Chapter and found at http://www.ecfr.gov.

History

Effective 2025-10-15

Chapter 29 Medicaid Case Management

Wyo. Code R. 048.0037.29.08132020 § 1 Authority

The Department of Health ("Department") promulgates this Chapter under Wyoming Statute 42-4-104.

History

Effective 2020-08-13

Wyo. Code R. 048.0037.29.08132020 § 2 Purpose and applicability

This Chapter governs case management by establishing the responsibilities and powers of the Department, clients, providers, and facilities to address the most efficient and cost-effective means of delivering care.

History

Effective 2020-08-13

Wyo. Code R. 048.0037.29.08132020 § 3 Hospital Reporting Requirements

(a) A hospital is not entitled to receive the full Medicaid allowable payment for covered services furnished to a client unless the hospital has reported the client to the Department on an Inpatient Census Report ("ICR"), subject to the following provisions:

(i) A hospital shall submit an ICR to the Department by 5:00 p.m. on Friday of each week.

(ii) An ICR must:

(A) Be submitted electronically in the form and manner established by the Department; and

(B) Report each client admitted to the hospital since the last ICR deadline.

(iii) If a hospital fails to timely report a client on an ICR, the hospital may not report the client on a subsequent ICR unless the client has not yet been discharged from the hospital.

(iv) If a hospital makes a late report of a client on an ICR, the Department may reduce, by up to twenty-five percent (25%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.

(v) If a hospital altogether fails to report a client on an ICR, the Department may reduce, by up to one hundred percent (100%), the Medicaid allowable payment to the hospital for all covered services furnished to the client.

(vi) If a hospital makes a late report of a client on an ICR late or altogether fails to report a client on an ICR and, nonetheless, the Department pays the hospital the full Medicaid allowable payment, the Department may recoup the overpayment pursuant to the procedures under Chapter 3 of Rules, Wyoming Department of Health, Medicaid ("the Medicaid Rules").

(b) If a client is determined eligible for Medicaid only after discharge from the hospital, then the Medicaid allowable payment to the hospital shall not be reduced for failure to include that client on prior ICRs.

History

Effective 2020-08-13

Wyo. Code R. 048.0037.29.08132020 § 4 Case Management

(a) The Department may subject a client to case management if the Department determines the client requires assistance in using covered services appropriately for any reason, including:

(i) The client appears unfamiliar with the Medicaid program or the delivery of services;

(ii) The client has a severe medical problem; or

(iii) The client is receiving high-cost services.

(b) If the Department subjects a client to case management, the Department need not notify the client.

(i) Monitoring the utilization of covered services to ensure that they are medically necessary and appropriate;

(ii) Conducting reviews of services while the client is at a facility;

(iii) Conducting on-site reviews with clients or providers to determine whether the provided services are medically necessary and appropriate; and

(iv) Taking any other action relevant to the coordination and facilitation of covered services in an efficient manner or setting consistent with the appropriate care for the client.

History

Effective 2020-08-13

Wyo. Code R. 048.0037.29.08132020 § 5 Client Lock-in

(a) The Department may lock-in a client if:

(i) The Department determines the client has engaged in fraud, theft, or abuse of services pursuant to Chapter 16 of the Medicaid Rules; or

(ii) The Department receives a referral from another Medicaid program which demonstrates that the client has previously engaged in fraud, theft, or abuse of services.

(iii) The client is receiving high-cost services.

(b) If the Department decides to lock-in a client pursuant to this Section, the Department shall comply with the sanction procedures under Chapter 16, Section 10 of the Medicaid Rules.

History

Effective 2020-08-13

Wyo. Code R. 048.0037.29.08132020 § 6 Stay of Client Lock-in

(a) If a client requests a contested case proceeding regarding lock-in pursuant to Chapter 4 of the Medicaid Rules, the client lock-in remains in effect during the contested case proceeding unless the Department stays the lock-in according to the following provisions:

(i) In order for a stay of the lock-in to be granted, the client, client's guardian, or an individual authorized to act on the client's behalf, shall submit a written request for a stay to the Department concurrent with the request for a contested case proceeding. The request for a stay must include a statement regarding the potential impact on the client's health and welfare if the lock-in were to remain in effect.

(ii) The Department may not grant a request for a stay unless the Department finds that the lock-in would cause the client irreparable harm.

(iii) If the Department grants a request for a stay, the Department may impose whatever conditions it finds necessary to protect the health and welfare of the client or the interests of the Medicaid program.

(iv) The Department shall provide written notice of its decision to grant or deny a request for a stay. The written notice must provide the grounds in support of the Department's decision.

History

Effective 2020-08-13

Chapter 30 Reimbursement of Inpatient Hospital Services

Wyo. Code R. 048.0037.30.05252021 § 1 Authority

(a) The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes § 42-4-104(a)(iv).

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 2 Purpose and Applicability

(a) This Chapter shall apply to and govern Medicaid reimbursement of inpatient hospital services, other than specialty services.

(b) The Department may issue manuals or bulletins to providers to interpret the sections of this Chapter. Such manuals and bulletins shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the sections of this Chapter.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 3 General Provisions

(a) The Department shall use the APR DRGs and relative weights developed by 3M Health Information Systems (3M) to assist in reimbursement calculations for inpatient hospital services. The Department shall update the APR DRG software, and update the version of DRGs assigned for reimbursement, as needed.

(b) The Department shall calculate reimbursement for all inpatient hospital services for Wyoming Medicaid recipients at participating and non-participating Wyoming Medicaid enrolled hospitals using a prospective per discharge system based-on APR DRGs for acute care services, a per diem-based reimbursement method for rehabilitation services, or a percent of billed charges for transplants, as applicable.

(c) The Department shall designate certain services to be reimbursed based on negotiated rates as specialty services. The Department shall notify providers of services that are reimbursed as specialty services.

(d) The Department shall distribute additional annual supplemental payments to disproportionate share hospitals pursuant to Wyoming Medicaid State Plan Attachment 4.19A.

(e) The Department shall distribute Qualified Rate Adjustment (QRA) payments to qualifying hospitals pursuant to 4.19A, Part 1, Addendum 1 of the Wyoming Medicaid State Plan.

(f) The Department shall distribute Private Hospital Supplemental (PHS) payments to qualifying hospitals pursuant to Wyoming Medicaid State Plan Attachment 4.19A, Addendum 3.

(g) The Department considers the following services and providers as exempt from APR DRG reimbursement:

(i) The Department shall continue to reimburse rehabilitation claims using a per diem payment.

(ii) The Department shall reimburse eligible transplant services at a level that covers the provider's eligible costs as calculated using billed charges. The most recently available provider-specific cost-to-charge ratios developed annually by the Department as part of the Department's Medicaid hospital supplemental payment policy calculations will also be used.

(iii) The Department may designate certain services to be reimbursed through negotiated rates or through other reimbursement methodologies.

(iv) Swing bed services are exempt from the APR DRG methodology.

(v) The Department shall not allow acute care hospitals to submit interim claims for APR DRG services.

(h) The Department shall require prior authorization for rehabilitation, psychiatric, transplant, and other services determined by the Department.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 4 Definitions

(a) "All Patients Refined Diagnosis Related Groups (APR DRGs)." A classification system that classifies inpatient services based on their reason for admission, severity of illness, risk of mortality, and resources used during treatment.

(b) "Extraordinary circumstances." A catastrophic occurrence, beyond the control of a hospital, which results in substantially higher costs. An "extraordinary circumstance" includes, but is not limited to fire, earthquakes, floods, or other natural disasters.

(c) "Participating Providers." All in-state Wyoming providers and out-of state providers that are currently enrolled in the Wyoming Medicaid program and/or Wyoming Medicaid providers that received at least eight-hundred thousand dollars ($800,000) in cumulative Wyoming Medicaid payments for inpatient services during state fiscal years 2015-2017.

(d) "Present on Admission." A patient's health condition as defined by a diagnosis code that was identified at the time of a patient's admission to a hospital.

(e) "Rehabilitation Services." Covered services furnished to an individual with a primary diagnosis for rehabilitation therapy.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 5 Medicaid Allowable Payment for Inpatient Acute Care Hospital Services

(a) The Department shall calculate APR DRG base rates using historical claims data with dates of payment in at least two of the most recent state fiscal years for which complete data is available as the base periods for development. The Department shall:

(i) Assign each certified hospital providing inpatient hospital services to Wyoming Medicaid recipients to one of the following three base rate categories for APR DRG services:

(A) In-state Level II Trauma providers, for which hospital-specific base rates are determined;

(B) In-state free-standing psychiatric providers; or

(ii) Establish base rates so that projected APR DRG payments maintain budget neutrality for claim payments in the base period for participating acute care providers;

(iii) Establish a base rate for free-standing psychiatric provider to include an additional $600,000 annual allocation to maintain funding at levels prior to APR DRG implementation. The following shall apply to such base rates:

(A) Only one base rate is available to each provider, per time period;

(B) The base rate represents a dollar amount used in the APR DRG calculation of reimbursement for a hospital stay;

(iv) Use transitional base rates for the first 12 months after the APR DRG implementation. The following shall apply to such transitional base rates:

(A) During this transition period, provider-specific APR DRG base rates shall be calculated so that estimated APR DRG inpatient hospital payments in the base period do not increase more than five percent or decrease more than four percent as compared to payments under the pre-DRG model;

(B) Following the 12-month transition period, providers shall receive the base rate from their assigned base rate category;

(C) During and after the APR DRG transition period non-participating providers shall be paid the "all other provider" base rate as specified in Section 5(c)(i) for APR DRG payment calculations;

(v) Post base rates for each provider category on the Department website. New rates shall be posted with a provider notice sent by the Department when any changes are made to the APR DRG base rates.

(b) The Department shall assign each claim an APR DRG code and Severity of Illness (SOI). APR DRG code is assigned a relative weight that reflects resources that are used to deliver the services associated with the assigned APR DRG categorization. Relative weights will be determined as follows:

(i) Calculated using a national dataset; and

(ii) Adjusted for anticipated documentation and coding improvement (DCI).

(c) During the rate modeling for the provider base rates used in the initial year of the APR DRG implementation, the Department shall apply a DCI factor of five percent to the relative weights to account for anticipated coding improvements made by providers following the implementation of APR DRGs.

(d) Following the first year of APR DRG implementation, the Department shall review coding improvement and may make future DCI adjustments to account for future provider coding improvements. Any future adjustments shall be reflected within the plan language and implemented upon approval by CMS.

(e) The Department shall allow only one policy or age adjustor to be applied per claim; the applicable adjustment factor with the highest value shall be applied to the APR DRG relative weight on the claim. The Department shall apply the following policy adjustors:

(i) A pediatric policy adjustor of 1.3 for pediatric claims where a recipient is younger than 19 on the date of admission;

(ii) A policy adjustor of 1.2 for Mental Health DRGs;

(iii) A policy adjustor of 1.2 for Substance Abuse DRGs;

(iv) A policy adjustor of 1.5 for Obstetrics DRGs;

(v) A policy adjustor of 1.9 for Normal Newborn DRGs;

(f) The Department shall make outlier payments for high cost claims that exceed a predetermined fixed loss threshold.

(i) The fixed loss threshold is specific to each of the below provider peer groups. Each provider peer group's fixed loss threshold is equal to two times the standard deviation of claim cost for all APR DRG base period claims for the following four peer groups: acute care hospitals, critical access hospitals, freestanding psychiatric hospitals, and children's hospitals. The following shall apply to the fixed loss threshold:

(ii) If a provider's costs for a claim exceed a threshold the provider shall receive an outlier payment.

(iii) The outlier payment shall be calculated as follows:

(A) The Department shall identify the cost of each claim by multiplying allowable charges on the claim by a hospital-specific cost-to-charge ratio;

(B) Participating providers are assigned the most recently available provider-specific cost-to-charge ratios developed annually by the Department as part of the QRA supplemental payment program;

(D) If the calculated allowable costs less the DRG base payment exceed the provider's cost outlier fixed loss threshold, an outlier payment shall be added to the DRG base payment; and

(E) The outlier payment shall be 75 percent of the calculated allowable costs less the DRG base payment that exceed the provider's fixed loss outlier threshold.

(g) The Department shall provide a discharge capital payment to participating providers. The following shall apply to a discharge capital payment:

(i) The Department shall set capital payments at $277.87 per discharge, as determined during the 2010 level of care rebasing, and may not be inflated

(h) The Department shall apply transfer payment adjustments to claims for services provided to a patient who is transferred after admission from one acute care hospital to another acute care hospital. The following shall apply to such transfer payment adjustments:

(i) The Department shall not apply transfer payment adjustments when a patient is discharged from an acute care hospital to a skilled nursing or rehabilitation facility, or when a patient is moved to or from a distinct part hospital unit of the hospital or from one unit to another within a hospital.

(ii) The type of transfer-to facility is determined using the patient discharge status billed on the institutional claim. Acute-to-acute transfer claims are identified using a distinct list of patient discharge status codes. The Department shall list these codes in related provider policy manuals.

(iii) For a provider transferring a Medicaid recipient, the DRG base payment is calculated as the lesser of the calculated APR DRG base payment or the calculated APR DRG transfer per diem payment.

(iv) The APR DRG per diem is calculated as APR DRG base payment divided by APR DRG average length of stay.

(v) APR DRG transfer per diem payment is calculated as APR DRG per diem multiplied by (Length of Stay plus one).

(vi) Claims from providers transferring a patient and from providers receiving transfers can receive outlier payments.

(vii) Transfer payments do not impact the claim payment for the provider receiving a patient in cases where that provider does not in-turn transfer the patient.

(viii) Transfer status is not considered for certain neonate transfer DRGs. In these cases, the transferring provider will receive the full APR DRG payment instead of a transfer adjusted payment.

(i) Reimbursement for less than one-day stays shall be based on an APR DRG per-diem and shall not include outlier reimbursement or capital payments. The Department shall review all inpatient stays lasting less than one day.

(j) The Department shall use the 3M APR DRG grouper to review for hospital acquired conditions (HACs) based on present on admission (POA) indicators required for hospitals' submission on all APR DRG claims.

(i) Hospitals shall document a valid POA indicator for each inpatient diagnosis, pursuant to CMS regulations in 42 CFR §412.

(ii) The Department shall use POA definitions as outlined by CMS.

(iii) The Department shall not provide additional reimbursement for the treatment of an acquired condition if the presence of a HAC would increase payment.

(k) The final APR DRG claim payment is calculated as follows:

(i) Claim Payment = APR DRG Base Payment or (APR DRG Per Diem X (actual length of stay + 1)) + Outlier Payment (if applicable) + Capital Payment (if applicable).

(ii) Final reimbursement amounts shall be equal to a claim's allowed amount minus any deductions for recipient cost sharing, patient responsibility, third-party liability or HACs.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 6 Payment for Rehabilitation Claims

(a) Payment of a rehabilitation claim shall include a per diem operating cost payment and a per diem capital cost payment, as determined for purposes of the 2010 rehabilitation level of care rebasing.

(b) The Department shall calculate the allowable cost of each rehabilitation claim for each participating hospital using each hospitals' as-filed Medicare cost reports for hospital fiscal years ending in state fiscal years 2005 and 2006 and each hospitals' inpatient claims paid in state fiscal years 2006 and 2007 (base period).

(d) The Department shall identify base period allowable costs as the sum of routine per diem costs and ancillary service costs. The following shall apply to such base period allowable costs:

(i) Base period allowable costs shall be inflated forward from the date of service to the midpoint of SFY 2007 using the CMS-PPS Hospital Market Basket.

(ii) The Department shall determine the number of days of rehabilitation services provided by each hospital from the adjusted base period claims data.

(iii) The Department shall calculate a cost per day for each hospital for rehabilitation services. The following shall apply to such calculations:

(A) For each hospital, the Department shall divide total costs for rehabilitation services in the base period by total days from the base period claims data.

(B) High and low-cost Medicaid outlier costs shall be identified for rehabilitation costs per diem.

(iv) The Department shall determine the base period allowable Medicaid cost per diem for rehabilitation services for each hospital by subtracting high and low-cost Medicaid outliers from the costs determined in subparagraph (A) of this Section.

(v) The Department shall calculate a ventilator payment per day for qualifying services not to exceed a fixed amount per diem. The ventilator payment shall be calculated as an incremental cost of rehabilitation services when a patient is receiving ventilator services. The Department shall calculate the ventilator payment per day to reflect the difference in resources used to provide rehabilitation services to patients with more intensive rehabilitation needs, as measured by an examination of prior year's claims, the relative weights for rehabilitation services under the Medicare MS-DRG methodology and research about other states' payment methodologies.

(e) The Medicaid payment rate for the rehabilitation services shall be the average payment rate for all participating providers. The Medicaid payment rate for non-participating hospitals shall not include reimbursement for capital costs.

(f) The Department shall accept interim claims for inpatient rehabilitation services.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 7 Reimbursement of New Hospitals

(a) The Medicaid APR DRG base payment rate for new hospitals shall be the APR DRG base payment rate for other providers as described in Section 5(c)(i)(C). Rates shall remain in effect until the APR DRG system or the rehabilitation per diem payment is rebased.

(b) The Medicaid rehabilitation payment rate for new hospitals is the average rehabilitation per diem payment for all participating providers and includes reimbursement for capital costs.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 8 Reimbursement of Merged Hospitals

(a) When two hospitals merge the rate will be the APR DRG and rehabilitation payment rates of the surviving hospital and a capital payment add on.

(b) The capital payment shall be the statewide capital payment per diem amount.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 9 APR DRG Exempt Hospitals

(a) The Department shall reimburse an exempt hospital for its reasonable costs using all-inclusive per diem rates determined on an annual basis, based upon the following:

(i) At the beginning of each state fiscal year, the Department shall determine an interim rate using the costs reported in the most recent available Medicare cost report. The rate is calculated by dividing total allowable costs by total days.

(ii) The final rates shall cover one hundred per cent of the total allowable costs to treat Medicaid clients. If final rates are greater than the interim rates, the Department shall pay each hospital the difference between the final and interim rates. If final rates are less than the interim rates, the Department shall recover any overpayments.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 10 Reimbursement of Capital Costs

(a) The Department shall calculate capital payment for eligible APR DRG services as follows:

(i) Using the per discharge capital payment rate determined for non-rehabilitation levels of care during the 2010 level of care rebasing;

(ii) Calculating the allowable capital cost for each participating hospital using hospitals' as-filed Medicare cost reports for hospital fiscal years ending in state fiscal years 2005 and 2006 and hospitals' inpatient claims paid in state fiscal years 2006 and 2007;

(iii) Calculating a capital cost per discharge for each participating hospital by dividing total capital costs by total discharges; and

(iv) Arraying the average capital cost per discharge of all participating hospitals and selecting the median capital cost per discharge for the capital payment rate for all participating hospitals.

(b) Capital payment for eligible rehabilitation services shall be calculated as follows:

(i) The Department shall use the per discharge capital payment rate determined for the rehabilitation level of care;

(ii) The Department shall identify the per diem capital payment by dividing the median capital cost per discharge by the average length of stay of all participating hospitals with rehabilitation services discharges; and

(iii) The capital payment amount for rehabilitation services may not exceed the per discharge amount calculated.

(c) An adjustment to a provider's capital rate shall not result in the redetermination of the statewide average prospective capital rate.

(d) The Department shall not make a capital payment to a non-participating provider.

(e) A provider may request an adjustment of its capital rate only to compensate for capital expenditures resulting from extraordinary circumstances.

(f) A redetermination pursuant to this subsection is effective 30 days after the Department issues a notice of rate adjustment.

(g) The statewide base year capital rate shall not be adjusted to reflect adjustments to hospital-specific rates pursuant to this subsection.

(h) Capital rates shall not be inflated.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 11 Third Party Liability

(a) The Medicaid payment for a claim for which third party liability exists shall be the difference between the Medicaid allowable payment and the third party payment.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 12 Preparation and Submission of Cost Reports

(a) A hospital shall submit a complete cost report to the Medicare intermediary in accordance with Medicare requirements.

(b) A hospital shall prepare cost reports in conformance with Medicare requirements.

(c) The Department may request, in writing, that a hospital submit information to supplement its cost report. The hospital shall submit the requested information within 30 days after the date of the request.

(d) The failure of a hospital to comply with reporting requirements shall immediately result in suspension of all Medicaid payments to the hospital.

(i) All Medicaid payments under review shall be repaid by the hospital to the Department within ten days of the suspension.

(ii) The suspension of payments shall continue until the hospital complies with this Section.

(iii) Upon the Department's receipt of all information required, payments shall be reinstated, without interest.

(e) Reinstatement of payment shall not affect the Department's right to withhold payments, terminate provider participation, or invoke other remedies permitted by applicable statutes and rules.

(f) If the hospital cannot comply with this Section because of delay caused by the intermediary, the hospital must submit verification of the delay from the intermediary on or before the designated date. In such a case, the Department shall not withhold payments.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 13 Rebasing

(a) The Department shall rebase operating costs when the rates determined no longer meet the requirements of the Social Security Act.

(b) The Department may update rates based on changes to hospital peer groups, hospital billing practices, or changes in hospital operations.

History

Effective 2021-05-25

Wyo. Code R. 048.0037.30.05252021 § 14 Partial Eligibility

(a) The Department shall maintain a partial eligibility policy in which providers may only submit claims for days the recipient is an eligible Medicaid recipient.

(b) The claim admit date shall be the actual admit date, and the number of days billed to the Department shall include only the dates for which the recipient is eligible even if s/he stayed longer.

History

Effective 2021-05-25

Chapter 31 Selective Contracting of Services

Wyo. Code R. 048.0037.31.09232019 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through 42-4-412.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 2 Purpose and Applicability

(a) This Chapter has been adopted to govern Medicaid reimbursement of specialty services, except as otherwise specified in the rules of the Department, and shall apply to all clients and providers for all specialty services provided on or after this Chapter's effective date.

(b) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals and bulletins shall be subordinate to the provisions of this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 3 General Provisions

(a) Terminology. Except as otherwise specified in the Rules and Regulations of Wyoming Medicaid, Chapter 1, Definitions, or as otherwise specified in this Chapter, the terminology used in this Chapter is the standard terminology and has the standard meaning used in accounting, health care, Medicaid and Medicare.

(b) General methodology. The Department shall reimburse providers of specialty services pursuant to contracts with the providers. Except as otherwise specified by contract, selective services shall be provided pursuant to this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 4 Provider Participation

(a) Payments only to providers. Except as otherwise specified in this Chapter, no provider that furnishes specialty services to a recipient shall receive Medicaid funds unless the provider is certified, has signed a provider agreement, is enrolled, and has signed a contract with the Department.

(b) Qualified provider. A provider or group of providers that contracts to provide specialty services must meet the criteria that the Department establishes as part of the selective contracting process.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 5 Provider Records

(a) A provider shall comply with Chapter 3's provider records requirements.

(b) Out-of-state records. If a provider maintains financial or medical records in a state other than the state where the provider is located, the provider shall either transfer the records to an in-state location that is acceptable to the Department, or reimburse the Department for reasonable costs, including travel, lodging and meals, incurred in performing the audit in an out-of-state location, unless otherwise agreed by the Department.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 6 Verification of recipient data

A provider shall comply with Chapter 3's client data verification requirements.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 7 Medicaid allowable payment for specialty services

(a) All-inclusive rate. No additional Medicaid reimbursement will be given to providers of specialty services. The only remuneration will be as specified in the all-inclusive contract rate.

(b) Services that require prior authorization or admission certification. The Department may require prior authorization or admission certification as a prerequisite to Medicaid payment. Failure to obtain prior authorization or admission certification shall result in the denial of Medicaid payment.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 8 Reimbursement of readmissions

Medicaid shall not reimburse for a readmission if the readmission is for continuation of treatment begun in the initial admission, and the Department determines that the treatment should have been provided during the initial admission.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 9 Reimbursement to non-contracting providers

(a) Medicaid reimbursement for specialty services furnished by non-contracting providers shall be limited to reimbursement for services provided in response to an emergency.

(b) The Medicaid reimbursement rate for specialty services furnished by a non-contracting provider to a recipient, in response to an emergency, shall be the average Medicaid rate paid to contracting providers for such services.

(c) Retroactive eligibility. Specialty services furnished by a non-contracting provider to an individual that becomes eligible for Medicaid after the date of admission, shall be reimbursed at the average Medicaid rate paid to a contracting provider for the same or similar services.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 10 Third party liability

(a) Submission of claims. Claims for which third party liability exists shall be submitted in accordance with Chapter 35.

(b) Medicaid payment. The Medicaid payment for a claim for which third party liability exists shall be the difference between the Medicaid allowable payment and the third party payment. In no case shall the Medicaid payment exceed the payment otherwise allowable pursuant to this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 11 Payment of Claims

Payment of claims shall be pursuant to Chapter 3, Provider Participation.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 12 Recovery of overpayments

. The Department shall recover overpayments pursuant to Chapter 16, Medicaid Program Integrity.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 13 Reconsideration

A provider may request reconsideration of a request to recover overpayments pursuant to the provisions of Chapter 16, Medicaid Program Integrity.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 14 Interpretation of Chapter

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of various provisions.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 15 Superseding effect

This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.31.09232019 § 16 Severability

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.32.01062015 Reimbursement of Disproportionate Share Hospitals

CHAPTER 32

Rules and Regulations for Medicaid

Reimbursement of Disproportionate Share Hospitals (DSHs)

Section 1. Authority. This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at W.S. § 42-4-104 and the Wyoming Administrative Procedure Act at W.S. § 16-3-102.

Section 2. Purpose and Applicability.

(a) This Chapter has been adopted to govern disproportionate share payments made on or after its effective date. This Chapter is intended to implement the Department's responsibility to make disproportionate share payments under Section 1923 of the Social Security Act, codified at 42 U.S.C. § 1396r-4. Hospital services are also subject to the provisions of Chapters 4, 8, 31 and 33 of the Rules and Regulations for Medicaid, except as otherwise specified in this Chapter.

(b) The requirements of Title XIX of the Social Security Act, 42 C.F.R. § 1396r-4, and the Medicaid State Plan apply to Medicaid and are incorporated by this reference as of the effective date of this Chapter, and may be cross-referenced throughout this Chapter where applicable. This incorporation by reference does not include any later amendments or editions of the incorporated matter. The incorporated rules and regulations may be viewed at http://www.ecfr.gov/cgi-bin/ECFR and http://www.health.wyo.gov/healthcarefin/medicaid/spa.html, or may be obtained at cost from the Department.

Section 3. Definitions. Except as otherwise specified in Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

Section 4. General Provisions.

(a) General methodology. Disproportionate share hospitals (DSHs) shall receive an annual payment after the year end settlement of the hospital's cost report. The hospital's eligibility for and the amount of any disproportionate share payment shall be determined pursuant to this Chapter.

(b) Disproportionate share payments shall not be redetermined because of changes that result from a reopening, redetermination, administrative hearing, settlement agreement, or other change in a hospital's allowable costs.

(c) The Department shall calculate disproportionate share payments after the state fiscal year end and make payments prior to the end of that same calendar year.

Section 5. Disproportionate Share Payment.

(a) In addition to the payment rates established pursuant to State Plan Amendments 4.19A, Part 1, Addendum 1, and 4.19B, Addendum 1-Page 24A, a DSH shall be entitled to a disproportionate share payment computed pursuant to this section.

(b) Determination of eligibility for disproportionate share payment. To be eligible for disproportionate share payment a hospital shall meet both of the following criteria:

(i) Have a Wyoming Medicaid utilization rate of not less than five percent (5%), defined as the percentage resulting from dividing Medicaid patient days by total patient days, based on the most current available information; and

(ii) Have at least two (2) obstetricians with staff privileges at the hospital who have agreed to provide obstetric services to individuals entitled to such services under the Medicaid State Plan. In the case of a hospital located in a rural area (that is, an area located outside of a Metropolitan Statistical Area as defined by the Executive Office of Management and Budget), the "obstetrician" includes any physician with staff privileges at the hospital to perform nonemergency obstetric procedures.

(i) For each DSH, the Department shall determine total hospital payments for covered services as follows:

(A) Calculate the hospital's inpatient and outpatient Medicaid payments for furnishing covered services during a payment period;

(B) Calculate any amounts payable to the hospital by other third parties and beneficiaries for Medicaid covered services during a payment period; and

(C) Calculate Qualified Rate Adjustment (QRA) payments pursuant to State Plan Amendments 4.19A, Part 1, Addendum 1 and 4.19B Addendum 1- Page 24A.

(D) The results of paragraphs (A), (B), and (C) shall be summed to determine the total payments for covered services for each hospital.

(ii) For each DSH, the Department shall determine hospital Medicaid costs as follows:

(A) Calculate the hospital-specific ancillary department cost-to- charge ratios and the ratio of Medicaid allowable costs to billed charges using the hospital's most recently available Medicare cost report.

(B) Inflate hospital ancillary billed charges to the midpoint of the payment period using the CMS-PPS Hospital Market Basket index.

(C) Multiply the cost-to-charge ratios by the hospital's inflated billed charges reported on Medicaid claims paid during the most recently ended State fiscal year.

(D) Calculate hospital-specific routine department per diems using the hospital's most recently available Medicare cost report.

(E) Inflate hospital-specific routine department per diems to the midpoint of the payment period using the CMS-PPS Hospital Market Basket Index.

(F) Multiply the inflated routine per diems by the number of days reported on Medicaid claims paid during the most recently ended State fiscal year.

(G) Sum the product determined in subsection (c)(ii)(C) and subsection (c)(ii)(F) to determine a hospital's allowable Medicaid costs for furnishing covered services during the most recently completed payment period.

(iii) For each DSH, the Department shall determine the Medicaid payment deficit as the difference between total payments in subsection (c)(i)(D) and Medicaid costs of services in subsection (c)(ii)(G).

(d) Determination of hospital-specific preliminary disproportionate share payment. For each DSH, the Department shall calculate a preliminary disproportionate share payment as follows:

(i) Calculate the ratio of the hospital's Medicaid payment deficit to the hospital's total payments to determine the hospital-specific Medicaid payment deficit percentage.

(ii) Calculate a percentage to represent each DSH's payment deficit as a percentage of all DSHs' payment deficits by dividing the hospital-specific Medicaid payment deficit percentage by the sum of all DSHs' Medicaid payment deficit percentages.

(iii) Multiply the percentage obtained in subsection (d)(ii) for each DSH by Wyoming's federal fiscal year allotment to determine each hospital's preliminary disproportionate share payment.

(e) Determination of preliminary hospital-specific disproportionate share payment upper limit. Disproportionate share payments shall be limited to no more than one hundred percent (100%) of costs related to caring for Medical Assistance patients and uncompensated costs related to caring for indigent patients. For each DSH, the Department shall test the hospital-specific disproportionate share payment using the hospital-specific disproportionate share hospital upper limit as follows:

(i) Sum total payments from subsection (c)(i)(D) and the preliminary disproportionate share payment from subsection (d)(iii) and compare the total to Medicaid costs determined in subsection (c)(ii)(G).

(A) If a DSH's Medicaid costs as calculated in subsection (c) (ii) (G) are greater than the sum of total payments as calculated in subsection (c)(i)(D) and the preliminary disproportionate share payment for the hospital as calculated in subsection (d) (iii), then the hospital has not exceeded the hospital-specific disproportionate share hospital upper limit.

(B) If a DSH's Medicaid costs as calculated in subsection (c) (ii) (G) are less than the sum of total payments as calculated in subsection (c)(i)(D) and the preliminary disproportionate share payment for the hospital as calculated in subsection (d) (iii), then the hospital has exceeded the hospital-specific disproportionate share hospital upper limit.

(f) Determination of final hospital-specific disproportionate share payments. For each DSH, the Department shall determine the final disproportionate share payment as follows:

(i) Use the Medicaid payment deficit amount as calculated in subsection (c)(iii) to substitute the disproportionate share payment amount determined in subsection (d)(iii) for DSHs that reach the hospital-specific disproportionate share hospital upper limit in subsection (e)(i)(B).

(ii) Distribute unallocated disproportionate share payments. The Department shall distribute any disproportionate share hospital allotment amounts that are not allocated due to the hospital-specific disproportionate share hospital upper limit test to the remaining DSHs that have not exceeded the hospital-specific disproportionate share hospital upper limit as follows:

(A) The Department shall sum the preliminary disproportionate share payments allocated to each DSH; and

(B) Subtract the amount determined in subsection (f)(ii)(A) from Wyoming's federal fiscal year allotment for disproportionate share payments to calculate the unallocated disproportionate share payments.

(C) For each hospital that has not exceeded its hospital-specific disproportionate share hospital upper limit the Department shall allocate any remaining disproportionate share hospital payment allotment as calculated from subsection (f)(ii)(B) as follows:

(I) Calculate a percentage to represent each DSH's payment deficit as a percentage of all DSHs' payment deficits by dividing the hospital- specific Medicaid payment deficit percentage by the sum of all DSHs' Medicaid payment deficit percentages, excluding the payment deficits for each DSH that has reached the hospital-specific disproportionate share hospital upper limit.

(II) Multiply subsection (f)(ii)(C)(I) by the unallocated disproportionate share hospital allotment pursuant to subsection (f)(ii)(B) to determine the additional disproportionate share hospital allocation.

(III) Sum total payments from subsection (c)(i)(D), the preliminary disproportionate share payment from subsection (d)(iii), and the additional disproportionate share hospital payment from subsection (f)(ii)(C)(II) and compare the total to Medicaid costs from subsection (c)(ii)(G) to perform the hospital-specific upper payment limit test described in subsection (e).

(iii) The Department shall follow the steps outlined in subsection (f) until the entire disproportionate share hospital allotment is distributed to DSHs or until each DSH has been allocated disproportionate share payments up to its hospital-specific disproportionate share hospital upper limit.

(g) In conformity with OBRA '93, the Department shall not establish disproportionate share payments greater than each hospital's unreimbursed costs for services rendered to Title XIX patients and uninsured patients. The Department shall review cost and payment information annually for each hospital receiving disproportionate share payments. The annual review shall consist of comparing providers' proposed disproportionate share payments to their unreimbursed costs for services rendered to Title XIX patients and uninsured patients.

(h) If a provider's proposed disproportionate share payments are less than or equal to unreimbursed costs, then the provider's disproportionate share payments conform with OBRA '93 and shall not be adjusted. If a provider's proposed disproportionate share payments are greater than the provider's unreimbursed costs, the Department shall reduce the provider's proposed disproportionate share payments to equal the unreimbursed costs. The Department shall calculate unreimbursed costs by applying provider-specific cost-to-charge ratios to charges for services provided to Title XIX and uninsured patients and subtracting payments from the costs of those services. For purposes of the cost-to-charge ratio calculation, the Department shall use cost and charge data from the same cost reports as those used to calculate the disproportionate share payments. This calculation shall occur following the most recently ended state fiscal year.

(i) Disproportionate share payments for hospitals located outside Wyoming.

(i) Request. Hospitals certified as DSHs by the Medicaid agency in a state other than Wyoming may submit a request for consideration for disproportionate share payments.

(ii) Time and contents of request. A request for disproportionate share payments shall be sent to the Department, by certified mail, on or before October 1st of each year. The hospital shall submit the correct cost report with the request, if it is available. The hospital shall contact the Department before that date to determine which fiscal year's cost report to submit with the request. The failure to timely submit a request, including the correct cost report, shall preclude the hospital from receiving disproportionate share payment.

(iii) Determination of amount of payment. The amount of the disproportionate share payment shall be that proportion of the amount determined pursuant to subsection (f).

(j) Notice of disproportionate share payment.

(i) The Department shall notify all Wyoming hospitals providing inpatient hospital services of whether they are entitled to disproportionate share payments.

(ii) Such notice shall:

(A) Be in writing;

(B) Be mailed by certified mail, return receipt requested; and

(C) Include the hospital's right to request reconsideration of the determination of disproportionate share payments or the denial of disproportionate share payments, pursuant to Chapter 16.

Section 6. Provider Records.

(a) A hospital shall comply with the provider record provisions of Chapter 3.

(b) Out-of-state records. If a provider maintains financial records or medical records in a state other than Wyoming, when requested, the provider shall either transfer the records to an in-state location that is suitable for the Department or reimburse the Department for reasonable costs, including travel, lodging and meals, incurred in performing the audit in an out-of-state location, unless otherwise agreed by the Department.

Section 7. Audits. Audits are subject to the provisions of Chapter 16.

Section 8. Recovery of Overpayments. The Department shall recover over- payments pursuant to the provisions of Chapter 16.

Section 9. Reconsideration. A provider may request reconsideration of the denial or calculation of disproportionate share payments pursuant to Chapter 16.

Section 10. Automatic Expiration of Rule. This Chapter shall automatically expire upon the elimination of Section 1923 of the Social Security Act.

Section 11. Limitations on Payments. Disproportionate share payments shall not exceed the disproportionate share hospital state allotment, except as otherwise required by the Social Security Act. In no event shall the Department be obligated to use State Medicaid funds to pay more than the State Medicaid percentage of disproportionate share payments due a provider.

Section 12. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

Section 13. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

Section 14. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2015-01-06

Chapter 33 Reimbursement of Outpatient Hospital Services

Wyo. Code R. 048.0037.33.04262019 § 1 Authority

This Chapter is promulgated by the Wyoming Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes 42-4-101 through -121.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 2 Purpose and Applicability

(a) This Chapter has been adopted to establish the scope of Medicaid reimbursement of outpatient hospital services furnished to individuals admitted on or after its effective date.

(b) The requirements of XVIII and XIX of the Social Security Act, 42 C.F.R. Ch. IV, Subch. B, Pt. 413 and 419, 42 C.F.R. Ch. IV, Subch. C, Pt. 447, and the Medicaid State Plan also apply to Medicaid and are incorporated by this reference.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 3 Definitions

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

(a) "Chapter" used herein refers to the specified Chapter in the Wyoming Department of Health, Medicaid Rules.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 4 Provider Participation

(a) Payments only to providers. No provider that furnishes outpatient hospital services to a client shall receive Medicaid funds unless the provider is enrolled.

(b) Compliance with Chapter 3. A provider that wishes to receive Medicaid reimbursement for outpatient hospital services furnished to a client shall meet the requirements of Chapter 3.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 5 Medicaid Allowable Payment for Outpatient Hospital Services

(a) Generally. Payment to facilities for outpatient hospital services shall be provided pursuant to 42 C.F.R. § 413.65. State-developed fee schedule rates for services described in this section shall be the same for public and private providers. The fee schedule and any periodic adjustments to the fee schedule shall be published at the Department's fiscal agent's website. Medicaid allowable payments for outpatient hospital services shall be made according to one of the following fee schedules depending on the type of service:

(i) Medicaid Ambulatory Payment Classification (APC) fee schedule. The APC fee schedule shall be based on services that are included and excluded in Medicare's outpatient prospective payment system pursuant to 42 C.F.R. §§ 419.21 and 419.22.

(A) Services included under the APC fee schedule:

(I) Significant outpatient procedures, e.g., a procedure or surgery provided to a patient that constitutes the primary reason for the visit to the hospital;

(II) Ancillary Services;

(III) Emergency Services;

(IV) Observation;

(V) Drugs;

(VI) Laboratory services not included in Medicare's clinical laboratory fee schedule;

(VII) Durable medical equipment, prosthetics and orthotics;

(VIII) Radiology; and

(IX) Vaccines and immunizations.

(B) Ambulatory Payment Classification relative weights. The Department shall use Medicare's APC relative weights.

(C) Wyoming-specific Medicaid conversion factors. The Department shall use a Wyoming-specific Medicaid conversion factor for each of the following three (3) hospital groups: children's hospitals, critical access hospitals, and general acute care hospitals as follows:

(I) For each group of hospitals, the Wyoming-specific Medicaid conversion factor shall be the result after dividing the estimated costs of APC-based services by the sum of the relative weights for the hospital group.

(1.) For each hospital, the calculated estimated cost-to-charge ratios shall be determined by dividing state fiscal year (SFY) 2005 estimated Medicaid costs by SFY 2005 Medicaid billed charges (paid claims).

(2.) The Department shall calculate estimated SFY 2005 Medicaid costs by multiplying SFY 2005 billed charges by hospital-specific outpatient hospital cost-to-charge ratios calculated from provider fiscal year end 2004 as-filed cost reports.

(II) For each group of hospitals, the Department shall calculate the conversion factor percentage of Medicare's final calendar year (CY) 2006 conversion factor as published in the Federal Register Vol. 70, No. 217 (November 10, 2005). The Department divided the Wyoming-specific Medicaid conversion factor by Medicare's final CY 2006 conversion factor as follows:

(1.) The Wyoming-specific Medicaid conversion factor for children's hospitals shall be one hundred seventy-one percent (171%) of Medicare's final CY 2006 conversion factor.

(2.) The Wyoming-specific Medicaid conversion factor for critical access hospitals shall be one hundred ninety-six percent (196%) of Medicare's final CY 2006 conversion factor.

(3.) The Wyoming-specific Medicaid conversion factor for general acute care hospitals shall be seventy-five percent (75%) of Medicare's final CY 2006 conversion factor.

(D) Fee schedule payment calculation. The fee schedule shall be established by multiplying the Wyoming-specific Medicaid conversion factor by the Medicare APC relative weight.

(E) Discounting. Payment amounts for certain multiple, bilateral or discontinued procedures, reimbursed using the Medicaid APC fee schedule, shall be discounted. The Department shall use the discount formulas that are included in Medicare's Integrated Outpatient Code Editor (I/OCE) with the exception of discount formula 8 (used for bilateral procedures). For discount formula 8, the Department shall use one hundred fifty percent (150%) rather than Medicare's two hundred percent (200%). Medicare outlines its discount formulas in the I/OCE Quarterly Transmittal, Appendix D, which is incorporated herein.

(F) Medicaid physician fee schedule. The Medicaid allowable payment shall be based on the reported procedure code and shall be the lesser of charges or the fee schedule amount. The following outpatient hospital services shall be reimbursed using the physician fee schedule:

(I) Physical, occupational, and speech therapy;

(II) Radiology, including mammography screening and diagnostic mammography; and

(III) Vaccines and immunization.

(G) Medicaid durable medical equipment, prosthetics and orthotics fee schedule. For those durable medical equipment, prosthetics and orthotics not included in the APC fee schedule, the Medicaid allowable payment shall be based on the reported procedure code and shall be the lesser of billed charges or the fee schedule amount.

(H) The Medicaid laboratory fee schedule. For those laboratory services not included in the APC fee schedule, the Medicaid allowable payment shall be based on the reported procedure code and shall be the lesser of billed charges or the fee schedule amount. The laboratory fee schedule is described in detail in State Plan Attachment 4.19 B, Policy and Methods of Establishing Payment Rate for Each Type of Care Provided, (3) Other Laboratory and X-ray Services.

(I) Percent of charges. The following services shall be reimbursed based on a percent of allowed charges. These services include the following:

(I) Transplants shall be reimbursed at fifty-five percent (55%) of billed charges, not to exceed the upper payment limits described in Section 1903(i) of the Social Security Act;

(II) Corneal tissue shall be reimbursed using the hospital-specific Medicaid cost-to-charge ratio calculated annually for inpatient level of care participating providers and may not exceed one hundred percent (100%). Non-participating hospitals shall be reimbursed using the average Medicaid cost-to-charge ratio for their provider type (children's hospital, critical access hospital and general acute care hospital);

(III) Medical devices that are paid transitional pass-through payments under Medicare's outpatient prospective payment system pursuant to Social Security Act § 1833(t)(6) shall be reimbursed using the hospital-specific Medicaid cost-to-charge ratios used in Section 5(a)(i)(C)(I) of this Chapter;

(IV) Dental shall be reimbursed using the hospital-specific Medicaid cost-to-charge ratios used in Section 5(a)(i)(C)(I) of this Chapter.

(ii) Qualified Rate Adjustment payments. The Department shall annually reimburse non-State government owned and operated hospitals that qualify for Qualified Rate Adjustment payments pursuant to State Plan Attachment 4.19B, Part 1, Addendum 1, by the end of the first quarter of each federal fiscal year.

(iii) Private Hospital Supplemental payments. The Department shall quarterly reimburse privately owned and operated hospitals that are providing services as of July 1 of each year and that qualify for a private hospital supplemental payment pursuant to State Plan Attachment 4.19B, Part 1, Addendum 2, by the end of each quarter. For each year, the first private hospital supplemental payment shall be made by December 31.

(b) Upper payment limits. The Medicaid payments shall not exceed Medicare upper payment limits according to 42 C.F.R. § 447.321. Reimbursement for laboratory services shall comply with federal upper limits for laboratory services pursuant to Section 1903(i) of the Social Security Act.

(d) Services that require prior authorization. The Department may designate outpatient hospital services that require prior authorization. In designating such services, the Department shall consider the cost of the service, the potential for over-utilization of the service, and the availability of lower cost alternatives. The Department shall disseminate a current list of services that require prior authorization to providers through manuals and bulletins. The failure to obtain prior authorization shall result in denial of Medicaid payment for the service.

(e) Claims for outpatient and inpatient hospital services. A claim seeking reimbursement for outpatient hospital services provided to a client within twenty-four (24) hours before the client received inpatient hospital services for the same or similar diagnosis shall be denied.

(f) Updates. The APC conversion factors and relative weights shall be reviewed annually. Considerations for update include adequate provider participation, beneficiary access, and the reduction of inequities in the system.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 6 Third Party Liability

. Third Party Liability is subject to the requirements of Chapter 35.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 7 Payment of Claims

. Payment of claims shall be pursuant to Chapter 3.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 8 Audits

. Audits shall be subject to the provisions of Chapter 16.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 9 Recovery of Overpayments

. The Department shall recover overpayments pursuant to Chapter 16.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 10 Reconsideration

. A provider may request reconsideration of the decision to recover overpayments pursuant to Chapter 16.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 11 Interpretation of Chapter

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 12 Superseding Effect

. This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 13 Severability

. If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2019-04-26

Wyo. Code R. 048.0037.33.04262019 § 14 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each rule or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Section 5 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Ch. IV, Subch. B, Part 413, Subpart E, incorporated as of the effective date of this Chapter and can be found at https://www.ecfr.gov.

(ii) Referenced in Section 5 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Chapter IV, Subch. B, Part 419, incorporated as of the effective date of this Chapter and can be found at https://www.ecfr.gov.

(iii) Referenced in Section 5 of this Chapter is the Federal Register, Volume 70, No. 217, November 10, 2005, incorporated as of the effective date of this Chapter and can be found at https://www.gpo.gov/fdsys/pkg/FR-2005-11-10/content-detail.html.

(iv) Referenced in Section 5 of this Chapter is the I/OCE Quarterly Transmittal, Appendix D, incorporated as of the effective date of this Chapter and can be found at https://www.cms.gov/Medicare/Coding/OutpatientCodeEdit/OCEQtrReleaseSpecs.html.

(v) Referenced in Section 5 of this Chapter is the Wyoming Medicaid State Plan Attachment 4.19 B, incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/healthcarefin/medicaid/spa/.

(vi) Referenced in Section 5 of this Chapter is Section 1903(i) of the Social Security Act, incorporated as of the effective date of this Chapter and can be found at https://www.ssa.gov/OP_Home/ssact/title19/1903.htm.

(vii) Referenced in Section 5 of this Chapter is Section 1833(t)(6) of the Social Security Act, incorporated as of the effective date of this Chapter and can be found at https://www.ssa.gov/OP_Home/ssact/title18/1833.htm.

(viii) Referenced in Section 5 of this Chapter is Title XIX of the Social Security Act, 42 CFR, Chapter IV, Subch. C, Part 447, Subpart F, incorporated as of the effective date of this Chapter and can be found at https://www.ecfr.gov.

History

Effective 2019-04-26

Chapter 34 Home and Community Based Waiver Services Community Choices Waiver Program

Wyo. Code R. 048.0037.34.01032024 Home and Community Based Waiver Services Community Choices Waiver Program

CHAPTER 34

Home and Community Based Services

Community Choices Waiver Program

Section 1. Authority.

(a) The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute 42-4-101 through-124.

(b) The services offered under the Community Choices Waiver program are authorized by the Medical Assistance and Services Act at W.S. 42-4-103(a)(xvii).

(c) The Community Choices Waiver program is federally authorized by waiver of the amount, scope, and duration requirements contained in § 1902(a)(10)(B) of the Social Security Act governing Medicaid. This Waiver has been granted to Wyoming by the United States Department of Health and Human Services under § 1915(c) of the Social Security Act and approved by the Centers for Medicare and Medicaid Services (CMS).

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to govern the Community Choices Waiver program (CCW) for covered home and community-based services (HCBS) provided to eligible individuals who would otherwise qualify for and require the services and level of care provided in a nursing facility.

(b) This Chapter shall apply to all HCBS provided and reimbursed under the CCW not otherwise available under the Wyoming Medicaid State Plan.

Section 3. Definitions.

(a) Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, or this Section, the terminology used in this Chapter is the standard terminology and has the standard meaning as used in accounting, health care, Medicaid, and Medicare.

(b) "Chemical restraint" means "Drug used as a restraint" as defined in Wyoming Medicaid Rules Chapter 1.

(d) "Restrictive intervention" means a limitation or restriction of a participant's rights.

(e) "Room and Board" means any shelter-type expenses, including all property-related costs such as rental or purchase of real estate, and basic furnishing, maintenance, utilities, and related administrative services, as well as three meals per day or any other full nutritional regimen.

Section 4. Application Process.

(a) Applicants shall submit a CCW application in the manner and form prescribed by the Department. The application shall be completed, dated, and signed by the applicant or a legal guardian who is assisting the applicant.

(b) Applicants may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process.

(i) Applicants may request assistance from a case manager for completing the application or obtaining required verification.

(ii) A case manager assisting the applicant shall submit all required documentation within thirty (30) calendar days of receipt.

(c) The Department or its agent shall review all applications, supporting documentation, and evaluations within thirty (30) calendar days of receipt by the Department and determine whether the applicant is eligible for the CCW.

(d) Applicants shall be notified in writing of their approval, denial, or other determination by the Department and, if applicable, will receive an explanation of their right to request an administrative hearing in accordance with Wyoming Medicaid Rules Chapter 4.

Section 5. Waiver Program Eligibility.

(a) The Department shall offer CCW enrollment only to those individuals determined by the Department to meet all applicable eligibility requirements of Wyoming Medicaid Rules Chapter 18 and of this Chapter.

(i) The individual shall be a member of one (1) of the following CCW target groups:

(A) The individual is aged sixty-five (65) years or older; or

(B) The individual is between the ages of nineteen (19) and sixty-four (64) years and has been determined disabled by the Social Security Administration or by the Department pursuant to Wyoming Medicaid Rules Chapter 18.

(ii) The individual shall need services that qualify for a nursing facility level of care as measured by the level of care assessment approved by the Department and conducted pursuant to Wyoming Medicaid Rules Chapter 22.

(A) The individual's need for nursing facility level of care must have been evaluated no more than three hundred sixty-five (365) days prior to enrollment in CCW and re-evaluated at least annually thereafter.

(B) An individual who has lost eligibility based on not meeting a nursing facility level of care, upon new application may be re-evaluated within three hundred sixty-five (365) days of their last assessment if the individual documents a change in condition sufficient to warrant a new evaluation.

(b) The individual shall be eligible, and maintain continuous eligibility, for the Wyoming Medicaid program pursuant to Wyoming Medicaid Rules Chapter 18.

(c) Individuals who reside in a nursing facility, hospital, intermediate care facility for individuals with intellectual disabilities, or other institutional setting shall be ineligible to receive CCW services.

(i) During a declared emergency this ineligibility may not apply to certain temporary services available to support the individual's transition from an institutional setting, for which services are limited to thirty (30) consecutive days.

(ii) Participants admitted to an institutional setting for a period greater than thirty (30) consecutive days shall be terminated from the CCW.

(iii) Individuals residing in an institutional setting may receive transitional services for a period of six (6) months prior to transitioning to HCBS in accordance with the Department's standards and requirements.

(d) Individuals denied enrollment or continued participation in the CCW pursuant to the provisions of this Section shall be issued a written notice of adverse action and informed of their right to request an administrative hearing in accordance with Wyoming Medicaid Rules Chapter 4.

Section 6. Reserved Capacity and Waiting List.

(a) The Department may manage participant enrollment capacity on a statewide basis.

(b) If participant enrollment reaches the maximum capacity of the CCW, eligible individuals who cannot be served within the program's capacity limits shall be eligible for placement on a waiting list.

(i) The waiting list shall be maintained by the Department.

(ii) An individual's position on the waiting list shall be based upon the date the individual was determined eligible pursuant to this Chapter.

(iii) As capacity for additional enrollments becomes available, individuals on the waiting list shall be enrolled in chronological order; however, the Department may reserve capacity for the prioritized enrollment of individuals included in a priority group specified in the CCW.

Section 7. Loss of Eligibility.

(a) A participant is no longer eligible for the CCW, and the Department shall terminate the participant's enrollment and provision of services, if any of the following occur:

(i) The participant does not meet target group requirements;

(ii) The participant does not meet financial eligibility;

(iii) The participant changes residence to another state;

(iv) The participant voluntarily does not receive at least one (1) waiver service, for thirty (30) consecutive calendar days, and a reevaluation conducted pursuant to Medicaid Rules Chapter 22 demonstrates the participant no longer needs an institutional level of care;

(v) A re-evaluation using the level of care assessment approved by the Department demonstrates the participant no longer needs an institutional level of care; or

(vi) The participant is in a nursing home, hospital, residential treatment facility, in-patient hospice, or other institutional setting, or is incarcerated for thirty (30) or more consecutive calendar days.

(b) The Department may terminate a participant's CCW enrollment and provision of services if any of the following occur:

(i) The participant is in an out-of-state placement or residence for six (6) consecutive months or resides out of state for six (6) consecutive months; or

(ii) The participant is enrolled in a different HCBS waiver.

(c) The Department shall notify the participant in writing within fifteen (15) calendar days of the date the individual is determined ineligible for CCW services.

(d) In accordance with Wyoming Medicaid Rules Chapter 4, the Department shall provide notice of adverse action and the right to request an administrative hearing to any individual whose Medicaid service coverage or eligibility is denied, reduced, terminated, or suspended under this Section.

(e) A participant whose CCW enrollment and services were terminated under this Section may reapply at any time. Eligibility will be determined pursuant to Section 5.

Section 8. CCW Provider Certification and Recertification.

(a) The Department shall not pay CCW funds to any individual or entity that provides services to a participant unless the individual or entity is a party to a fully executed provider agreement and is enrolled as a Medicaid provider and certified as a CCW provider by the Department.

(b) The Department shall establish CCW provider qualifications and participation standards to assure that CCW services are delivered in a safe and effective manner. These qualifications and standards shall:

(i) Ensure providers not be excluded from participation in federally funded health care programs by the U.S. Department of Health and Human Services, Office of Inspector General;

(ii) Be appropriate to the type of each CCW service provided;

(iii) Ensure providers have the sufficient training, experience, and education necessary to reasonably assure the health and welfare of participants;

(iv) Ensure any applicable state licensure or certification requirements are met by the entities or individuals furnishing services; and

(v) Ensure the settings and manner in which CCW services are rendered support the participant's full access to the greater community and do not have the effect of isolation or segregation.

(c) The Department shall allow for the open, continuous enrollment and certification of all willing and qualified CCW service providers without restriction or limitation on the number of providers.

(d) The following procedure governs the certification of CCW providers:

(i) An individual or entity that wishes to provide CCW services shall apply to be a provider on the forms specified by the Department, and shall submit the qualifying documentation and information required by the Department to be certified as a provider. Failure to supply all information required will result in denial of the application.

(ii) The Department or its designated agent shall make a determination on a completed application within thirty (30) calendar days of the date it receives the completed application.

(iii) If the application is denied, the Department shall notify the applicant of its decision in writing in accordance with Wyoming Medicaid Rules Chapter 4.

(e) The Department shall deny certification of any individual or entity who was previously decertified by the Department due to adverse action.

(f) The provider's certification shall become effective when all requisite state and federal verifications have been completed and the Medicaid provider agreement has been fully executed. The initial certification remains in effect for one (1) year.

(g) CCW service providers may not be certified retroactively, notwithstanding the provisions of Wyoming Medicaid Rules Chapter 3 allowing for retroactive Medicaid enrollment.

(h) All providers must adhere to the conditions for Medicaid provider participation contained in Wyoming Medicaid Rules Chapter 3.

(i) The Department shall notify all providers that their CCW certification is expiring at least ninety (90) calendar days prior to the certification expiration date. The notification shall detail requirements that the provider shall meet in order to renew their certification.

(j) Providers shall submit verification that they have met all applicable certification renewal requirements forty-five (45) calendar days prior to their certification expiration date.

(i) During recertification, the Department may require an on-site inspection.

(ii) Providers that do not submit the required verification for recertification as described in this Section shall submit transition plans to the Department detailing the transition of each participant to other settings within twenty (20) calendar days prior to their certification expiration date.

(k) Providers that fail to submit the applicable certification renewal requirements to the Department will be notified in writing that the decertification process has been initiated.

(l) A provider shall be considered voluntarily decertified if the provider fails to complete the certification renewal process and fails to respond to the Department's attempts at contacting the provider for certification renewal.

(i) A provider that is voluntarily decertified may reapply for certification at any time.

(ii) Voluntary decertification is not considered an adverse action and is not subject to the fair hearing process under Wyoming Medicaid Rules Chapter 4.

(m) Falsifications of statements or documents, or any concealment of material fact may result in a denial of certification, denial of recertification, decertification, or referral for criminal prosecution.

(n) Providers may dispute an adverse action related to the denial of a renewal of certification in accordance with Wyoming Medicaid Rules Chapters 4 and 16.

Section 9. Provider Participation Standards and Decertification.

(a) A CCW provider must offer and render services without discrimination based on race, religion, political affiliation, gender, national origin, age, sexual orientation, gender expression, or disability, except as allowed by law.

(b) A CCW provider shall identify in writing their potential conflicts of interest, including those of their employees, with the participant, other service providers on the participant's service plan, relatives of the participant, or any legal guardian of the participant, and address how a conflict of interest shall be mitigated. The provider shall share this information with a participant and/or their legal guardian and the case manager prior to being added to the participant's service plan.

(c) A CCW provider shall not place restrictions or criteria on the services it will make available, the type of health conditions it will accept, or the persons it will accept for care or treatment, unless the provider applies those restrictions or criteria to all individuals seeking the provider's services.

(d) A CCW provider shall institute policies and procedures as required by the Department to assure the safe and effective delivery of waiver services.

(e) A CCW provider shall deliver services that meet the service definitions established in the CCW Service Index and align with the participant's service plan.

(f) A CCW provider shall only agree to provide services to a participant if the provider has the adequate administrative and staffing resources and emergency backup systems necessary to render services as described and agreed to in the participant's service plan, and in accordance with all applicable state and federal service standards. A CCW provider shall make all reasonable efforts to avoid disruptions of service delivery that would jeopardize the participant's health and welfare.

(g) A CCW provider shall notify the participant and the Department in writing thirty (30) calendar days prior to ending services with the participant. All transitions occurring from this decision shall follow standards and requirements established by the Department.

(h) If acting as an employer or contractor of personnel, a provider entity shall ensure:

(i) Personnel operate within the limits and scope of practice allowed under the individual's professional licensure or certification and within the limits of the entity's licensure or certification, if applicable; and

(ii) Routine confirmation that it complies with the U.S. Department of Health and Human Services, Office of Inspector General's regulations and guidance on employment of individuals excluded from participation in federally funded health care programs.

(i) A provider shall comply with all applicable state and federal laws in safeguarding information about applicants and participants.

(j) The Department shall conduct monitoring and enforcement activities as necessary to assure compliance with its established CCW provider qualifications and participation standards.

(k) The Department may attempt to resolve any suspected noncompliance with this Chapter by issuing technical assistance or corrective action. Technical assistance and corrective action are not considered an adverse action and are not subject to the fair hearing process pursuant to Medicaid Rules Chapter 4.

(i) When requested, providers shall submit corrective action plans that address each area of suspected noncompliance to the Department's satisfaction. Corrective action plans include identification of the area of noncompliance, the actions that will be taken to address the area of noncompliance, the individual(s) responsible for each action, and anticipated due dates of each action.

(ii) If an approved corrective action plan is not submitted and implemented to address all areas of suspected noncompliance, the Department may take adverse action against the provider.

(l) A CCW provider is subject to an inspection by the Department at any time to ensure compliance with provider requirements.

(m) The Department shall decertify a CCW provider upon termination of the provider's Medicaid enrollment pursuant to Wyoming Medicaid Rules Chapter 3.

(n) The Department may take adverse action against a CCW provider that fails to meet standards established by the Department.

(o) The Department may decertify a CCW provider for any violation of standards established by the Department.

(p) A CCW provider that is subject to adverse action pursuant to this Chapter shall be provided a notice of adverse action and an opportunity for due process pursuant to Wyoming Medicaid Rules Chapters 4 and 16.

Section 10. Background Screening Requirements.

(a) All CCW providers, associated staff members, and adult volunteers shall be required to complete a background screening in accordance with this Section. This requirement applies to any person who may have unsupervised access to waiver participants during the provision of services, including managers, supervisors, direct-care staff, and workers hired through participant-direction.

(b) Individuals who fail a background screening shall not have access to waiver participants, supervise staff, or provide or bill for waiver services on behalf of a CCW provider.

(c) Volunteers under the age of eighteen (18) shall be under the direct supervision of a provider or staff member who has passed a background screening. An individual convicted of a sexual offense shall not be a volunteer.

(d) To satisfy the requirements of this Section, a background screening must include the following:

(i) A Wyoming Department of Family Services Central Registry Screening;

(ii) A United States Department of Health and Human Services, Office of Inspector General's Exclusions Database search result;

(iii) A national, name and social security based criminal history database screening; and

(iv) A United States Department of Justice, National Sex Offender Public Website search.

(e) Workers employed under the participant-directed service delivery option shall complete the background screening through the contracted Financial Management Services.

(f) An individual or entity shall fail a background screening under this Section if the results confirm they:

(i) Are listed on the Wyoming Department of Family Services Central Registry;

(ii) Are listed as excluded from federally funded healthcare programs; or

(iii) Have been convicted of any barrier crime listed in Wyo. Stat. Title 6, Chapter 2 (Offenses Against a Person) and Chapter 4 (Offenses Against Morals, Decency and Family).

(g) At the discretion of the provider or employer of record, an individual worker may provide unsupervised services on a provisional basis while the results from a submitted background screening are pending if no disqualifying crimes, offenses, or other exclusions are disclosed in the worker's employment application.

(h) Background screenings are not transferrable from one provider entity or employer to another.

(i) All CCW providers, associated staff members, and adult volunteers, as described in subsection 10(a) shall be required to complete a full subsequent background screening in accordance with this Section every five (5) years. Those who fail to pass the subsequent background screening shall not supervise, provide, or bill for waiver services, or have unsupervised access to participants on behalf of a provider.

(j) Background screening results shall not be altered in any manner. If altered, the screening results shall be considered null and void.

(k) The Department may request a background screening at its own expense as part of an investigation.

(l) A provider shall maintain employee files including documentation of successful criminal history and background screening results, which must be provided to the Department upon request.

Section 11. Provider Training Standards.

(a) Prior to the delivery of services, providers and direct care staff shall receive training in all areas established by the Department.

(b) Providers shall maintain documentation of participant-specific and Department established training that demonstrates staff members are qualified to provide waiver services. Documentation shall include verification of completed trainings, date training was completed, who conducted the training, and how the staff member demonstrated understanding.

(c) Providers shall designate one staff member to receive training on the service plan by the participant's case manager.

(d) Providers and direct care workers shall receive participant-specific training prior to the service plan start date or before any changes to the service plan occur in accordance with Department standards.

Section 12. Covered Waiver Services.

(a) CCW services, as outlined in the CCW Service Index, supplement but do not supplant other services available to participants, such as: Wyoming Medicaid State Plan services; services available through other federal, state, or local public programs; or the supports that families and other community resources provide. The categories of services furnished under the CCW program include:

(i) Caregiver Support;

(ii) Case Management;

(iii) Community Transition Services;

(iv) Day Services;

(v) Equipment, Technology, Modifications;

(vi) Home-Based Services;

(vii) Home-Delivered Meals;

(viii) Non-Medical Transportation;

(ix) Nursing; and,

(x) Round-the-clock services.

(b) Costs for room and board are not covered or included in the reimbursement for CCW services, except as provided in 42 C.F.R. § 441.310(a)(2). Participants who receive services in a provider-owned or controlled residential setting are responsible for all room and board costs pursuant to the participant's lease or similarly enforceable residential agreement.

(i) The lease or agreement must not include charges for covered CCW services and must include an itemized list of any additional charges beyond room and board.

Section 13. Freedom of Choice.

(a) In selection of services, the participant has the freedom to choose:

(i) Between receiving services in an institutional setting or through the CCW;

(ii) From among all allowable service alternatives and service delivery options offered under the CCW; and

(iii) From among all willing and qualified providers enrolled and accepting referrals for services in the participant's county of residence.

(A) In areas where availability of case management providers is limited, the participant may choose a case management agency from a different county, as long as the agency is certified to provide case management services in the participant's county of residence.

Section 14. Participant Rights and Safeguards.

(a) A participant has the same legal rights and responsibilities guaranteed to all U.S. citizens under the United States and Wyoming Constitutions and federal and state laws.

(b) A participant's rights shall not be restricted except in accordance with state or federal law and Department requirements.

(c) A participant's right to be free from physical, mechanical, and chemical restraints shall not be restricted unless authorized in writing by the participant or the participant's legal guardian. Any use of restraints shall meet the following conditions:

(i) Restraints shall not be used for the purposes of discipline or convenience to the provider.

(ii) Restraints shall not be authorized unless:

(A) The participant receives services in an assisted living or skilled nursing facility; and

(B) The restraint is supported by a specific assessed need and justified in the participant's service plan.

(d) Any document authorizing the use of restraints shall be made a part of the participant's permanent file.

(e) In emergency circumstances, restraints may be used only to ensure the immediate physical safety of the participant, provider, or other persons, and when the risk of injury without the restraint is greater than the risk associated with the restraint.

(i) Emergency restraints must be time limited and removed immediately when the participant no longer presents a risk of immediate harm to themselves or others.

(ii) Any emergency use of restraint shall be reported to the Department within three (3) business days.

(f) A participant's right to full access to the greater community, privacy, independence in making life choices, freedom to control their own schedules and activities, access to food, and ability to have visitors of their choosing at any time shall not be restricted by a provider unless the restriction supports a specific assessed need and is documented in the participant's service plan, including:

(i) The specific and individualized assessed need;

(ii) The positive interventions and supports used prior to any modifications to the person-centered service plan;

(iii) Less intrusive methods of meeting the need that have been tried but were unsuccessful;

(iv) A clear description of the condition that is directly proportionate to the specific assessed need for a restriction;

(v) How data is regularly collected and reviewed to measure the ongoing effectiveness of the restriction;

(vi) Established time limits for periodic reviews, not to exceed six (6) months, to determine if the restriction remains necessary or can be terminated;

(vii) Informed consent of the participant or a legal guardian; and

(viii) Assurance that restrictions and restrictive interventions will cause no harm to the individual.

(g) A provider shall not use an aversive technique to modify a participant's behavior. Aversive techniques include any intervention that causes pain, harm, discomfort, seclusion, or social humiliation.

(h) A provider shall not request or require a participant to agree to any rights restriction as a condition of receiving services.

(i) A provider shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against any individual who exercises any right established by state or federal law.

(j) Any individual who is affiliated with the CCW and has a reasonable suspicion that a participant's health or safety is in jeopardy shall immediately contact the appropriate entities in accordance with state and federal law and Department requirements.

Section 15. Incident Reporting and Complaints.

(a) A provider shall develop and maintain incident reporting policies and procedures, and shall review internal incident data in accordance with Department requirements.

(b) After assuring the health and safety of the participant, a provider shall immediately report the following critical incidents to the Department, the participant's case manager, and legal guardian in accordance with Department requirements:

(i) Suspected abuse as defined by W.S. 35-20-102;

(ii) Suspected neglect as defined by W.S. 35-20-102;

(iii) Suspected self-neglect as defined by W.S. 35-20-102;

(iv) Suspected abandonment as defined by W.S. 35-20-102;

(v) Suspected exploitation, including sexual exploitation and medication diversion, as defined by W.S. 35-20-102;

(vi) Suspected intimidation as defined by W.S. 35-20-102;

(vii) Suspected sexual abuse as defined by W.S. 35-20-102; and

(viii) Death that is not the result of an expected medical diagnosis.

(c) After assuring the health and safety of the participant, a provider shall report the following non-critical incidents to the Department, the participant's case manager, and the legal guardian within three (3) business days:

(i) Serious injury to the participant;

(ii) Elopement;

(iii) Any use of seclusion;

(iv) Unscheduled medical or behavioral admissions and emergency room visits that occur while the participant is receiving a CCW service;

(v) Use of restraint;

(vi) Unauthorized use of restrictive interventions; and

(vii) Other incidents of death.

(d) A provider shall comply with the Department, case manager, and other state agency or law enforcement requests for information relating to any incident.

(e) A provider's failure to report incidents in accordance with this Section may result in corrective or adverse action, including the provider's decertification.

(f) The Department or its designee shall conduct an investigation of all reported incidents. The scope and duration of the investigation will vary based upon incident circumstances and follow up actions required. The investigation is not considered concluded until all follow up actions have been taken to reasonably assure the health and safety of the participant(s).

(g) A provider shall have policies and procedures for handling complaints in accordance with any requirements of the Long Term Care Ombudsman and the Department.

Section 16. Home and Community-Based Settings Standards.

(a) All home and community-based settings must meet the following criteria and standards:

(i) Ensure the participant's right to privacy, dignity and respect, freedom from coercion and restraint, and receipt of services in settings that are physically accessible to the participant shall never be restricted.

(ii) Be integrated in and support the participant's full access to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community to the same degree as individuals not receiving waiver services.

(iii) Be selected by the participant from among settings options, including non-disability specific settings. The settings options and selection shall be identified and documented as part of the service planning process described in Section 17 and based upon the participant's needs and preferences.

(iv) Optimize, but not regiment, the participant's initiative, autonomy, and independence in making life choices, including but not limited to choices regarding daily activities, physical environment, and with whom to interact.

(v) Facilitate the participant's choice regarding services and supports, and who provides them.

(b) Waiver services delivered in provider-owned or controlled residential settings shall meet the following additional standards:

(i) The participant's unit or dwelling must be a specific physical place that can be owned, rented, or occupied under a lease or other legally enforceable residential agreement where the participant has the same responsibilities and protections, including protection from eviction that tenants have under state, county, city, or other laws.

(ii) The participant must have privacy in their sleeping or living unit.

(A) Units must have entrance doors that can be locked by the participant, with only appropriate staff having keys to doors.

(B) Participants sharing units must have a choice of roommates in that setting.

(C) The participant must have the freedom to furnish and decorate their sleeping or living units included within the terms of the lease or other residential agreement.

(iii) The participant must have the freedom and support to control their own schedule and activities.

(iv) The participant must have access to food at any time.

(v) The participant must be able to have visitors of their choosing at any time.

(c) Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment, or in a building on the grounds of, or immediately adjacent to, a public institution, or any other setting that has the effect of isolating individuals from the broader community of individuals not receiving CCW services will not be considered a home and community based setting.

(d) Any restriction of the rights established in this Section shall be supported by a specific assessed need and justified in the service plan as described in Section 14.

Section 17. Case Management and Service Planning Requirements.

(a) Upon application, participants shall select a case management agency from a list of all CCW qualified agencies serving the participant's county of residence, unless availability is limited. The participant's selected case management agency shall assign one (1) person to serve as the primary case manager, based on the participant's preferences.

(b) Case managers shall assist the participant with:

(i) Accessing CCW and Wyoming Medicaid State Plan services;

(ii) Identifying and coordinating access to medical, social, educational, employment and other services, regardless of the funding source; and

(iii) Identifying and coordinating natural supports.

(c) The case manager shall conduct a comprehensive assessment of the participant's strengths, needs, goals, preferences, and any potential health and safety risks using the Department's prescribed methods, tools, and procedures.

(d) The case manager shall develop a person-centered service plan using Department identified systems and processes. The service plan shall:

(i) Assure the health and welfare of the participant;

(ii) Acknowledge the participant's strengths, and promote the participant's self-determined goals;

(iii) Address the participant's assessed needs;

(iv) Include a plan to mitigate identified risks;

(v) Accommodate participant preferences to the extent possible;

(vi) Reflect the scope, frequency, and duration of the services chosen by the participant;

(vii) Include a backup plan or identify an alternate service or support to ensure the continuity of services; and

(viii) Consider services and supports available through the CCW, the Medicaid State Plan, other federal, state, and local public programs, the participant's family or natural support system, and any other relevant community resources.

(e) The case manager shall facilitate a person-centered planning process which shall support and encourage the participant to direct service plan development to the maximum extent possible.

(i) The case manager shall abide by the participant's choice of individuals included and excluded from the service plan development process. If the participant's decision-making authority has been conferred to a legal guardian, the case manager shall involve the representative in the service plan development process to the extent authorized.

(ii) The case manager shall provide education and information on the long-term care programs and service options available to the participant.

(iii) The case manager shall provide the participant a current list of all HCBS enrolled providers serving the participant's county of residence. The case manager shall disclose any ownership of, affiliation with, or financial interest in any potential waiver service providers.

(iv) The case manager shall provide information on participant-directed services to include potential benefits, liabilities, risks, and responsibilities associated with the service delivery option. The case manager shall provide this information during the following times:

(A) Initial service plan development;

(B) At annual service plan reviews;

(D) At any other time the participant requests.

(v) The case manager shall facilitate discussion among the individuals participating in the service plan development process in order to assist the participant in determining which services, supports, and delivery options will be included in the service plan.

(vi) The case manager shall ensure service planning activities are conducted at times and locations convenient to the participant.

(vii) The case manager shall ensure the service planning process reflects the cultural considerations of the participant and shall provide information in plain language and in a manner that is accessible to participants with disabilities or with limited English proficiency.

(f) The case manager shall hold a service plan team meeting to review and update the service plan at least annually.

(g) The case manager shall hold a service plan team meeting upon request by the participant or in response to a significant change in the participant's condition or circumstances disclosed through monitoring and evaluation activities.

(h) The case manager shall coordinate and monitor all services and supports included in the service plan.

(i) The case manager shall coordinate transitions when the participant changes, stops, or adds providers to the service plan, including requested changes of a case manager.

(j) The case manager shall provide participant-specific training to each provider delivering a direct service listed in the service plan.

(k) The Department may establish caseload limits to ensure case managers effectively coordinate services for all participants on their caseloads.

(l) The Department shall establish conflict of interest protections as necessary to safeguard against undue influence or restrictions on the participant's freedom of choice. At minimum:

(i) The case manager must not be related by blood or marriage to the participant, or to any person paid to provide CCW services to the participant;

(ii) The case manager must not share a residence with the participant or with any person paid to provide CCW services to the participant;

(iii) The case manager and case management agency must not be financially responsible for the participant;

(iv) The case manager and case management agency must not be empowered to make financial or health-related decisions on behalf of the participant; and

(v) The case manager and case management agency must not own, operate, be employed by, or have a financial interest in any entity that is paid to provide CCW services to the participant. Financial interest includes a direct or indirect ownership or investment interest or any direct or indirect compensation arrangement.

(m) In the event a conflict of interest exists between the participant's chosen case manager and CCW service provider, the case manager shall document the conflict, and shall assist the participant in selecting a new case manager, case management agency, and/or CCW service provider as necessary to eliminate the conflict of interest.

Section 18. Participant Direction of CCW Services.

(a) The participant, legal guardian, or another appropriate individual designated by the participant may serve as the Employer of Record (EOR) and assume responsibility for managing the activities associated with the direction of CCW services.

(b) The EOR must sign an agreement of understanding that they are willing and able to assume the EOR responsibilities and comply with established EOR standards.

(c) The EOR cannot delegate or assign the responsibilities of the EOR to another person or entity and cannot be reimbursed to provide CCW services to the participant.

(d) The EOR shall carry out the duties and responsibilities associated with participant direction of CCW services, such as:

(i) Recruiting employees;

(ii) Verifying that employees meet the minimum qualifications established by the Department;

(iii) Specifying, verifying, and maintaining documentation of any additional employee qualifications;

(iv) Hiring employees as the common law employer;

(v) Determining employee duties consistent with the service scope and limitations;

(vi) Determining employee wages within the limits established by the Department;

(vii) Scheduling employees;

(viii) Orienting and instructing employees in their duties;

(ix) Supervising employees;

(x) Evaluating employee performance;

(xi) Verifying the time worked by employees and approving time sheets; and

(xii) Terminating employees.

(e) An EOR's failure to carry out duties and responsibilities in accordance with this Section may result in the EOR being disqualified to act as an EOR by the Department.

(i) The Department shall maintain a list of disqualified EOR's and employees and prohibit their future employment under the participant-directed service delivery option.

(ii) The Department shall establish policies and procedures for disqualification, placement on the list, and the EOR's opportunities to dispute disqualification and removal from such a list.

(f) The participant's case manager shall provide information and assistance in support of participant direction, such as:

(i) Assisting the EOR in obtaining and submitting employer enrollment documentation;

(ii) Determining the participant-directed budget based on the participant's assessed needs and the approved methodology;

(iii) Assisting the participant or EOR in obtaining and completing required documents;

(iv) Coordinating with the Fiscal Management Services agency;

(v) Monitoring participant-directed service effectiveness, quality, and expenditures as determined by the Department;

(vi) Reviewing and updating the participant-directed budget as required by the Department; and

(vii) Facilitating the transition of a participant to a different service delivery option when the participant voluntarily terminates, or is involuntarily terminated from, participant direction.

(g) Participant-Directed Employees.

(i) The Department shall establish the minimum employee qualifications for all participant-directed eligible services.

(ii) The EOR may require their employees to meet additional training, education, or experience requirements in addition to the Department's minimum qualifications.

(iii) The EOR may hire a participant's relative or spouse as an employee provided it is authorized in the CMS approved waiver agreement and they meet the requirements and standards established by the Department.

(h) The participant may choose to withdraw from the participant-directed service delivery option at any time.

(i) Participants who elect to voluntarily withdraw from the participant-directed service delivery must contact their case manager to facilitate the transition to an alternative service delivery option.

(ii) Participants who voluntarily withdraw from the participant-directed service delivery option may return to the participant-directed service delivery option at any time.

(i) Participants shall be involuntarily terminated from the participant-directed service option if they no longer meet the Departments standards and requirements.

(i) Participants involuntarily terminated from the participant-directed service option will be provided a Notice of Adverse Action and informed of the opportunity to request a fair hearing in accordance with Wyoming Medicaid Rules Chapter 4.

(ii) Participants who are involuntarily terminated from participant direction may be prohibited from electing the participant-directed service delivery option in the future.

Section 19. CCW Service Authorization and Reimbursement.

(a) CCW service authorization and reimbursement for service claims shall meet the same standards and requirements established in Wyoming Medicaid Rules Chapter 3.

(b) The provider shall make billing information available to the case manager by the tenth (10th) business day of the month following the month the claim was submitted for payment.

Section 20. Service Documentation Standards.

(a) A provider shall document the following information whenever a service is provided:

(i) The location of services;

(ii) The date of service, including year, month, and day;

(iii) The time services begin and end, using either AM and PM or military time, with documentation for each calendar day, even when services span a period longer than one calendar day;

(iv) An initial or signature of the staff member performing the service; and

(v) A detailed description of services provided in accordance with Department standards and requirements.

(b) A provider shall document services electronically or in writing in accordance with Department standards.

(c) Electronic documentation shall have automated tracking of all attempts to alter or delete information that was previously altered.

(d) Electronic documentation shall include electronic signatures and automatic date stamps.

(e) A provider delivering a waiver service requiring electronic visit verification (EVV) shall utilize the Department's EVV system or another operational EVV system that complies with Department policy and federal requirements, including those for the information gathered and verified. Another EVV system may not be used unless it connects to and interacts with the Department's EVV system for integration and billing of waiver services.

(f) A provider shall separately maintain all written or electronic service documentation to support the provision of service, notwithstanding the maintenance of documentation by others for purposes of claims submission.

(g) The provider shall make service documentation, as described in Section 20(a), available to the case manager each month by the tenth (10th) business day of the month following the date that the services were provided. If services are not provided during a month, the provider shall report that information to the case manager by the tenth (10th) business day of the following month.

(h) The case manager shall submit service documentation, in a manner established by the Department, by the tenth (10th) business day of the month following the month that the case management service was provided.

(i) The case manager shall maintain a participant's file and service documentation.

(i) The case manager shall assure that all information, including but not limited to guardianship paperwork and physical and mailing addresses of the participant, legal guardian, and other contacts is updated and accurate at all times. The case manager shall notify the Department and other providers of any changes.

(ii) The case manager shall securely store and retain all confidential documentation received from other providers for a twelve (12) month period from the month services were provided, and shall follow safe destruction policies, even if the participant changes case managers.

(iii) The case manager shall document all monitoring and evaluation activities, and follow-up on concerns and actions completed.

(j) All documentation shall be made available to the Department upon request.

(k) A provider or case manager that fails to make documentation available to the Department as required in this Section may receive a corrective or adverse action.

Section 21. Statewide Information System.

(a) All individuals who have been determined eligible for Medicaid waiver services shall be included in the statewide information system used by the Department for planning, monitoring, and analysis of the Medicaid waiver program. Information in the system is considered confidential and shall not be released without proper authorization, or otherwise as required by law.

(b) Providers shall submit data on programs, participant outcomes, costs, and other information as required by the Department.

History

Effective 2024-01-03

Chapter 35 Medicaid Benefit Recovery

Wyo. Code R. 048.0037.35.02192019 § 1 Authority

This Chapter is promulgated pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute § 42-4-104(a)(iv).

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 2 Purpose and Applicability

(a) This Chapter shall apply to and govern all Medicaid third party liability and estate benefit recoveries.

(b) The requirements of Title V and Title XIX of the Social Security Act, 42 U.S.C. § 1396(a)(25), 42 U.S.C. § 1396K(a)(1)(A), 42 U.S.C. § 1396p, 42 C.F.R. Ch, IV §§ 433.135-433.154, 42 C.F.R. § 433.36, and the Wyoming Medicaid State Plan under Title XIX of the Social Security Act also apply to Medicaid herein.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 3 General Provisions

(a) This Chapter is intended to implement and to be read in conjunction with W.S. §§ 42-4-114, 42-4-201 through 42-4-208, 42-4-122, 14-2-1001 through -14-2-1008, and applicable federal law.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 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, health care, Medicaid, and Medicare.

(a) "Birth cost" - "Birth costs." As defined in W. S. § 14-2-1002(a)(i).

(b) "Bona fide effort to sell." The act of putting property up for sale and entering a written agreement with the Department.

(c) "Estate recovery." The recovery from the estate of a deceased client or from the estate of the spouse of a deceased client for reimbursement of Medicaid payments made on behalf of a client.

(d) "Incentive allowance." An allowance payment to the heirs, legatees or other person(s) who, having a valid claim to ownership of the deceased client's assets, who cooperate fully with the Department in maintaining and disposing of the assets so as to satisfy to the full extent possible the State's reimbursement right.

(e) "Medicaid benefit recovery." The recovery for reimbursement of Medicaid funds paid on behalf of a client.

(f) "Net proceeds." The dollar value from the sale of any real or personal property determined by deducting from the gross proceeds any amounts, including at a minimum, any liens or encumbrances against the property, realtor's commission fee, maintenance and repairs to the home required by a property inspection or needed to sell the property, an appraisal or broker's price opinion, attorney's fees and costs, and closing costs.

(g) "Non-probate estate." That portion of a client's estate or the estate of the spouse of a client which is not administered pursuant to the Wyoming Probate Code.

(h) "Probate estate." That portion of a client's estate or the estate of the spouse of a client which is administered pursuant to the Wyoming Probate Code.

(i) "Reasonable expenses incurred preserving or disposing of the asset(s)." Reasonable expenses incurred either in maintaining or disposing of the assets of a client's estate distributed pursuant to the summary distribution provisions pursuant to the Wyoming Probate Code or distribution pursuant to an affidavit, including:

(i) Closing costs for the sale of real property which results in the partial or complete satisfaction of the Department's reimbursement right (closing costs include the reasonable attorney's fees of the seller, the cost of title insurance, and recording costs);

(ii) Costs of an Administration pursuant to W.S. § 2-1-301(viii) and probate administration pursuant to W.S § 2-7-802;

(iii) An incentive allowance as prescribed in Section 6 of this rule;

(iv) If Medicaid participates in a probate with a claim then it should not reduce its lien by the amount of the costs to sell the property;

(v) Property insurance premiums;

(vi) Real or personal property taxes;

(vii) Utility costs which are necessary to preserve the property, only allowed if the property is vacant or not payable by a renter or lessee pursuant to a rental or lease agreement;

(viii) Other costs incurred pursuant to a written property management agreement signed by the Department;

(ix) Expenses incurred in providing necessary maintenance or making necessary repairs, without which the salability of the property would be substantially impaired.

(A) Reasonable expenses do not include payment of credit card bills, telephone (cell phone) bills, or cable bills.

(j) "Third party payer." Any person, entity, agency, insurer, or government program that may be liable to pay, or that pays pursuant to an applicant's or client's right of recovery arising from an illness, injury, or disability for which Medicaid funds were paid or are obligated to be paid on behalf of the applicant or client. "Third party payer" includes, but is not limited to, the following: Medicare; liability insurance carriers; medical payments coverage carriers; workers' compensation; persons or entities alleged to be liable by contract, tort, equity, or otherwise for the client's Medicaid reimbursable expenses for the illness, injury, or disability of the applicant or client; a spouse or parent of an applicant or client who is obligated by law or court order to pay all or part of such costs; a client's estate; health insurers; self-insured plans; group health plans; long-term care insurers; service benefit plans; managed care organizations; pharmacy benefit managers; and any other parties that are, by statute, contract, or agreement legally responsible for payment of claims for health care items or services for an applicant or client.

(k) "TPL waiver." A waiver granted by CMS of the third party liability requirements of this chapter.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 5 Assignment of Benefits and Third Party Liability

(a) Assignment of Benefits, Third Party Liability, and Estate Recovery.

(i) By signing an application, an applicant shall be deemed to have made an assignment to the Department [the right to medical support or payment of medical expenses] on the applicant's behalf and on behalf of any relative, ward, or legal dependent for whom application is made.

(ii) The assignment of benefits is effective upon a determination of eligibility and remains in effect with respect to services provided during the period of eligibility for Medicaid, including any period of retroactive eligibility.

(b) Payer of last resort. Medicaid will pay for services only after payment of all other third party payers has been exhausted, except as provided by 42 U.S.C. § 1396d(b) and Title V of the Social Security Act.

(c) Recovery of payments from third party payers. If the Department pays or becomes obligated to pay Medicaid funds on behalf of an applicant or a client because of an injury, illness, or disability for which a third party is legally liable or obligated to pay, the Department may recover the full amount of such Medicaid funds from the third party to the extent of such party's liability up to the amount of medical assistance paid, as provided by law.

(d) Estate recoveries. If the Department pays or becomes obligated to pay Medicaid funds on behalf of a client who is fifty-five (55) years of age or older, or who was an inpatient in a nursing facility, intermediate care facility for people with intellectual disability or other medical institution, the Department may recover the full amount of such Medicaid funds from the estate of the deceased client or from the estate of a spouse.

(e) The Department, Division of Healthcare Financing, or its successor shall be named payee on all payments for Medicaid benefit recovery.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 6 Duties of Applicants and Clients

(a) Notification of third party liability. An applicant or client shall notify the Social Security Administration or the Department of the possibility of third party liability at the time of application, at the time of an eligibility redetermination, and within ten (10) days after any event creating third party liability or any change in potential third party payers.

(b) Notice to providers. A client shall present the client's eligibility card to a provider at the time the client requests services. A client shall also inform a provider of the existence or possible existence of a third party payer at the time the client requests services from the provider and upon request from the provider.

(c) Cooperation in establishing paternity and obtaining medical support. As a condition of eligibility or continued eligibility, an applicant or client shall cooperate with the Department and local agency in establishing paternity of a child eligible for Medicaid or applying for Medicaid, and identifying and collecting from any third party payer. Cooperation includes:

(i) Appearing at the Department or local agency office to provide information or evidence regarding paternity;

(ii) Appearing as a witness at a court or other proceeding to testify regarding paternity;

(iii) Paying to the Department any medical support or medical payments received that are covered by the assignment of benefits;

(iv) Upon request from the Department or local agency, taking any other reasonable steps to assist in establishing paternity, determining third party liability and securing payment from third party payers; and

(v) Cooperating with the Department and the Department of Family Services in establishing paternity for applicable Medicaid births for the purposes of recovery of birth cost pursuant to W.S. §§ 42-4-122 and 14-2-1001 through 14-2-1008. Pursuant to W.S. §14-2-1003, not more than sixty (60) days after an unmarried client of Medicaid gives birth to a child, the Department shall notify the Department of Family Services of the total birth cost. Total birth cost shall include:

(A) Maternity related expenditures including prenatal and postpartum care from nine (9) months prior to delivery through two (2) months after delivery, but not to exceed the average birth cost paid by Wyoming Medicaid.

(d) The refusal to cooperate in establishing paternity as set forth above, or the refusal to cooperate in locating third party payers or recovering payments from such payers, shall render such person ineligible for Medicaid, except as provided in 42 C.F.R. § 433.147 and 433.148.

(e) Incentive allowance for Estate Recovery.

(i) The Department may allow an incentive payment to the heirs, legatees or other person(s), when the following conditions are met:

(A) An incentive allowance shall be the lesser of ten percent (10%) of the net proceeds from the sale of the asset(s), or two-thousand ($2,000.00) dollars:

(B) An incentive allowance shall be permitted only upon approval in writing by the Department or their designee, and only if the Medicaid benefits paid on behalf of the client exceeds the net proceeds; and

(C) The net proceeds from the sale shall be determined by deducting from the sale price the costs of discharging any encumbrances on the property and other reasonable expenses incurred preserving or disposing of the asset(s).

(f) If a Medicaid client is enrolled with a private health insurer, the client must follow the rules of the primary insurance, including using an in-network provider.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 7 Duties of Providers

(a) Verify and obtain information. At the time a client requests services from a provider, the provider shall review the client's eligibility card for information regarding third party payers. The provider shall ask the client if the information on the card is current and whether there are or may be additional third party payers. If the provider learns of a potential third party payer that is not listed on the eligibility card, the provider shall notify the Department in writing of that information within thirty (30) calendar days.

(b) Notify the Department of requests for information. Release of information by providers for casualty related third party resources not known to the State may be identified through requests for medical reports and bills received by providers from attorneys, insurance companies, and other parties. Providers shall contact the Department before responding to such requests.

(i) An institutional provider shall notify the Department, in writing, of any client's death which occurs in the facility or which occurs after the client is transported from the provider's facility to another facility, such as a hospital or hospice.

(ii) Time of notice. The notification shall be sent to the Department on or before the end of the third working day after the client's death.

(iii) Contents of notice. The notification shall be in the form and contain the information required by the Department, as specified in the Provider Manual.

(d) Billing. Unless otherwise provided by a TPL waiver, this subsection shall govern the submission of bills involving third party payers.

(i) When a provider is informed that the client has or may have coverage by a third party payer, the provider shall seek payment from the third party payer prior to submitting a Medicaid claim. When the amount payable by the third party payer is less than the allowable Medicaid payment, the provider may submit a Medicaid claim for the difference. The Medicaid claim shall be accompanied by documentation of the amount payable by the third party payer or submitted electronically with the appropriate coordination of benefits information, including claims adjustment reason and remark codes.

(ii) If a third party payer rejects the request for payment, the provider may submit a Medicaid claim to the Department. The provider shall attach a copy of the notice of rejection to the Medicaid claim, upload a copy of the notice of rejection to the Medicaid web portal to be linked to the corresponding electronic claim, or submit the Medicaid claim electronically with the appropriate coordination of benefits information, including claims adjustment reason and remark codes.

(iii) If a provider has not received payment or a rejection notice from a third party payer within ninety (90) days after submitting two (2) requests or attempts for payment, the provider may submit a Medicaid claim. The provider shall submit with the Medicaid claim, copies of the requests for payment to the third party payer, and any written communication the provider has received from the third party payer.

(iv) A provider which has received payment from a third party payer may submit a Medicaid claim. In such cases the provider shall submit with the Medicaid claim documentation of the payment received. The Department shall allow the Medicaid claim only to the extent the allowable Medicaid reimbursement exceeds the payment received from the third party payer and subject to the Department's normal procedures and standards.

(v) A provider shall submit Medicaid claims to the Department within twelve (12) months of the date of service or discharge, whichever is later, regardless of the potential involvement of a third party payer, except that Medicare crossover claims shall be submitted within six (6) months after the date of payment or rejection by Medicare. Medicaid claims submitted after the time limits specified in this paragraph shall be rejected. Refer to Chapter 3 of the Medicaid rules for further information.

(vi) For the purposes of paragraph (d)(i) of this section, any amount paid by Medicaid when combined with the amount paid by the third party payer, shall not exceed the amount payable to the provider under any preferred provider or similar agreement between the provider and that third party payer. The Department is only responsible for the patient's responsibility.

(vii) A provider shall not opt-out of participation with a third party payer. If a provider chooses to opt-out of participation with a third party payer, the Department shall not pay for services covered by, but not billed to, the third party payer. The provider shall work with the third party payer or client to have the claim submitted to the carrier.

(viii) If a provider chooses to bill Wyoming Medicaid, the provider accepts Medicaid payment as payment in full. The provider shall not bill Wyoming Medicaid and accept payment and bill the other third party. The provider shall choose whether to bill Wyoming Medicaid or bill the other party and wait for legal liability to be established.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 8 Payment or Rejection of Medicaid Claims Subject to Third Party Liability

(a) Probable existence of liability of third party payer established at time of Medicaid claim. If the Department has established the probable existence of liability of a third party payer at the time a provider submits a Medicaid claim, the Department shall reject the Medicaid claim and return it to the provider for a determination of the amount of such liability.

(b) Establishing probable existence of liability of a third party payer. The probable existence of liability of a third party payer is established when the Department receives information from any source confirming the existence and extent of liability of a third party payer. When the amount of liability is established, the Department shall process and pay Medicaid claims involving third party liability only to the extent that the Medicaid payment allowed by the Department's normal procedures and standards exceeds the amount of the third party payer's liability.

(c) Unavailability of third party payments. Third party payments are not available at the time of the submission of a Medicaid claim if the existence and extent of third party payer liability is still disputed. If third party payments are not available, the Department shall process Medicaid claims subject to its normal procedures.

(d) Reconsideration. A provider may request that the Department reconsider a decision to recover payments because of third party liability. Such request shall be made and shall be handled pursuant to the reconsideration provisions as set forth in Chapter 3, Section 14, of the Wyoming Medicaid Rules.

(e) Denial of improper claims. The Department shall deny claims which are improperly submitted or which contain errors of any kind. Denied claims may be resubmitted, subject to applicable federal and state requirements, including Chapter 1 and Chapter 16.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 9 Duties of Attorneys

(a) Attorneys shall be obligated to cooperate with the Department to recover under this Section in accordance with W.S. §§ 42-4-201 through 42-4-208.

(b) An attorney representing a Medicaid client shall not disburse any insurance proceeds to the Medicaid client or retain any portion as attorney's fees prior to submitting a statement of net recovery distribution and payment to the Department.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 10 Medicaid Third Party Liability Recovery

(a) The Department may not agree to a settlement which involves the compromise or release of any portion of the federal medical assistance percentage, except as allowed by federal law.

(b) Amount of the Department's recovery. The Department may recover from any settlement or judgment involving a third party payer the full amount of Medicaid funds paid or to be paid on behalf of the client because of the injury, illness, or disability for which such payments were made.

(i) If the Department does not file an independent action or intervene in an existing action, the Department shall calculate its reduced lien by deducting:

(A) Thirty-three percent (33%) for attorney's fees; and

(B) A proportionate share of the reasonable attorney's costs incurred in obtaining the client's recovery.

(I) The Department's proportionate share of the reasonable costs incurred in making the client's recovery shall be determined by:

(1.) Dividing the amount of the Department's recovery (the amount of Medicaid benefits reimbursed minus attorney's fees as provided in this Section) by the amount of the client's gross recovery; and

(2.) Multiplying the determined fraction by the reasonable costs incurred in making the recovery.

(II) For purposes of this section, "the reasonable attorney's costs incurred in making the client's recovery" shall be court costs, costs of litigation, travel costs, expert witness fees, deposition expenses, and any other costs necessarily incurred in making the recovery. Reasonable costs shall be in the sole discretion of the Department and shall not include any items for which the client is not also responsible.

(ii) The Department may consider the cost-effectiveness of reducing its claim for reimbursement after evaluating all relevant factors, including:

(A) Available insurance coverage or other factors relating to the assets or solvency of the liable third party;

(B) Factual and legal issues pertaining to liability;

(C) Legal issues or restrictions on the Department's recovery, including problems of proof affecting the ability to obtain settlement or judgment and;

(D) Estimated fees and costs associated with the Department pursuing its claim.

(c) Structured settlements. A client's recovery shall not be placed in a structured settlement until the Department has been reimbursed and issued a release of its reimbursement right. If a client prematurely enters into a structured settlement under which the initial payment to the client is insufficient to reimburse the Department, the client shall pay the Department all funds received in each installment until the Department is paid in full. All structured settlements shall fully comply with the requirements pertaining to annuities under the Department's rules.

(d) Future Medicaid payments. Except as otherwise agreed, the settlement of a client's claim does not preclude the Department from seeking Medicaid benefit recovery for Medicaid payments made after the date of such settlement.

(e) The Department shall have the right to recover directly from a third party payer to the extent of Medicaid funds paid or to be paid on behalf of a client when the existence and extent of liability of such third party payer is established. In situations where a Medicaid client was not represented by legal counsel, an attorney representing an insurance company shall not disburse any insurance proceeds to the Medicaid client prior to submitting a statement of available proceeds (declaration sheet), payment to the Department, and approval by the Department.

(f) The Department shall have the right to recover from any attorney who knowingly fails to notify the Department of any settlement of judgment or fails to ensure the Department is reimbursed to the extent of its reimbursement right.

(g) The Department shall have the right to recover directly from a provider which has received Medicaid funds paid on behalf of a client to the extent the provider has received payments from a third party payer for the same services.

(h) The Department shall have the right to recover from any attorney who knowingly fails to notify the Department of any settlement or judgment or fails to ensure the Department is reimbursed to the extent of its reimbursement right.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 11 Estate Recoveries

(a) Pursuant to W.S. § 42-4-207(c), the Department may impose a pre-death lien against a client's real property:

(i) If the client is an inpatient in a nursing facility, intermediate care facility for people with intellectual disability, or other medical institution; and the client cannot reasonably be expected to be discharged from the facility and return home; or

(ii) If the client has been institutionalized for ninety (90) days or longer without a discharge plan, it is presumed that the client will not be discharged and return home; however, an applicant or the client will be provided with a notice of their right to a hearing prior to a determination being made that the applicant or the client is permanently institutionalized.

(b) Pursuant to W.S. § 42-4-207(j), the Department may impose a lien upon property of any estate, as defined in W.S. § 42-4-206(g), of a deceased client for the amount of medical assistance provided while the client was fifty-five (55) years of age or older or while the client was an inpatient in a nursing facility, intermediate care facility for people with intellectual disability or other medical institution. The lien may be imposed regardless of the presence in the home of individuals identified in W.S. § 42-4-207(e).

(i) For estate recovery purposes, the Department defines "legal title" for real property in W.S. § 42-4-206(g) to mean title of record in the county public property records.

(c) If the client has purchased a long-term care partnership certified policy, the Department shall take into consideration the benefits paid by the policy in determining the extent of estate recovery.

(d) The Department may recover against a lien imposed under W.S. § 42-4-207 only after the death of the client's surviving spouse, if any, and:

(i) If the client has no surviving child who is under age twenty-one (21), or is blind, or permanently and totally disabled.

(e) A claim filed pursuant to W.S. § 42-4-206(a) against the surviving spouse's estate, is limited to the value of the assets of the estate determined to exist at the time of death of the surviving spouse that were marital property or jointly owned property at any time during the marriage.

(f) The Department may foreclose its lien outside the probate action pursuant to W.S. §§ 2-7-717.

(g) Procedures for recovery from non-probate estate.

(i) The Department shall have the right to recover from non-probate assets pursuant to W.S. §§ 42-4-206 or 207, and shall have the discretion to decide how to proceed.

(ii) The Department shall have the right to recover directly from a transferee or other individual or entity which has possession, control, or ownership of property received from the non-probate estate of a deceased client.

(h) Any lien or claim against the estate or assets of a client age fifty-five (55) years or older when receiving medical assistance or an inpatient in a facility, intermediate care facility for people with intellectual disability or other medical institution shall be limited to amounts expended for nursing facility services, home and community-based services including waiver services, related hospital and prescription drug services, and any items or services under the State Plan.

(i) Reasonable expenses incurred in preserving or disposing of the assets are only allowed if:

(i) They are documented with specificity and by an itemized statement or ledger of expenses with copies of receipts,

(ii) They are paid by someone other than the client (use of the client's personal funds will not be reimbursable), and

(iii) They were paid after one of the following events occurred:

(A) Client entered a nursing facility, an assisted living facility, an intermediate care facility for people with intellectual disability, or other medical institution, never returned home, and failed to pay the expenses; or

(B) Client passed away.

(j) The Department may decline to pursue an estate recovery if it determines that it is not cost-effective to recover.

(k) Bona Fide Efforts to Sell. The Department may enter into a stipulation and consent agreement with Medicaid client(s), heirs, or legatees when the following conditions are met:

(i) The client has received Medicaid for a period of at least six (6) months;

(ii) Net proceeds shall be paid to the Department to reimburse medical payments made on behalf of the client;

(iii) The property shall be actively placed on the market;

(iv) The property shall not be sold for less than eighty percent (80%) of fair market value, unless the Department provides approval of the sale of the property for less than eighty percent (80%) of its value; and

(v) If the net proceeds exceed the amount of the Medicaid benefits paid, Medicaid will receive payment in full for the benefits and services provided to the Medicaid client(s) and eligibility for benefits shall be redetermined.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 12 Undue Hardship Waiver

(a) Notice of right to request undue hardship waiver. At the time the Department imposes a lien or files a probate claim, it shall provide written notice by mail to the personal representative or known heirs of the right to request an undue hardship waiver.

(b) Request for undue hardship waiver.

(i) Any individual who receives notice pursuant to subsection (a) may request an undue hardship waiver.

(ii) A request for an undue hardship waiver shall be mailed to the Department by certified mail, return receipt requested, within thirty-three (33) days of the date of the Department's notice pursuant to subsection (a). The request shall include documentation that the decedent's home is part of the estate, that the decedent's home is part of a business, including a working farm or ranch, show that recovery of the home would result in the heirs or beneficiaries losing their means of making a living, and provide other relevant documentation upon the Department's request. The failure to provide the information required by this paragraph with the request shall result in the dismissal with prejudice of the undue hardship waiver request.

(c) Consideration of request. Within thirty (30) days of receipt of a request for an undue hardship waiver, the Department shall consider whether the information furnished shows an undue hardship. During the thirty (30) days of review, the Department may request additional information before making a final decision. The request shall be made in writing by certified mail, return receipt requested. The party to whom the request is directed shall provide the requested information within thirty (30) days after the receipt of the certified mail. The Department shall have fifteen (15) days from receipt of the additional information to make a decision. Failure to provide the requested information shall result in a denial of the request. The Department's decision shall be in writing, and shall be delivered by certified mail, return receipt requested. If the request is denied, the Department shall provide notice of the opportunity to request that the Department reconsider the decision.

(d) Reconsideration. A party may request that the Department reconsider a decision to deny an undue hardship waiver. Such request shall be made and shall be handled pursuant to the reconsideration provisions as set forth in Chapter 3, Section 14, of the Wyoming Medicaid Rules. A party may submit any additional relevant information at the time of the request. A party that fails to request reconsideration pursuant to this section may not subsequently request an administrative hearing pursuant to Chapter 4 regarding the adverse action.

(e) Administrative Hearing. If an administrative hearing is requested, it shall be conducted in accordance with Wyoming Medicaid Rules, Chapter 4, Medicaid Administrative Hearings, except the burden of proof in subsection (f) applies to this Chapter.

(f) Burden of proof. If an administrative hearing is requested, it shall be conducted in accordance with the Wyoming Medicaid Rules, Chapter 4, Medicaid Administrative Hearings, except the burden of proof in subsection (f) applies to this Chapter.

History

Effective 2019-02-19

Wyo. Code R. 048.0037.35.02192019 § 13 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in this rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules:

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each rule or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Section 2 and 5 is Title V of the Social Security Act, which is incorporated as the effective date of this Chapter and can be found at http://ssa.gov.

(ii) Referenced in Section 2 is Title XII of the Social Security Act, including 42 U.S.C. §§ 1396a(25), 1396k(a)(1)(A), and 1396p, which is incorporated as of the effective date of this Chapter and can be found at http://ssa.gov.

(iii) Referenced in Section 2 is 42 C.F.R. §§ 433.135 through 433.154, which is incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(iv) Referenced in Section 2 is 42 C.F.R. § 433.36, which is incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(v) Referenced in Section 2 is the Wyoming Medicaid State Plan, which is incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/healthcarefin/medicaid/spa/.

(vi) Referenced in Section 5 is 42 U.S.C. § 1396d(b), which is incorporated as of the effective date of this Chapter and can be found at http://ssa.gov.

(vii) Referenced in Section 6 is 42 C.F.R. § 433.148(b), which is incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(viii) Institutional Provider Manual at wymedicaid.portal.conduent.com/manuals, go to provider, select provider manuals and bulletins, choose institutional manual, and go to Medicaid Death Report Form.

History

Effective 2019-02-19

Chapter 36 Administrative Transportation

Wyo. Code R. 048.0037.36.06142017 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to the Medical Assistance and Services Act at Wyoming Statutes § 42-4-101 through -306.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 2 Purpose and Applicability

This Chapter establishes the scope of administrative transportation covered by Medicaid and the methods and standards of reimbursing for such services. Any person, facility, or agency that furnishes transportation and seeks Medicaid reimbursement for doing so shall be subject to these rules. This Chapter shall apply to all administrative transportation provided on or after its effective date.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 3 General Provisions

(a) The Department may issue manuals or bulletins to providers or other affected parties to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of the Wyoming Medicaid Rules.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 4 Definitions

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

(a) "Ambulance." An ambulance as defined by Chapter 15.

(b) "Department of Transportation (DOT)." The Wyoming Department of Transportation, its agent, designee or successor.

(c) "Excess payments." Medicaid funds received by a provider, to which the provider is not entitled for any reason, including payments which exceed the Medicaid allowable payment. "Excess payments" includes, but is not limited to:

(i) Overpayments;

(ii) Payments made as a result of system errors;

(iii) Payments for services furnished to an individual that is not a client;

(iv) Payments for non-covered services furnished to a client;

(v) Payments for services which are not documented or supported by medical records or financial records;

(vi) Payments for services for which admission certification has been denied or withdrawn;

(vii) Payments which exceed a provider's usual and customary charge, unless otherwise permitted by the Department's rules.

(d) "Local trade area." The geographic area surrounding the client's residence, excluding portions of states other than Wyoming, that is commonly used by other persons in the same area to obtain similar services.

(e) "Medical appointment." A scheduled appointment with a provider.

(f) "Reimbursement request and certification." Documentation, in the form specified by the Department, that contains:

(i) An itemized statement of the administrative transportation for which a client is requesting reimbursement; and

(ii) The original signature of the client or other payee that receives the reimbursement.

(g) "Subsidized public transportation." Public transportation carriers that receive a subsidy from the Department of Transportation.

(h) "Wyoming Rural Transit Program." The transportation program operated by the Wyoming Department of Transportation.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 5 Provider participation

An individual or entity that wishes to receive Medicaid reimbursement for furnishing covered services to clients shall meet the provider participation requirements of Chapter 3.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 6 Reimbursable transportation expenses

(a) Ambulance transportation. Transportation in an ambulance is a covered service as specified in Chapter 15.

(b) Administrative transportation to and from a medical appointment is reimbursable if:

(i) The covered services furnished to the client at the medical appointment are medically necessary;

(ii) Transportation has been approved by the Department at least three working days in advance of the necessary transportation; and

(iii) The transportation is the least costly mode of transportation selected and approved by the Department pursuant to subsection (c).

(i) The Department shall be responsible for selecting and approving the mode of administrative transportation.

(ii) In selecting and approving transportation, the Department:

(A) May consider the following modes of transportation:

(I) Public transportation, including subsidized public transportation and the Wyoming Rural Transit Program;

(II) Private automobile;

(III) Taxi;

(IV) Bus;

(V) Shuttle services; and

(VI) Airline; and

(B) Shall select the least expensive and most appropriate mode of transportation reasonably available.

(iii) Per diem expenses. Per diem expenses are reimbursable to a client or a client's legal guardian if:

(A) The client receiving services is a client under age twenty-one; and

(B) The services to be received are covered services.

(d) Transportation to medical appointments outside Wyoming and within the Wyoming Medicaid Service Area (WMSA) is reimbursable if:

(i) The covered service is not available in the local trade area; and

(ii) The specified city within the WMSA is closer (in highway miles) than the nearest location within Wyoming where the service is available.

(e) Transportation to medical appointments outside the WMSA is not reimbursable unless:

(i) A person licensed to practice medicine, dentistry, psychiatry, osteopathy, or optometry has referred the client to a specified provider for covered services that are not available in the service area; and

(ii) The referral is in writing and the medical necessity of the referral is documented in the client's medical records.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 7 Excluded transportation expenses

The following transportation expenses are not reimbursable:

(a) Transportation to receive services which are not covered services;

(b) Transportation of a family member or friend to visit a client or consult with the client's physician or other provider of medical services, unless the transportation is to visit a client under age twenty-one and the visit is medically necessary;

(d) Transportation of a resident of a nursing facility to receive services that are available at the nursing facility;

(e) Transportation of a client in response to detention ordered by a court or law enforcement agency;

(f) Transportation to receive covered services from a provider because another provider has denied services to the client due to the client's refusal to follow medical advice or the client's unacceptable conduct;

(g) Missed appointments. If a client misses or cancels a medical appointment for which Medicaid reimbursement has been pain pursuant to this rule, the client shall refund the cost of the appointment to the Department within fifteen days of the missed appointment (unless the medical appointment has been rescheduled). Medicaid funds that are not refunded shall be considered excess payments and may be recovered pursuant to Section 12.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 8 Procedures for obtaining reimbursement

(a) Request for reimbursement. A client wishing to receive reimbursement for administrative travel shall contact the Department and request reimbursement. The request may be oral or written. The client shall furnish information as requested by the Department and complete the Department's required documentation.

(b) Payment. Payment shall be by warrant issued to the client or other payee.

(c) Reimbursement request and certification. After the client or other payee submits a request for administrative transportation, the client or payee shall sign the reimbursement request and certification and return it to the Department. Reimbursement requests and certifications shall become part of the client's file and be retained by the Department.

(d) Reimbursement to enrolled providers. Providers of lodging, taxi or non-taxi transportation services may enroll with the Wyoming Medicaid Program to be reimbursed for covered transportation services directly by Wyoming Medicaid.

(e) Provider Payment. Providers shall submit all claims to Wyoming Medicaid and reimbursement will be according to Wyoming Medicaid reimbursement rates for the covered procedure codes billed on the submitted claim as published in the Wyoming Medicaid Fee Schedule.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 9 Prior authorization

(a) Prior authorization of administrative transportation shall be governed by the prior authorization requirements of Chapter 3.

(b) All administrative transportation requires prior authorization.

(i) In deciding whether to authorize administrative transportation, the Department shall consider the:

(A) Cost of the transportation;

(B) Potential for over-utilization of the transportation;

(D) Excess payments owed by the client.

(ii) The failure to obtain prior authorization shall result in denial of Medicaid reimbursement.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 10 Allowable Medicaid reimbursement

(a) Medicaid reimbursement for administrative transportation shall be as follows:

(i) Reimbursement to a client shall be by one of the following methods:

(A) Prospective reimbursement. The client may be reimbursed for projected administrative transportation expenses.

(B) Retroactive reimbursement. The client may be reimbursed for actual administrative transportation expenses.

(ii) Reimbursement to a provider shall be the lesser of the provider's billed charge and Wyoming Medicaid's allowed amount per the published Wyoming Medicaid Fee Schedule.

(b) Private automobile. Medicaid reimbursement for administrative transportation furnished in a private automobile shall:

(i) Be based on mileage as determined by the Wyoming State Auditor, or if not so determined, on map mileage using major highways as determined by the Department;

(ii) Be limited to the maximum amount recommended by the State Auditor in order to avoid any requirement for reporting mileage income to the Internal Revenue Service; and

(iii) Not be paid for fractions of a mile.

(c) Per diem expenses. Medicaid reimbursement for per diem expenses is limited to $25.00 per person, per day, to be used for meals and commercial lodging. Lesser amounts will be reimbursed for additional clients transported together.

(d) Retroactive reimbursement. Reimbursement for administrative transportation that is already completed is reimbursable to clients or providers if:

(i) Requested within thirty days after the date the travel was completed; and

(ii) The request contains the information and documentation required by the Department, including a valid receipt for travel expenses.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 11 Payment of claims

Payment of claims shall be pursuant to the payment of claims provisions of Chapter 3.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 12 Recovery of excess payments or overpayments

(a) The Department may recover excess payments and overpayments pursuant to Chapter 16.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 13 Reconsideration

(a) A provider or client may request that the Department reconsider a decision to recover excess payments or overpayments. The request for reconsideration, the reconsideration, and any administrative hearing shall be pursuant to the reconsideration provisions of Chapter 3.

(b) Reconsideration shall be limited to whether the Department has complied with the provisions of this Chapter.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 14 Disposition of recovered funds

The Department shall dispose of recovered funds pursuant to the provisions of Chapter 16.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 15 Administrative hearing

(a) Clients. A client may request an administrative hearing pursuant to Chapter 4 regarding the termination, reduction or denial of covered services.

(b) Procedures. A request for an administrative hearing shall be made in conformance with Chapter 4, and the hearing shall be held pursuant to Chapter 4.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 16 Superseding effect

This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 17 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-06-14

Wyo. Code R. 048.0037.36.06142017 § 18 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of these rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of the section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(b) Each rule incorporated by reference is further identified as follows:

(i) Referenced in Section 4 is Chapter 1 - Rules and Regulations for Medicaid - Definitions, adopted by the Department of Health and effective on November 7, 2011, found at http://soswy.state.wy.us/Rules/RULES/8384.pdf.

(ii) Referenced in Sections 5, 9, 11, and 13 is Chapter 3 - Provider Participation, adopted by the Department of Health and effective on December 16, 1998, found at http://soswy.state.wy.us/Rules/RULES/3349.pdf.

(iii) Referenced in Section 15 is Chapter 4 - Medicaid Administrative Hearings, adopted by the Department of Health and effective on November 7, 2011, found at http://soswy.state.wy.us/Rules/RULES/8385.pdf.

(iv) Referenced in Sections 4 and 6 is Chapter 15 - Ambulance Services, adopted by the Department of Health and effective on September 8, 1995, found at http://soswy.state.wy.us/Rules/RULES/1529.pdf.

(v) Referenced in Sections 12 and 14 is Chapter 16 - Program Integrity, adopted by the Department of Health and effective on November 7, 2011, found at http://soswy.state.wy.us/Rules/RULES/8386.pdf.

History

Effective 2017-06-14

Chapter 37 Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

Wyo. Code R. 048.0037.37.08112023 Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC)

CHAPTER 37

FEDERALLY QUALIFIED HEALTH CENTERS AND

RURAL HEALTH CLINICS

Section 1. Authority.

(a) The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Medical Assistance and Services Act at Wyoming Statutes 42-4-101 through -124.

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to establish the Wyoming Medicaid requirements and reimbursement for services provided in Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), as defined in 42 U.S.C. § 1396d(l)(2).

(b) This Chapter applies to all clients and providers for all Medicaid-covered services furnished in FQHCs and RHCs.

Section 3. Definitions. Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, or as defined herein, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

(a) "Base period" means FQHC or RHC fiscal years 1999 and 2000; if a FQHC or RHC provided services for only one (1) fiscal year, that year shall be used as the "base period."

(b) "Medicare Economic Index (MEI)" means the measure of practice cost inflation used to estimate annual changes in physicians' operating costs and earnings levels.

(c) "Visit" means a face-to-face encounter between a FQHC or RHC client and a FQHC or RHC professional staff member for the purpose of providing FQHC or RHC services. Telehealth visits are considered face-to-face visits.

Section 4. Provider Enrollment and Participation. In order to receive Medicaid reimbursement for furnishing services to a client, a FQHC or RHC shall be an enrolled Medicaid provider and in compliance with requirements for Medicaid participation in accordance with Wyoming Medicaid Rules Chapter 3.

Section 5. Reimbursable Services.

(a) FQHC and RHC reimbursable services are outpatient services that occur during an eligible visit and include:

(i) Physician services;

(ii) Nurse practitioner, physician's assistant, and certified nurse midwife services;

(iii) Behavioral health services provided pursuant to Wyoming Medicaid Rules Chapter 13 by providers licensed to provide such services;

(iv) Preventive primary care services;

(v) Dental services;

(vi) Vision services;

(vii) Audiology services;

(b) The following services and supplies furnished as incidental to the provider's services are included in the provider's rate and are not billable as a stand-alone visit, even if the service is performed on a separate day from the original visit:

(i) Lab services;

(ii) Drugs and biologicals that cannot be self-administered;

(iii) Supplies;

(iv) Radiology;

(v) Diagnostic services;

(vi) Therapeutic services;

(vii) Outreach;

(viii) Case management;

(ix) Transportation;

(c) If services are furnished at a permanent site in more than one location, each site will be independently considered for approval as a provider, unless prior approval was granted by CMS to operate both locations under a single provider number. To be considered a satellite provider location both sites must share medical staff, office staff, and/or administrative staff.

Section 6. General Reimbursement Methodology.

(a) Base period allowable costs are considered to be reasonable costs which are related to providing covered services during the base period as determined pursuant to 42 U.S.C. 1396a(bb)(2). Graduate medical education costs shall be allowable costs for qualifying FQHCs and RHCs and shall be determined pursuant to 42 C.F.R. § 405.2468(f), except that the calculation shall be based on the FQHC's or RHC's Medicaid costs rather than Medicare costs.

(b) In accordance with 42 U.S.C. § 1396a(bb) the Department shall reimburse FQHCs and RHCs for covered services using a prospective payment system based on each FQHC's or RHC's base period costs for that calendar year, per visit, inflated forward using the MEI, and adjusted for changes in services.

Section 7. Medicaid Allowable Payment for Services Furnished on or After January 1, 2001.

(a) The Department shall reimburse for covered services provided to clients in a FQHC or RHC using a prospective payment rate determined pursuant to this Chapter.

(b) The Department shall establish a separate payment rate for each FQHC and RHC. The rate shall be determined using the base period Medicaid allowable costs, which are calculated as follows:

(i) The Department shall calculate a per visit cost for each FQHC and RHC for the FQHC's and RHC's 1999 and 2000 fiscal years. A fiscal year shall be the twelve (12) month period used by a FQHC or RHC for accounting and tax purposes.

(ii) The Medicaid baseline rate (rate established using the base period for each FQHC and RHC) with 1999 and 2000 fiscal year data shall be determined by calculating a per visit rate (total allowable costs divided by total patient visits) for fiscal years 1999 and 2000; adding the two (2) rates together; and dividing the sum by two (2).

(iii) The Medicaid baseline rate for each FQHC and RHC with only 2000 fiscal year data shall be determined by calculating a per visit rate (total allowable costs divided by total patient visits) for fiscal year 2000.

(iv) Scope of service changes for baseline rate.

(A) An FQHC or RHC which desires an adjustment to its baseline rate due to an increase or decrease in its scope of service shall:

(I) Notify the Department, in writing, of the increase or decrease; and

(II) Submit a settled Medicare Cost Report which documents the change in services and substantiates the costs associated with that change.

(B) The Department shall assess the information provided and shall determine if a rate change is warranted and the amount of any such change. Those determinations shall be based upon:

(I) The nature of the new or discontinued service regarding the type, intensity, duration, and amount of services. A change in the cost of a service is not considered in and of itself a change in the scope of services; and

(II) The reasonableness of the FQHC's or RHC's costs.

(C) The Department may request that the FQHC or RHC provide additional information to document the change in service. The information shall be provided before the Department is obligated to consider the FQHC's or RHC's request.

(v) The per visit rate calculated pursuant to this Section, as adjusted for changes in scope of service pursuant to this Section, shall be the FQHC's or RHC's baseline rate for services provided on or after January 1, 2001, and shall be the basis for future rate determinations.

(vi) For any FQHC or RHC that was not in operation during 1999 or 2000 fiscal years, refer to Section 7.

(c) The Department shall base all cost and rate calculations on a FQHC's or RHC's most recently settled Medicare Cost Report. If a settled Medicare Cost Report is not available, the Department shall use the FQHC's or RHC's Medicare Cost Report as filed.

(i) If a cost or rate calculation is based on an "as filed" Medicare Cost Report, the Department shall recalculate the cost or rate within a reasonable time after the FQHC's or RHC's settled cost report becomes available. If the cost or rate based on an "as filed" cost report is different from the cost or rate calculation based on the settled cost report, the Department shall only adjust the rate prospectively and shall not retroactively reimburse the FQHC or RHC for any underpayment or recover any overpayment.

(ii) A change in a FQHC's or RHC's rate pursuant to this subsection shall not affect any averages.

(d) The Department shall re-determine each provider's Medicaid allowable payment each Federal fiscal year beginning on or after October 1, 2001, as follows:

(i) The provider's Medicaid allowable payment in effect on October 1 of each year shall be adjusted by the percentage increase in the MEI as calculated using the annual data published in the fourth (4th) calendar quarter in the Federal Register or posted at the CMS Health Care Indicators website at https://www.cms.gov on the Market Basket Data updates page.

(ii) The provider's Medicaid allowable payment shall be adjusted prospectively to reflect any increase or decrease in the scope of services furnished by the FQHC or RHC during the FQHC's or RHC's fiscal year. The provisions of Section (b)(iv) shall apply to any proposed rate changes based on a change in services.

(iii) The payment established pursuant to Section 7(d) of this Chapter shall be effective for the calendar year beginning January 1 following the determination of the new rate.

Section 8. Medicaid Allowable Payment for New Providers.

(a) A provider that qualifies as a FQHC or RHC after September 30, 1999, must submit a settled or "as filed" Medicare Cost Report to the Department, which will serve as the basis for the provider's rate calculation. Upon submission of a settled or an "as filed" Medicare Cost Report a visit rate will be calculated as described by the cost formula in Section 7.

(b) If the FQHC or RHC does not have a settled or an "as filed" Medicare Cost Report, the provider shall submit cost information to the Department for services previously provided indicating estimates for its next fiscal year and the number of patients and services it expects to offer during that period.

(c) The Medicaid allowable payment for a new provider shall be an interim visit rate equal to one hundred (100) percent of the reasonable costs used in calculating the rates of FQHCs or RHCs with similar caseloads located in the state during the same facility fiscal year, adjusted by the percentage increase in MEI, as described by the cost formula in Section 7. Interim visit rates will be specific to each provider type: Independent RHCs, Hospital-based RHCs, and FQHCs.

(i) If there are no FQHCs or RHC's with similar caseloads, the Medicaid allowable payment for a new provider shall be an interim visit rate equal to the Medicaid statewide average visit rate for the calendar year, adjusted by the percentage increase in MEI, as described by the cost formula in Section 7. Interim visit rates will be specific to each provider type: Independent RHCs, Hospital-based RHCs, and FQHCs.

(d) The interim rate determined pursuant to subsection (c) shall remain in effect until the FQHC or RHC has submitted a settled Medicare Cost Report, at which time the FQHC's or RHC's rate shall be recalculated pursuant to Section 7, except that the new FQHC's or RHC's base period shall be its first fiscal year during which the FQHC or RHC provided Medicaid services. The Department shall not retroactively reimburse the FQHC or RHC for any underpayment or recover any overpayment based on changes in the calculated rate.

Section 9. Medicaid Allowable Payment for Out-of-State FQHCs and RHCs.

(a) The Medicaid allowable payment for out-of-state FQHCs and RHCs shall be the statewide average Medicaid allowable payment in effect in Wyoming as of October 1st of that year.

(b) The statewide average Medicaid allowable payment shall not be affected by a subsequent change in a FQHC's or RHC's rate.

History

Effective 2023-08-11

Chapter 40 Psychiatric Residential Treatment Facilities

Wyo. Code R. 048.0037.40.12202023 Psychiatric Residential Treatment Facilities

F:\COMMON\JERI\Jeri\2002 Rules\Health\Mental Health\ch40

CHAPTER 40

Psychiatric Residential Treatment Facilities

Section 1. Authority. This Chapter is promulgated by the Department of Health pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statute 42-4-101 through -124.

Section 2. Purpose and Applicability.

(a) This Chapter shall apply to and govern the furnishing of inpatient psychiatric services for individuals under age twenty-one (21) in psychiatric residential treatment facilities (PRTFs) as defined by 42 C.F.R. § 483.354.

(b) The Department may issue manuals and bulletins to providers and other affected parties to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals and bulletins shall be subordinate to the provisions of this Chapter.

Section 3. Definitions. Except as otherwise specified in Medicaid Rules Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, Medicaid, and Medicare.

(a) "Certification of need for services." A certification pursuant to Section 8 that meets the requirements of 42 C.F.R. §§ 441.152-.153, which requirements are incorporated by this reference.

(b) "Chapter" used herein refers to the specified Chapter in the Wyoming Department of Health, Medicaid Rules.

(d) "Facility." A PRTF which has been certified by the Centers for Medicare and Medicaid Services (CMS) pursuant to 42 C.F.R 483.354 and also maintains compliance with the conditions of participation found at 42 C.F.R Subpart G.

(e) "Financial Report." A report of a facility's costs for a specified fiscal period prepared and submitted in the form and manner specified by the Department. Financial report includes any supplemental request by the Department for additional information relating the facility's costs.

(f) "Foster home." A home certified by the Wyoming Department of Family Services (DFS) as a foster home.

(g) "Group Home." An institution certified by DFS as a group home.

(h) "Individual written plan of care (plan of care)." A written treatment plan, prepared by an interdisciplinary team, that meets the requirements of 42 C.F.R. § 441.155, except that the plan must be completed within fourteen (14) calendar days of an individual's admission to the facility.

(i) "Usual and customary per diem charge." A provider's per diem charge for comparable services provided to non-Medicaid recipients other than persons eligible for payment on a reduced or sliding fee schedule.

Section 4. Provider participation.

(a) Except as otherwise specified in this Chapter, no facility that furnishes covered services to a recipient shall receive Medicaid funds unless the provider has signed a provider agreement, and is enrolled.

(b) Compliance with Medicaid Rules Chapter 3, Provider Participation. A facility that wishes to receive Medicaid reimbursement for covered services furnished to a recipient must meet the provider participation requirements of Medicaid Rules Chapter 3.

(i) A PRTF must be certified. In-state PRTF's shall be certified by the Division of Healthcare Financing in conjunction with Healthcare Licensing and Surveys and CMS approval. Out-of-state PRTF's shall be certified by their own state's licensing and survey agency and CMS.

(ii) A PRTF shall be licensed. For in-state PRTF's, a PRTF shall be licensed by the State of Wyoming, Department of Family Services. For out-of-state PRTF's, a PRTF shall be licensed by that state's licensing authority.

(iii) A PRTF shall have one of the following accreditations: JCAHO, CARF, COA, or any other accrediting organization with comparable standards recognized by the State.

(iv) No facility shall become a provider or receive Medicaid funds for services furnished before the date on which an authorized individual signs an attestation letter which meets the requirements regarding restraint, seclusion, and death reporting policies of 42 C.F.R. § 441.51 and 42 C.F.R. Subpart G.

Section 5. Provider records. PRTF shall be subject to the record-keeping provisions of Chapter 3, Provider Participation.

Section 6. Verification of client data. A provider shall comply with the verification of client data requirements of Medicaid Rules Chapter 3, Provider Participation.

Section 7. Admission.

(a) Before admission to a facility, an interdisciplinary team shall complete a certification of need for services in accordance with 42 CFR § 441.154.

(b) Admission Certification. Admissions to PRTFs are subject to the prior authorization procedures outlined in Section 8 of this Chapter. The Department shall determine the medical necessity of admission to an PRTF using the following criteria:

(i) The client presents with a longstanding (at least six months) psychiatric diagnosis characterized by severely distressing, disruptive or immobilizing symptoms that are persistent and pervasive, and which cannot be reversed with treatment in an outpatient treatment setting, or is being stepped down in intensity from an acute psychiatric facility. The diagnosis shall meet the criteria for an Axis 1 as defined by the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM);

(ii) There are documented attempts to treat the client with the maximum intensity of services available at a less intensive level of care that cannot meet or has failed to meet the needs of the client within the past six (6) months. The client shall have failed to respond to outpatient interventions. Six (6) months of alternative, less restrictive levels of care shall have been tried and have failed, or are not psychiatrically indicated;

(iii) At least one of the patterns of behavior listed below must be present:

(A) Persistent, pervasive and frequently occurring oppositional/defiant behavior;

(B) Reckless or impulsive behavior, which represents a disregard for the well-being or safety of self/others;

(D) Gestures with intent to injure self/others, which have not resulted in serious injury, without evidence that such gestures are immediately progressing to life threatening behavior;

(E) Self-induced vomiting, use of laxatives/diuretics, strict dieting, fasting and/or vigorous exercise;

(F) Extreme phobic/avoidant behavior;

(G) Extreme social isolation; or

(H) History of repeated life threatening injury to self/others, resulting in acute care admissions within the past twelve (12) months. The client is not currently considered at risk to inflict life-threatening injury to self/others in the residential treatment setting.

(iv) Without intervention, there is clear evidence that the client will likely decompensate and present a risk of serious harm to self or others; or

(v) A psychiatric evaluation by a board certified child/adolescent psychiatrist. The child/adolescent psychiatrist must be licensed, board certified, and in good standing. The child/adolescent psychiatrist must be independent of the PRTF being considered for admission. If the child/adolescent psychiatrist works for the PRTF being considered for admission, a second opinion must be obtained from the agency contracted by the Division for such services. The evaluation must take place no more than forty-five (45) days prior to PRTF Admission.

Section 8. Prior authorization.

(a) Prior authorization of PRTF services shall be governed by Medicaid Rules Chapter 3, Provider Participation.

(b) All inpatient psychiatric services for individuals under age twenty-one (21) furnished in a facility shall be prior authorized.

(d) The facility shall submit a request for prior authorization in the manner specified by the Department before the submission of a claim for such services. The Department may request, and the facility shall provide additional information as necessary to review the plan of care.

(e) Reauthorization. The physician or the interdisciplinary team must review and reauthorize the client's plan of care every seven (7) to thirty (30) days. Reauthorized plans of care are subject to the prior authorization provisions of this Section.

(f) For the court ordered placement of a client in a PRTF, after a clinical review and determination that the PRTF placement no longer meets the medical necessity criteria outlined in Section 7, a transition period of up to thirty (30) days may be authorized permitting time for the necessary court hearings, MDT meetings and court orders to be updated. Upon expiration of an approved transitional period, no further reimbursement shall be authorized.

Section 9. Covered services. Inpatient psychiatric services for individuals furnished to a client under age twenty-one (21) in a PRTF are covered services.

Section 10. Educational services. Education services shall be provided and reimbursed in accordance with Chapter 14 of the Wyoming Department of Education Rules, Education Program Approval of Public and Private Institutions Receiving State Funds For the Education Costs of Students Placed by a Court Order.

Section 11. Excluded services. The following services are not Medicaid reimbursable when provided in a PRTF:

(a) Services provided in an emergency;

(b) Services provided pursuant to a physician's standing orders; and

Section 12. Out-of-state facilities. Covered services provided in a facility located outside of Wyoming shall be Medicaid reimbursable to the same extent as services provided in a facility inside Wyoming.

Section 13. Medicaid allowable payment for covered services.

(a) The Department reimburses for covered services provided to clients under age twenty-one (21) using an all-inclusive per diem rate determined pursuant to this Section.

(b) The rates shall be established by the Department of Health based on reasonable, actual costs for services and treatment of residents in the PRTF. Rates are provider-specific, all-inclusive for room and board and the treatment services specified in the treatment plan.

(c) Reported PRTF costs and adjustments are used to develop the data set to calculate the room and board and licensed treatment rate components.

(i) Reported costs and days data from providers using Medicaid's PRTF cost report.

(ii) Reported costs are adjusted to standardize data for analysis and to remove non-allowable costs.

(iii) Administrative cost adjustments occur.

(iv) Adjustments to reported days occur.

(d) The costs of medical and ancillary services not provided by the PRTF, excluding those services in the treatment plan, shall not be included in the all-inclusive prospective per diem rate, and shall be billed as a separate service by the provider of those services and Medicaid shall pay for those covered services using the appropriate Medicaid fee schedule.

(e) The rate shall not exceed the facility's usual and customary rate.

(f) Newly enrolling PRTFs shall receive the in-state average rate for in-state providers and out-of-state PRTFs shall receive the out-of-state average rate until they qualify to submit a PRTF cost report. Upon submission of the cost report, PRTF per diem rates may be updated using the PRTF cost report pursuant to funding availability.

Section 14. Preparation and submission of financial reports.

(a) Each facility shall submit a complete financial report in accordance with the instructions of the Department.

(b) Submission of additional information. The Department may request, in writing, that a facility submit information to supplement its financial report. The facility shall submit the requested information within thirty (30) days after the date of the request.

Section 15. Submission and Payment of claims. The submission and payment of claims shall be pursuant to the provisions of Medicaid Rules Chapter 3, Provider Participation.

Section 16. Title IV-E clients.

(a) Title IV-E of the Social Security Act (42 U.S.C. §§ 671-679b) is a funding stream for foster care costs. It provides for federal reimbursement for a portion of the maintenance and administrative costs of foster care for children who meet specified federal eligibility requirements.

(b) Wyoming Medicaid clients on a Title IV-E adoption program and placed in a PRTF out of state shall transfer to the receiving state's Medicaid program. 45 C.F.R. Part 1356 redefines the client's residency to that of the receiving state. Therefore, the receiving state's Medicaid program shall be notified of the placement by Wyoming Medicaid's Utilization Management vendor.

(c) If the receiving state refuses to accept the transfer of Medicaid coverage, the Wyoming Department of Health shall maintain primary clinical and placement oversight and coverage responsibility as determined medically necessary.

(d) Wyoming Medicaid's Utilization Management vendor shall engage in an agreement with the admitting facility to remain involved in the treatment and progress of the client in order to certify ongoing medical necessity of the placement.

Section 17. Third-party liability.

(a) Claims for which third-party liability exists shall be submitted in accordance with Medicaid Rules Chapter 35, Medicaid Benefit Recovery.

Section 18. On-Site Compliance Review.

(a) All enrolled PRTFs shall be subject to the On-Site Compliance Review (OSCR) which monitors a PRTF's overall operations for compliance with state and federal conditions of participation as referenced in Section 4, as well as evaluate the quality of clinical programs and services.

(b) An OSCR may be conducted at any time, and may be conducted as a partial off-site (review of records) and partial on-site (facility tour and staff/resident interviews) compliance review. An interim review may be scheduled at any time at the discretion of the Department to address specific concerns.

(i) Probation. A PRTF receiving this rating shall be subject to the following actions by the Department:

(A) A hold on new admissions;

(B) Youth transfers shall be considered;

(C) Guardian notifications of PRTF ratings shall be initiated for all Wyoming Medicaid clients receiving services from the PRTF; and

(D) Notification of facility rating shall be provided to the PRTF's licensing and survey authority and the PRTF's Board of Directors.

(ii) Suspension. A PRTF receiving this rating shall be subject to the following actions by the Department:

(A) A hold on new admissions;

(B) Youth transfers shall be initiated;

(C) Guardian notifications of rating shall be initiated for all Wyoming Medicaid clients receiving services from the PRTF;

(D) Notification of facility rating shall be provided to the PRTF's licensing and survey authority and the PRTF's Board of Directors;

(E) A PRTF receiving two (2) suspension ratings during its course of enrollment with Wyoming Medicaid shall be dis-enrolled as a Wyoming Medicaid provider. The suspension ratings do not need to be consecutive; and

(F) Petitions for re-enrollment shall be considered on a case by case basis, no sooner than twenty-four (24) months after dis-enrollment. Dis-enrollment may be considered by the Department after one (1) suspension rating depending on the severity and scope of the findings.

(iii) Deferred. In cases of deferred status, the Department shall re-contact the PRTF within ten (10) days to:

(A) Request additional information or documentation, which shall then be provided by the PRTF within ten (10) days of receiving the request;

(B) Schedule a continuation of the OSCR, in which case additional team members may participate in further on-site review of the facility, or

(C) Submit a final status ruling. The ten (10) day request/submission response cycle shall continue until a final status determination is made.

(d) Corrective Action Plan (CAP). Any facility receiving a rating of Review, Probation or Suspension shall submit a Corrective Action Plan (CAP). The CAP shall be received by the Department no later than ten (10) working days following the PRTF's receipt of its status ruling. The CAP shall address separately each concern cited in the OSCR report.

Section 19. Audits.

(a) The Department, the Medicaid Fraud Control Unit (MFCU), or CMS may audit a provider's financial records or medical records at any time to determine whether the provider received excess payments or overpayments. An audit may be a desk review or a field audit.

(b) The Department, MFCU, or CMS may perform audits through employees, agents, or a third party. Audits shall be performed in accordance with generally accepted auditing standards.

(d) Reporting audit results. If, at any time, during a financial audit or medical audit, the Department discovers evidence suggesting fraud or abuse by a provider, that evidence, in addition to the Department's final audit report regarding that provider, shall be referred to the MFCU.

Section 20. Recovery of overpayments. The Department may recover overpayments pursuant to Medicaid Rules Chapter 16, Program Integrity.

Section 21. Reconsideration. A provider may request that the Department reconsider a decision to recover excess payment or overpayments. The request for reconsideration, the reconsideration, and any administrative hearing shall be pursuant to the reconsideration provisions of Medicaid Rules Chapters 16, Program Integrity and 4, Administrative Hearings.

Section 22. Disposition of recovered funds. The Department shall dispose of recovered funds pursuant to the provisions of Medicaid Rules, Chapter 16, Program Integrity.

History

Effective 2023-12-20

Chapter 44 Environmental Modifications and Specialized Equipment for Medicaid Home and Community-Based Waiver Services

Wyo. Code R. 048.0037.44.12202019 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to Wyoming Statute 9-2-102 and the Wyoming Medical Assistance and Services Act at Wyoming Statutes 42‑4‑101 through -121.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 2 Purpose and Applicability

(a) This Chapter shall apply to and govern Medicaid reimbursement of environmental modification and specialized equipment services provided under the Wyoming Medicaid Comprehensive Waiver and Wyoming Medicaid Supports Waiver, (herein collectively referred to as the "DD Waivers").

(b) This Chapter, in addition to Chapters 45 and 46 of the Department of Health's Medicaid Rules, shall govern services and provider requirements of the DD Waivers.

(c) The Division of Healthcare Financing, hereafter referred to as the "Division," may issue provider manuals and provider bulletins to providers or other affected parties to interpret the provisions of this Chapter. Such provider manuals and provider bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in provider manuals and provider bulletins shall be subordinate to the provisions of this Chapter.

(d) Wyoming's currently approved Centers for Medicare and Medicaid Services (CMS) Comprehensive and Supports Waiver Applications and the Comprehensive and Supports Waiver Service Index apply to this Chapter.

(e) The requirements of Title XIX of the Social Security Act, 42 C.F.R. Part 441, Subpart G and the Medicaid Sate Plan apply to this Chapter.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 3 General Provisions

(a) Except as otherwise specified in Chapter 1 of the Department of Health's Medicaid Rules, or as defined in this Section, the terminology used in this Chapter is the standard terminology and has the standard meaning used in accounting, health care, Medicaid, and Medicare.

(b) "Case manager" means individual who provides case management services, as established in Chapter 45, Section 9.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 4 Environmental Modifications - Scope and Limitations

(a) Environmental modifications to a participant's residence shall meet at least two of the following criteria:

(i) Be functionally necessary;

(ii) Contribute to a person's ability to remain in or return to his or her home and out of an intermediate care facility for individuals with an intellectual or developmental disability (ICF/IID) or other institutional setting; and

(iii) Be necessary to ensure the person's health, welfare, and safety.

(b) Environmental modifications may include, but are not limited to:

(i) The installation of ramps;

(ii) The installation of grab-bars;

(iii) Widening of doorways;

(iv) A bathroom modification that is the most cost effective option to meet the needs of the participant.

(v) Installation of specialized electric or plumbing systems necessary to accommodate specialized medical equipment or supplies, which are necessary for the welfare of the participant;

(vi) Modifications that address accessibility limitations;

(vii) Modifications that address fire code requirements; and

(viii) Fences for health or safety concerns.

(A) Fences shall not take the place of required supervision of the participant.

(B) Payment for fences shall not exceed the cost for 200 linear feet of the material needed to ensure the safety of the participant, and shall be consistent with the neighborhood standard.

(i) Modifications to a residence that are of general utility or are primarily for the convenience of persons other than the participant, such as caregivers or family members;

(ii) Modifications to a residence that are not of direct medical or functional benefit to the participant;

(iii) Installation or replacement of carpeting;

(iv) Roof repair or replacement;

(v) Central air conditioning;

(vi) New carports, porches, patios, garages, porticos, decks, or repairing such structures;

(vii) Pools, spas, hot tubs, or modifications to install pools, spas, or hot tubs;

(viii) Landscaping or yard work, landscaping supplies, pest exterminations, or removal of yard items;

(ix) Modifications that are part of new construction costs;

(x) Modifications that add to the square footage of the home except bathroom modifications as specified in (b)(iv) of this Section;

(xi) Window replacements;

(xii) Repairs or replacement of structural building components;

(xiii) Modifications to a residence when the cost of such modifications exceeds the value of the residence before the modification; and

(xiv) Any adaptations that are covered by another source, such as a state independent living center or a vocational rehabilitation provider.

(d) Covered modifications of rented or leased homes shall be those extraordinary alterations that are uniquely needed by the individual, and for which the property owner would not ordinarily be responsible.

(i) Such modifications shall require written approval from the homeowner or landlord.

(ii) Modifications shall include the minimum necessary to meet the functional requirements of the participant.

(iii) A participant shall not purchase home accessibility adaptations to adapt living arrangements that add value to a home that is owned or leased by providers of waiver services.

(e) The homeowner shall be responsible for general maintenance of environmental modifications.

(f) All services shall be provided in accordance with State or local building codes.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 5 Environmental Modifications Approval Process

(a) The plan of care team may request environmental modifications during the six-month or annual plan of care meeting. Environmental modification requests submitted at other times during the plan of care year may be submitted if significant health, safety, or access concerns are identified.

(b) When the plan of care team identifies an environmental concern or need, the case manager shall submit the following information to the Division for the overall scope of the project:

(i) A description of the environmental concern or need;

(ii) A description of how the environmental concern is related to the participant's diagnosed disability, based on an assessment from an occupational or physical therapist; and

(iii) A description of how the environmental modification will:

(A) Contribute to the participant's ability to remain in, or return to, his or her home;

(B) Increase the participant's independence;

(D) Address health and safety needs of the participant.

(c) The case manager shall work with the participant or legally authorized representative to identify two certified environmental modification providers, and contact the providers to obtain quotes. Quotes shall include:

(i) A detailed description of the work to be completed, including drawings or pictures when appropriate;

(ii) An estimate of the material and labor needed to complete the job, including costs of clean up;

(iii) An estimate for building permits, if needed;

(iv) An estimated timeline for completing the job;

(v) Name, address, and telephone number of the provider; and

(vi) Signature of the provider.

(d) The case manager shall submit the service authorization section of the individualized plan of care to the Division, including:

(i) The assessment completed by the professional team or the written approval from the Division to proceed with quotes; and

(ii) Two (2) quotes completed by certified environmental modification providers.

(A) If two quotes cannot be obtained, the case manager shall include an explanation as to why only one quote was submitted.

(B) The Division may review any request that does not include more than one quote.

(e) The Division may schedule an on-site assessment of the environmental concern, including an evaluation of functional necessity with appropriate professionals under contract with the Division. To ensure cost effectiveness, the Division may use a third party to assess the proposed modification and need for the modification. The assessment shall include:

(i) A statement verifying that the request meets at least two (2) of the criteria pursuant to Section 4(a) of this Chapter; and

(ii) A description of the modification that will address the environmental concern, including the minimum quality and quantity of material needed, and estimated cost range for modification.

(f) The Division shall notify the participant and case manager of the approval, including which quote was approved.

(i) Modifications shall be completed by the date stated in the individualized plan of care unless otherwise authorized by the Division.

(ii) If the cost of a modification increases due to a significant change in costs of material, the case manager shall submit a revised quote detailing the change in cost.

(iii) The case manager shall not give copies of the individualized plan of care to the environmental modification provider. The environmental modification provider shall receive a copy of the approved service authorization printout.

(g) Upon completion of the environmental modification, the provider shall have the homeowner sign the original quote verifying that the modification is complete.

(i) The environmental modification provider shall submit the signed quote to the participant's case manager.

(ii) If the homeowner has concerns with the modification, they shall contact the case manager. The case manager shall inform the Division of the concerns.

(iii) The Division or its representative agent shall complete an on-site review of the modification to determine if it is completed as described in the original quote.

(h) The Division or its representative agent may conduct on-site visits or any other investigations deemed necessary prior to approving or denying the request for an environmental modification.

(i) The Division reserves the right to deny requests for environmental modifications that are not within usual and customary charges or industry standards.

(j) A relative, as defined in Section 3 of this Chapter, may become certified to provide this service in accordance with Chapter 45 of the Department of Health's Medicaid Rules. If a relative provider quotes an environmental modification, the case manager shall always include one (1) other quote from a non-relative environmental modification provider.

(k) In accordance with Chapter 45 of the Department of Health's Medicaid Rules, provider agencies shall be certified by the Division to provide environmental modifications prior to providing the service.

(l) There is a lifetime cap of $20,000 for environmental modifications per family, regardless of waiver. Cap begins for purchases made after July 1, 2013 on previous Wyoming waivers. Critical health or safety service requests that exceed the lifetime cap are subject to available funding and approval by the Extraordinary Care Committee (ECC).

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 6 Specialized Equipment - Scope and Limitations

(a) Specialized equipment shall be functionally necessary and meet at least two of the following criteria:

(i) Be necessary to increase ability to perform activities of daily living or to perceive, control, or communicate with the environment in which the person lives;

(ii) Be necessary to enable the participant to function with greater independence and without which the person would require institutionalization; and

(iii) Be necessary to ensure the person's health, welfare, and safety.

(b) The individualized plan of care shall reflect the need for equipment, how the equipment addresses health, safety, or accessibility needs of the participant, or allows them to function with greater independence, and include specific information on how often the equipment is used and where it is used.

(i) The case manager shall inquire with Medicaid, Medicare, or a participant's other insurance carrier to see if the requested equipment is covered under their plans.

(ii) Medicaid is a payer of last resort, and shall not pay for specialized equipment that can be paid through another source.

(i) Devices, controls, or appliances, specified in the individualized plan of care, that enable participants to increase their ability to perform activities of daily living;

(ii) Devices, controls, or appliances that enable the participant to perceive, control or communicate with the environment in which they live;

(iii) Items necessary for life support or to address physical conditions along with the ancillary supplies and equipment necessary to the proper functioning of such items;

(iv) Durable and non-durable medical equipment not available under the Medicaid state plan that is necessary to address participant functional limitations; and

(v) Necessary medical supplies not available under the Medicaid state plan or other insurance held by the participant.

(d) Items reimbursed with waiver funds are in addition to medical equipment and supplies furnished under the Medicaid state plan and exclude those items that are not of direct medical or remedial benefit to the participant. All items shall meet applicable standards of manufacture, design, and installation.

(e) Specialized equipment shall not include the following, even if prescribed by a licensed health care professional:

(i) Items paid for under the Medicaid state plan or under Early Periodic Screening, Diagnosis, and Treatment (EPSDT);

(ii) Educational or therapy items that are an extension of services provided by the Department of Education;

(iii) Items of general use that are not specific to a disability, or that would normally be available to any child or adult, including but not limited to furniture, recliners, desks, shelving, appliances, bedding, bean bag chairs, crayons, coloring books, other books, games, toys, videotapes, CD players, radios, cassette players, tape recorders, television, VCRs, DVD players, electronic games, cameras, film, swing sets, other indoor and outdoor play equipment, trampolines, strollers, play houses, bike helmets, bike trailers, bicycles, health club memberships, merry-go-rounds, golf carts, four wheelers, go-carts, scooters, vehicles, automotive parts, and motor homes;

(iv) Pools, spas, or hot tubs;

(v) Computers and computer equipment, including the CPU, hard drive, and printers, except for situations pursuant to (c) of this Section;

(vi) Items that are not proven interventions through either professional peer reviews or evidence based studies; and

(vii) Communication items such as telephones, pagers, pre-paid minute cards and monthly services.

(f) Repairs on specialized equipment shall be completed by the manufacturer, if a warranty is in place.

(g) Requests for repairs on specialized equipment not covered by warranty may be submitted to the Division for approval.

(h) Sale of specialized equipment shall not profit the participant or family.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 7 Specialized Equipment Approval Process

(a) The team may submit requests for specialized equipment during the six-month or annual plan of care meeting. Specialized equipment requests submitted at other times during the plan of care year may be submitted if significant health, safety, or access concerns are identified.

(b) Approval for specialized equipment shall require:

(i) Prior authorization from the Division; and

(ii) A recommendation from a therapist or professional with expertise in the area of need. The recommendation shall include:

(A) A description of the functional need for the specialized equipment;

(B) How the specialized equipment will contribute to a person's ability to remain in or return to his or her home and out of an ICF/IID or other institutional setting;

(D) How the specialized equipment addresses accessibility, health, or safety needs of the participant;

(E) Documentation that the participant has the capability to use the equipment;

(F) Documentation that the waiver is the payer of last resort;

(G) A description of how equipment shall be delivered and who will train the person and providers on the equipment; and

(H) Documentation of two (2) quotes for the purchase of the equipment, including a maximum markup on the equipment of 20%.

(I) The quotes may include a detailed description of the need and costs for expert assembly of the equipment in addition to the 20% markup.

(II) The quotes may include a detailed description of the need and cost for training on the specialized equipment in addition to the 20% markup.

(III) If two (2) quotes cannot be obtained, an explanation as to why only one (1) quote was submitted shall accompany the request.

(IV) The Division may review any request that does not include more than one (1) quote.

(c) The Division may schedule a review of the specialized equipment quote, including an evaluation of functional necessity, with appropriate professionals under contract with the Division. The review shall include a statement verifying that the request meets at least two (2) of the criteria pursuant to Section 6(a) of this Chapter.

(d) If the participant has an Individualized Education Plan (IEP) or Individual Family Service Plan (IFSP), the case manager shall submit a copy of that document, along with documentation as to why the equipment is not sent home with the participant, or a reason why the equipment is necessary at home but not at school.

(e) The Division may request documentation that a less expensive, comparable alternative to requested equipment or supplies is not available or practical. If a more cost-effective alternative is determined to be available, the Division shall deny the original request or specify that only the less costly equipment or supplies are approved.

(f) Equipment purchases shall not exceed $2,000 per year. If an item needed exceeds that amount, the team may request an exception to the cap through the ECC. The Division may require an assessment for specialized equipment needs by a Certified Specialized Equipment (CSE) professional. The assessment is funded as part of the $2,000 cap. Insurance on items is not covered by the waiver but may be purchased by the participant separately.

(g) Electronic technology devices are only allowed once every five (5) years and like items shall not be purchased during those five (5) years. Electronic technology devices used as augmentative and alternative communication devices are exempt from this five (5) year limitation if accompanied by a letter of necessity from a Speech Language Pathologist.

(h) In accordance with Chapter 45 of the Department of Health's Medicaid Rules, provider agencies shall be certified by the Division to provide specialized equipment.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 8 Interpretation of Chapter

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 9 Superseding Effect

This Chapter supersedes all prior rules or policy statements issued by the Division, including Provider Manuals and Provider Bulletins, which are inconsistent with this Chapter.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 10 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2019-12-20

Wyo. Code R. 048.0037.44.12202019 § 11 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each code, rule, or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Section 2 of this Chapter is title XIX of the Social Security Act, 42 C.F.R. Part 441, Subpart G, incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(ii) Referenced in Section 2 of this Chapter is Wyoming Medicaid's State Plan, incorporated as of the effective date of this Chapter and can be found at http://www.health.wyo.gov/healthcarefin/medicaid/spa.

(iii) Referenced in Section 2 of this Chapter is Wyoming's Comprehensive and Supports Waiver Applications, incorporated as of the effective date of this Chapter and can be found at https://www.health.wyo.gov/behavioralhealth/dd/waivers/.

(iv) Referenced in Section 2 of this Chapter is Wyoming's Comprehensive and Supports Waiver Service Index, incorporated as of the effective date of this Chapter and can be found at https://www.health.wyo.gov/behavioralhealth/dd/comprehensive-support-waivers/.

History

Effective 2019-12-20

Chapter 45 DD Waiver Provider Standards, Certification and Sanctions

Wyo. Code R. 048.0037.45.12202019 DD Waiver Provider Standards, Certification and Sanctions

State of Wyoming

CHAPTER 45

DD WAIVER PROVIDER STANDARDS, CERTIFICATION, AND SANCTIONS

Section 1. Authority. This Chapter is promulgated by the Department of Health pursuant to Wyoming Statute 9-2-102 and the Wyoming Medical Assistance and Services Act at W.S. 42-4-101 through -121.

Section 2. Purpose and Applicability.

(a) This Chapter was adopted to govern certification of providers under the Wyoming Medicaid Supports Waiver and Comprehensive Waiver (hereinafter collectively referred to as the "DD Waivers").

(b) This Chapter, in addition to Chapters 44 and 46 of the Wyoming Medicaid Rules, shall govern services and provider requirements of the DD Waivers.

(c) The Division of Healthcare Financing, hereinafter referred to as the "Division," may issue provider manuals and provider bulletins to providers or other affected parties to interpret the provisions of this Chapter. Such provider manuals and provider bulletins shall be consistent with and reflect the rule provision's policies, as revised in this Chapter. The provisions contained in provider manuals or provider bulletins shall be subordinate to the provisions of this Chapter.

(e) The requirements of Title XIX of the Social Security Act, 42 C.F.R., Part 441, Subpart G and the Medicaid State Plan apply to this Chapter.

Section 3. General Provisions.

(b) "Case manager" means an individual who provides case management services, as established in Section 9 of this Chapter.

(c) "Corrective Action Plan", referred to previously as a quality improvement plan, means a step by step plan of action developed by the provider to achieve targeted outcomes for resolution of identified errors in an effort to eliminate repeated deficient practices.

(d) "Elopement" means the unexpected or unauthorized absence of a participant for more than is approved in the participant's individualized plan of care when that person is receiving waiver services, or the unexpected or unauthorized absence of any duration of a participant whose absence constitutes an immediate danger to themselves or others. This could be an unexpected participant action, which may not be intentional and may be due to wandering that is secondary to dementia.

(e) "Licensed Medical Professional" means a medical professional licensed to practice in the State of Wyoming and authorized to prescribe medication.

(f) "Relative" means a participant's biological, step, or adoptive parent(s).

Section 4. Rights of Participants Receiving Services.

(a) Each participant receiving services has the same legal rights and responsibilities guaranteed to all other U.S. citizens under the United States and Wyoming constitutions and federal and state laws.

(b) Participant rights shall not be modified or suspended except in accordance with state or federal law and this Chapter. A participant's right to dignity and respect, to be free from coercion, and to receive services in settings that are physically accessible to the participant shall not be limited or restricted.

(c) The participant, the participant's legally authorized representative(s), the participant's case manager, and the Division shall be informed in writing of the grounds for a denial or limitation of rights. Such notice shall be written in plain language and shall include a statement that the participant may choose an alternative provider, if the participant or legally authorized representative disagrees with the denial or limitation. If the Division disallows a limitation of a right in an individualized plan of care, this decision will apply to any provider offering services to the participant. Rights restrictions shall constitute a material change to the individualized plan of care. The following participant rights shall not be denied or limited, except for the purpose of an identified health or safety need, which shall be included in the participant's individualized plan of care:

(i) The right to privacy;

(ii) The right to freedom from restraint;

(iii) The right to privacy in their sleeping or living quarters;

(iv) The right to sleeping and living quarters that have entrance doors that can be locked by the individual, with only appropriate staff having keys to doors;

(v) The right to choose with whom and where they live;

(vi) Freedom to furnish and decorate their sleeping or living quarters within the lease or other agreement;

(vii) Freedom and support to control their own schedules and activities;

(viii) Freedom and support to have access to food at any time;

(ix) Freedom to have visitors of their choosing at any time, and associate with people of their choosing;

(x) Freedom to communicate with people of their choosing;

(xi) Freedom to keep and use their personal possessions and property;

(xii) Control over how they spend their personal resources;

(xiii) The right to access the community; and

(xiv) The right to make and receive telephone calls. No person shall limit a participant's right to make calls to Protection & Advocacy, or state and federal oversight or protection agencies as protected by 42 U.S.C. 10841(1)(M), such as the Division or Department of Family Services.

(d) A participant's right to be free from physical, mechanical, and chemical restraints shall not be denied or limited unless a court, the participant, or the participant's legally authorized representative authorizes the denial or limitation in writing. The request shall be accompanied by letters from a licensed medical and behavioral professional that detail medical and psychological contraindications that may be associated with a restraint.

(i) Such denial or limitation shall be included in the participant's individualized plan of care, shall address how other less restrictive interventions will be used prior to a restraint, and shall detail the manner in which a restraint may be used pursuant to Section 18 of this Chapter.

(ii) The authorizing document shall be made part of the participant's individualized plan of care.

(e) A provider that offers direct services shall have and implement policies and procedures that ensure:

(i) Except as identified in this section, participants have the opportunity to maximize their rights and responsibilities;

(ii) Participants have the right to refuse services and shall not be disciplined or charged with a monetary fee for refusing home and community based waiver services;

(iii) Participants, parents of a minor, and legally authorized representatives are informed of the participant's rights and responsibilities;

(A) The information shall be given at the time of entry to direct care and case management services, annually thereafter, and when significant changes occur; and

(B) The information shall be provided in a manner that is easily understood, given verbally and in writing, in the native language of the participant or legally authorized representative(s), or through other modes of communication necessary for understanding;

(iv) Participants are supported in exercising their rights while receiving waiver services;

(v) Rights shall not be treated as privileges or things that should be earned; and

(vi) Retaliation against a participant's services and supports due to the participant, family members, or legally authorized representatives advocating on behalf of the participant or initiating a complaint with an outside agency, is prohibited.

(f) Providers shall not request or require participants to waive or limit their rights as a condition of receiving service.

(g) Providers shall not intimidate, threaten, coerce, discriminate against, or take other retaliatory action against any individual who exercises any right established by, or for participation in any process provided in, these rules or the Wyoming Medical Assistance and Services Act.

(h) When rights restrictions are deemed necessary, the individualized plan of care shall include a rights restriction protocol that addresses the reasons for the rights restriction(s), including the legal document, court order, guardianship papers, or medical order, that allows a person other than the participant to authorize a restriction to be imposed.

(i) For any rights restriction imposed, the following items shall be addressed and documented in the individualized plan of care:

(A) Identification of the specific and individualized assessed need;

(B) Documentation of the positive interventions and supports used prior to any modifications to the individualized plan of care;

(D) A clear description of the condition that is directly proportionate to the specific assessed need;

(E) A system of regular data collection and review to measure the ongoing effectiveness of the modification;

(F) Established time limits for periodic reviews, not to exceed six (6) months, to determine if the modification is still necessary or can be terminated;

(G) Informed consent of the individual; and

(H) Assurance that interventions and supports will cause no harm to the individual.

(ii) In addition to the items mentioned in this Section, the individualized plan of care shall address how the team will work to restore any right described in this Section that has been limited or denied.

Section 5. Provider Qualifications for Each Waiver Service.

(a) All individual waiver providers, subcontractors, and provider employees offering direct services to waiver participants shall meet the following requirements unless otherwise specified in this Section:

(i) Be eighteen (18) years or older;

(ii) Be certified by the Division to provide the indicated service;

(iii) Maintain current CPR and First Aid Certification, which includes hands-on training from a trainer certified with a curriculum consistent with training standards set forth by the American Heart Association or the American Red Cross;

(iv) Have a valid email address, internet access, and the means to upload documentation into a Division designated portal; and

(v) If assisting with medications, maintain a current certificate in medication assistance training offered through the Division.

(b) A provider shall also meet the following specific requirements for the service in which they want to receive and maintain certification:

(i) Behavioral Support Services. A Behavioral Support Services provider or provider staff shall meet credentials as outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference.

(ii) Case Management.

(A) All providers of case management services shall have one (1) of the following:

(I) A Master's degree from an accredited college or university in one (1) of the following related human service fields:

(1.) Counseling;

(2.) Education;

(3.) Gerontology;

(4.) Human Services;

(5.) Nursing;

(6.) Psychology;

(7.) Rehabilitation;

(8.) Social Work;

(9.) Sociology; or

(10.) A related degree, as approved by the Division.

(II) A Bachelor's degree in one (1) of the related fields from subsection (b)(ii)(A)(I) of this Section from an accredited college or university, and one (1) year work experience as a case manager or in a related human services field.

(III) An Associate's degree in a related field from subsection (b)(ii)(A)(I) of this Section from an accredited college, and four (4) years of work experience as a case manager or in a related human services field.

(B) A case manager shall obtain and maintain his or her own National Provider Identifier (NPI) number for case management services through the Medicaid enrollment process.

(C) A case manager shall obtain and provide evidence of eight (8) hours of continued education relating to the delivery of case management services during each year of certification.

(D) A provider agency certified to provide case management services shall:

(I) Identify a back-up case manager from the list of Division certified case managers for each participant, and have policies and procedures for backup case management for each person's caseload, which include a process for how and when the case manager will notify the plan of care team that the backup case manager should be the primary contact. Case managers shall meet with their designated backup to review all participant cases on a quarterly basis. The review shall be documented in case notes.

(II) Document on the individualized plan of care that they have no conflict of interest with the participant or family.

(III) Meet all of the following conflict of interest requirements.

(1.) The case management agency and any managing employee shall not own, operate, be employed by, or have a financial interest in or financial relationship with any other person or entity providing services to a participant.

(2.) The case management agency may be certified in other waiver services, but shall not provide case management services to any participant to whom they are providing any other waiver services, including self-directed services.

(3.) The owner, operator, or managing employee of a case management agency shall not be related within the third degree by blood or marriage to the owner, operator, or managing employee of any other waiver service provider on the participant's individualized plan of care. A relationship within the third degree includes the spouse; biological, step, or adoptive parent; mother, father, brother, or sister-in-law; biological, step, or adoptive child; biological, step, or adoptive sibling; grand or great grand-parent or child; or aunt, uncle, niece, or nephew.

(4.) Any employee of a guardianship agency shall not provide case management to any participant who is receiving any services from the guardianship agency.

(5.) The case management agency shall not:

a. Employ case managers that are related to the participant, the participant's guardian, or a legally authorized representative, within the third degree, served by the agency. If the case management agency is a sole proprietor, the case manager shall not be related to the participant, the participant's guardian, or a legally authorized representative, within the third degree, served by the agency;

b. Make financial or health-related decisions on behalf of the participant receiving services from that agency, including but not limited to a guardian, representative payee, power of attorney, or conservator; or

c. Provide case management services to, or live in the same residence of, any provider on a participant's individualized plan of care in which they provide case management services.

(E) If a rural area of the State does not have a case manager without a conflict of interest for a participant, the participant or legally authorized representative may request to have a case manager with a conflict. If the Division confirms that there are no other case managers available in the region or a nearby region to provide case management, then the conflicted case manager may be approved on an annual basis. A third party entity without a conflict shall be involved in the participant's team to mediate, advocate for the participant as needed, and address unresolved grievances for any conflicts that are approved.

(F) All case managers shall notify the provider of a participant's or legally authorized representative's decision to discontinue services within three (3) business days.

(iii) Child Habilitation. A Child Habilitation provider, if operating a day care while also providing child habilitation services, shall follow the Department of Family Services licensing rules in addition to meeting the Medicaid waiver provider rules.

(iv) Cognitive Retraining. A Cognitive Retraining provider shall:

(A) Be certified in Cognitive Retraining from an accredited institution of higher learning;

(B) Be a certified Brain Injury Specialist through the Brain Injury Association of America; or

(C) Be a licensed professional with one year of acquired brain injury training or Bachelor's degree in related field and three (3) years of experience in working with acquired brain injuries.

(v) Dietician. A Dietician provider or provider staff shall have a license to provide dietician services by the Wyoming Dietetics Board and have a current National Provider Identifier (NPI).

(vi) Environmental Modification. Environmental Modification providers shall have all applicable building, construction, and engineer license and certifications that may be required to work as a contractor at the location where services will be provided. Employees do not have to be certified in CPR or First aid, complete a background check, or have participant specific training. The provider shall report critical incidents as defined in Section 20.

(vii) Individual Habilitation Training. Within one (1) year of being certified in this service, and annually thereafter, the provider or staff providing the service shall successfully complete at least eight (8) hours of continued education in any of the following areas: specific disabilities or diagnosed conditions relating to the population served, writing measurable objectives, gathering and using data to develop better training programs, or training modules posted by the Division.

(viii) Homemaker. A provider of Homemaker services shall be at least eighteen (18) years old but does not have to be certified in CPR and First Aid.

(ix) Occupational Therapy. An Occupational Therapy provider or provider staff shall have a current license to practice occupational therapy by the Wyoming Board of Occupational Therapy and have a current NPI.

(x) Physical Therapy. A Physical Therapy provider or provider staff shall have a current license to practice physical therapy by the Wyoming Board of Physical Therapy and have a current NPI.

(xi) Skilled Nursing. A skilled nursing provider or provider staff shall be licensed to practice nursing by the Wyoming Board of Nursing, and have a current NPI.

(xii) Special Family Habilitation Home. A Special Family Habilitation Home provider shall be at least 21 years of age.

(xiii) Specialized Equipment. A Specialized Equipment provider shall have the applicable license or certification for the type of equipment purchased, and does not have to be certified in CPR or First Aid.

(xiv) Speech, Hearing, and Language Services. A Speech, Hearing, and Language Service provider or provider staff shall have a current license to practice Speech, Hearing and Language Services by the Wyoming Board of Speech Pathology and Audiology, and have a current NPI.

(xv) Transportation. A Transportation provider shall have a current, valid driver's license; automobile insurance; and additional liability insurance for transporting people for business purposes.

Section 6. Standards for all Providers.

(a) Consistent with the provisions of this chapter, providers shall:

(i) Protect participants from abuse, neglect, mistreatment, intimidation, and exploitation;

(ii) Treat participants with consideration, respect, and dignity;

(iii) Honor participants' preferences, interests, and goals;

(iv) Provide participants with daily opportunities to make choices and participate in decision making;

(v) Facilitate activities that are meaningful and functional for each participant;

(vi) Direct services toward maximizing the growth and development of each participant for maximum community participation and citizenship;

(vii) Provide services in the most appropriate, least restrictive, most integrated environment;

(viii) Encourage participants to express their wishes, desires, and needs;

(ix) Protect and promote the health, safety, and well-being of each participant;

(x) Design services to meet the needs of all participants served by the provider; and

(xi) Establish and implement written policies and procedures that:

(A) Are available to staff, participants, legally authorized representatives and, upon request, the general public;

(B) Are updated or revised as needed by rule or policy changes;

(D) Describe the provider's operation and how systems are set up to meet participants' needs.

(b) Before providing services to a participant, the provider shall gather and review referral information regarding the participant so, to the greatest extent possible, the provider is aware of the participant's preferences, strengths, and needs. The provider shall use this information to:

(i) Make a determination as to whether the provider is capable of providing services to meet the participant's needs;

(ii) Consider the safety of all participants who the provider serves in the decision to accept new participants to services or the location for the services; and

(iii) Consider whether the provider has the capacity, commitment, and resources necessary to provide supports to the participant served. The provider shall not serve a participant if the provider cannot reasonably assure the participant, legally authorized representative, and case manager that it has the ability to meet the participant's needs.

(c) The provider shall orient, train, and manage staff with the skills necessary to meet the needs of participants in their services, and be able to respond to emergencies.

(d) The provider shall facilitate opportunities for all participants to receive services consistent with the needs and preferences of the participant.

(e) The provider shall develop a process for detecting and preventing abuse, neglect, exploitation, and intimidation, and handling allegations of abuse, neglect, exploitation, and intimidation in accordance with state and federal statutes and rules.

(f) The provider shall, at all times, maintain documentation to demonstrate sufficient staff provide services, supports, and supervision to meet the needs of each participant per the participant's individualized plan of care.

(g) The provider shall implement reasonable and appropriate policies and procedures to comply with the standards, specifications, and requirements of this Chapter and the Comprehensive and Supports Waiver Service Index, which is incorporated by reference. Compliance with this provision does not permit or excuse a violation of any standard, specification, or requirement of this Chapter. A provider may change its policies or procedures at any time, provided that the changes are documented, implemented, and maintained in accordance with the standards, specifications, and requirements of these rules.

(h) Any person who provides a service for which a license, certification, registration, or other credential is required shall hold the current license, certification, registration, or credential in accordance with applicable state laws. The license holder shall notify the Division if the license, certification, registration, or credential is revoked, within ten (10) business days. The provider shall maintain documentation of the staff credentials.

(i) If the Division receives information that the provider no longer meets the qualifications for a service for which the provider is certified, the Division shall send notice to the provider within five (5) business days regarding this missing qualification and the applicable sanction. If the missing qualification is not obtained within the timeframe given by the Division, the provider is disqualified from providing such waiver service(s).

(j) Providers that subcontract for services shall be responsible for assuring that the subcontractors meet all applicable requirements, qualifications, and standards for the services being provided. Failure of a provider that subcontracts to assure that the subcontractor meets all applicable requirements and standards may result in revocation of the provider's certification pursuant to Section 30 of this Chapter.

Section 7. Provider Recordkeeping and Data Collection.

(a) The provider shall collect and maintain data, records, and information as necessary to provide services.

(b) The provider shall develop and maintain a record keeping system that includes a separate record for each participant served.

(c) The provider shall develop and implement a systematic organization of records to ensure permanency, accuracy, completeness, and easy retrieval of information.

(d) The provider shall develop a process relating to retention, safe storage, and safe destruction of the participant's records to ensure retention of necessary information and to protect confidentiality of records. The provider shall retain all records relating to the participant and the provision of services in accordance with Chapter 3 of the Department of Health's Medicaid Rules.

(e) If there are changes in ownership of the provider agency, complete and accurate copies of all participant records shall be transferred to the participant's newly chosen provider. Before dissolution of any provider agency, the provider shall follow Medicaid disenrollment procedures and notify the Division in writing of the location and secure storage of any remaining participant records.

(f) The provider shall establish and implement policies that govern access to, duplication, dissemination, and release of information from the participant's record, which are consistent with applicable state and federal laws.

(g) Except as otherwise provided by law, the provider shall obtain a written authorization from the participant or the participant's legally authorized representative for the release of participant information that identifies or can readily be associated with the identity of a participant. The authorization shall comply with the requirements for hospital records identified in W.S. 35-2-607.

(h) Providers shall make all records maintained or controlled by the provider available upon request to Division staff, representatives from the State or Federal Medicaid programs, or the Medicaid Fraud Control Unit, without prior written authorization, consent, or other form of release.

(i) The provider shall specify the method and frequency for obtaining authorizations for medical treatment and consents.

(j) The provider shall ensure that all record entries are dated, legible, and clearly identify the person making the entry.

Section 8. Documentation Standards.

(a) In addition to the requirements of Chapter 3 of the Department of Health's Medicaid Rules, the following provisions shall apply to the documentation of services, and medical and financial records, including information regarding dates of services, diagnoses, services furnished, and claims affected by this Chapter.

(b) A provider shall complete all required documentation, including the required signatures, before or at the time the provider submits a claim.

(i) Documentation prepared or completed after the submission of a claim is prohibited. The Division shall deem the documentation to be insufficient to substantiate the claim, and Medicaid funds shall be withheld or recovered.

(ii) Documentation shall not be altered in any way once billing is submitted, unless the participant or legally authorized representative requests an amendment to the documentation in accordance with the patient privacy rules in the Health Insurance Portability and Accountability Act of 1996.

(d) Electronic documentation shall capture all data required by subsection (e) of this Section, shall include electronic signatures and automatic date stamps pursuant to W.S. 40-21-107, and shall have automated tracking of all attempts to alter or delete information that was previously entered.

(i) Electronic records shall not be altered or deleted prior to submission of payment unless incorrect, and the purpose of the correction shall be captured in the electronic documentation system.

(ii) If anyone other than the employee who provided the service completes electronic documentation for the purpose of claims submission, the provider of the service shall separately maintain all written or electronic service documentation to support the claim.

(iii) A provider shall make a participant's electronic case file, specific to the case manager's caseload, available to a case manager in the electronic record in order to comply with the required documentation reviews and service unit utilization specified in this Chapter.

(iv) Case management monthly documentation in the Electronic Medicaid Waiver System (EMWS), or its successor, once marked as final and submitted to the Division in the web portal, meets the requirements for an electronic signature and date stamp. These records shall not be altered once the case manager bills for the service provided.

(e) For written documentation, each physical page of documentation shall include:

(i) The full legal name of the participant;

(ii) The individualized plan of care start date for the participant;

(iii) The name and billing code of the service provided; and

(iv) A legible signature of each person performing a service, if initials are being used for documentation purposes.

(f) The following information shall be included each time a service is documented:

(i) The location of services;

(ii) The date of service, including year, month, and day;

(iii) The time services begin and end, using either AM and PM or military time, with documentation for each calendar day, even when services span a period longer than one calendar day;

(iv) An initial or signature of the person performing the service; and

(v) A detailed description of services provided that:

(A) Consists of a personalized list of tasks or activities that describe a typical day, week, or month for a participant, in which the participant and legally authorized representative has provided input;

(B) Supports recommendations from assessments by therapists, licensed medical professionals, psychologists, and other professionals in a manner that prevents the provision of unnecessary or inappropriate services and supports;

(D) Includes specific objectives for habilitation services, support needs, and health and safety needs.

(g) Different services shall be documented on separate forms and shall be clearly separated by time in and out, service name, documentation of services provided, signature of staff providing services, and printed name of staff providing the service.

(h) A provider shall not bill for the provision of more than one direct service for the same participant at the same time unless the participant's approved individualized plan of care identifies the need for more than one (1) direct service to be provided at the same time.

(i) A provider staff member shall not bill for the provision of more than one direct service for different participants at the same time.

(j) A provider shall not round up total service time to the next unit, except as outlined in the Skilled Nursing section of the Comprehensive and Supports Waiver Service Index.

(k) Documentation of services shall be legible, retrieved easily upon request, complete, and unaltered. If hand written, documentation shall be completed in permanent ink.

(l) Services shall meet the service definitions outlined in the Comprehensive and Supports Waiver Service Index, and be provided pursuant to a participant's individualized plan of care.

(m) For all direct care waiver services, the participant shall be in attendance in the service in order for the provider to bill for services.

(n) The provider shall make service documentation for services rendered available to the case manager each month by the tenth (10th) business day of the month following the date that the services were rendered. If services are not delivered during a month, the provider shall report the zero (0) units used to the case manager by the tenth (10th) business day of the following month.

(i) Failure to make documentation available by the tenth (10th) business day of the month may result in a corrective action plan or sanctioning.

(ii) The case manager shall give written notification of noncompliance to the provider with a copy submitted to the Behavioral Health Division. Chronic failure to make documentation available may result in provider sanctions.

(o) The provider shall make unit billing information for services rendered available to the case manager by the tenth (10th) business day of the month after unit billing has been submitted for payment.

Section 9. Case Management Services.

(a) Case management is a mandatory service for all participants enrolled on the waivers.

(b) Case managers shall complete all eligibility paperwork, as established under Chapter 46 of the Department of Health's Medicaid Rules, within thirty (30) calendar days.

(c) The case manager shall use person-centered planning to understand the needs, preferences, goals, and desired accomplishments of the participant. The case manager shall coordinate and assist the participant in accessing all needed and available resources, such as natural, paid, and community support. The case manager shall develop and monitor the implementation of an individualized plan of care.

(d) The case manager shall assure that all information, including but not limited to guardianship paperwork and physical and mailing addresses of the participant, legally authorized representative(s), and other contacts is updated and accurate at all times. The case manager shall update the Division and other providers of any changes.

(e) The case manager shall maintain a participant's file and service documentation.

(i) The case manager shall assure information is disseminated to, and received by, the participant and appropriate parties involved in the participant's care or as authorized by a signed release of information by the participant or the participant's legally authorized representative(s).

(ii) The case manager shall arrange and coordinate eligibility for applicants or waiver participants by providing:

(A) Targeted case management services to an applicant who is in the eligibility process for waiver services or awaiting a funding opportunity; and

(B) Services that include the coordination and gathering of information needed for initial and annual certification, clinical and financial eligibility, and the level of care determination.

(iii) The case manager shall provide the participant and any legally authorized representative(s) with a list of all providers available in their community in order to allow the participant a choice of providers. To the extent that they are available, participant choice shall include any certified waiver provider, self-directed options, Medicaid State Plan services, and services offered by other state agencies, as well as community and natural supports.

(A) At least once every six (6) months, the case manager shall provide information to the participant or the legally authorized representative(s) on all available waiver services, including self-direction service delivery options. This may be done more frequently as requested by the participant or legally authorized representative(s).

(B) The case manager shall coordinate transition plans when the participant chooses to change, stop, or add providers to his or her individualized plan of care, or exit the waiver, as established under Section 22 of this Chapter.

(C) If the case manager chooses to discontinue providing services, the case manager shall give the participant, legally authorized representative(s), and Division thirty (30) calendar days written notice. The case manager shall continue to provide case management services for the thirty (30) calendar days, or until a new case manager is approved, whichever is first.

(iv) The case manager shall involve and assist the participant's plan of care team with developing a person-centered individualized plan of care in accordance with this Chapter. The case manager shall assist the team with planning, budgeting, and prioritizing services for the participant using all available resources and the assigned individual budget amount.

(v) The case manager shall complete and submit the individualized plan of care, including all required components, in EMWS, or its successor, at least thirty (30) days before the intended plan start date.

(vi) If the participant chooses to self-direct services on the waiver, the case manager shall assist the participant in modifying the individualized plan of care as needed, and monitoring the services of the Financial Management Service utilized by the participant in accordance with the approved waiver.

(vii) The case manager shall ensure all providers on the participant's individualized plan of care sign off on the plan, receive a copy of the plan, receive team meeting notes, and complete participant specific training as required in Section 15(g) of this Chapter. Documentation of participant specific training shall be available to the Division upon request.

(viii) The case manager shall monitor and evaluate the implementation of the participant's individualized plan of care, including a review of the type, scope, frequency, duration, and effectiveness of services, as well as the participant's satisfaction with the supports and services. On a quarterly basis, the case manager shall include this information in a report prescribed by the Division.

(ix) The case manager shall report to the provider any concerns with provider implementation of the individualized plan of care, or concerns with the health and safety of a participant. Rule violations shall be reported to the Division through the incident reporting or complaint processes.

(x) The case manager shall send the Division and the provider or employer of record written notification of noncompliance with these rules, the health, safety, or rights of the participant specified in the individualized plan of care, or when documentation is not received by the tenth (10th) business day of the following month after services were provided.

(xi) The case manager shall securely store and retain all confidential provider documentation received from other providers for a participant's services for a twelve (12) month period from the month services were rendered and shall follow safe destruction policies as established under Section 7 of this Chapter, even if the participant changes case managers.

(xii) The case manager shall document all monitoring and evaluation activities, follow-up on concerns and actions completed, and make appropriate changes to the individualized plan of care with team involvement, as needed.

(f) The case manager shall be the second-line monitor for participants receiving medications. Second-line monitoring shall help to ensure a participant's medical needs are addressed and medication regimens are delivered in a manner that promotes the health, safety, and well-being of the participant. The case manager shall provide monitoring of, and review trends regarding, the usage of the participant's over-the-counter and prescription medications through a monthly review of medication assistance records and PRN medication usage records.

(g) The Division may establish caseload limits to ensure the case manager effectively coordinates services with all participants on his or her caseload.

Section 10. Individualized Plan of Care.

(a) A case manager shall convene the plan of care team to develop an individualized plan of care for each participant on his or her caseload, and base the plan on the results of the comprehensive assessment(s) and the person-centered planning process. The team shall be comprised of persons who are knowledgeable about the participant and are qualified to assist in developing an individualized plan of care for that person, including: the participant; any legally authorized representative(s); the case manager; providers chosen by the participant; and any other advocate, family member, or entity chosen by the participant or the participant's legally authorized representative(s).

(b) The plan of care meeting shall be timely and occur at times and locations that are convenient for the participant.

(c) The case manager shall provide written notice of the plan of care meeting to all team members at least twenty (20) calendar days prior to the meeting.

(d) The individualized plan of care shall not exceed twelve (12) months and shall be developed in accordance with state and federal rules, which include the submission of the complete individualized plan of care to the Division at least thirty (30) days prior to the plan start date. Corrections to the individualized plan of care required by the Division shall be submitted by the case manager within seven (7) business days of being issued.

(e) The individualized plan of care shall include:

(i) Necessary information and support to the participant to ensure that the participant directs the process to the maximum extent possible;

(ii) Services in a setting chosen by the participant from all service options available, including non-disability specific settings and alternate settings that were considered;

(iii) Opportunities for the participant to seek employment and work in competitive integrated settings;

(iv) Opportunities for the participant to engage in community life, control personal resources, and receive services in the community to the same degree of access as individuals not receiving Medicaid home and community-based services;

(v) Cultural and religious considerations;

(vi) Services based on the choices made by the participant regarding supports the participant receives and from whom;

(vii) What is important to the participant and for the participant;

(viii) Services provided in a manner reflecting personal preferences and ensuring health and welfare;

(ix) Services based on the participant's strengths and preferences;

(x) Any rights restrictions, including why the restriction is imposed, how the restriction is imposed, and the plan to restore the right to the fullest extent possible;

(xi) Clinical and support needs;

(xii) Participant's desired outcomes;

(xiii) Risk factors and plans to minimize them;

(xiv) Individualized backup plans and strategies, when needed;

(xv) Individuals important in supporting the participant, such as friends, family, professionals, specific staff or providers;

(xvi) Learning objectives for habilitation services that address the training activities, training methods, and the measurement used to gauge learning;

(xvii) Relevant protocols that have been updated within the past year;

(xviii) Informed consent of the participant or legally authorized representative in writing; and

(xix) Signatures of all providers listed in the individualized plan of care after the draft plan, as written, is completed by the team including participant's signature for informed consent.

(f) The individualized plan of care shall include information addressing a provider's inability to provide any of the supports outlined in subsection (e) of this Section.

(g) The individualized plan of care shall be reviewed at least semi-annually, when the participant's circumstances or needs change significantly, or at the request of any team member. The plan shall be revised upon reassessment of functional need, as needs arise, and every twelve (12) months for a new plan year.

(h) The individualized plan of care shall be written in plain language that is understandable to the participant, legally authorized representative(s), and persons serving the participant.

Section 11. Rate Reimbursement Requirements.

(a) Providers shall be reimbursed for services through the rate methodology established in the corresponding waiver agreement with CMS.

(b) Rates paid to providers for waiver services shall be less than or equal to the usual and customary rates for similar non-waiver services.

(i) The Department shall consult with waiver service providers, developmental disability waiver program participants and their families to gather information about reimbursement rates prior to calculating the new reimbursement rates.

(ii) If third party expertise is necessary, the Department shall follow a competitive bidding process to procure the services of an expert in the development of cost-based waiver program payments to assist with the development of new reimbursement rates for waiver providers.

(iii) The Department shall receive approval from CMS prior to the implementation of a new or modified reimbursement rate setting methodology.

(i) Cost data;

(ii) Claims data; and

(iii) Participant needs assessment data.

(d) Providers shall participate in reasonable audits of the data submitted in subsection (c).

Section 12. THIS SECTION RESERVED FOR FUTURE RULEMAKING

Section 13. Standards for Home and Community Based Waiver Services.

(a) Certified waiver providers offering direct care services to participants in a provider owned or operated service setting shall meet all applicable federal, state, city, county, and tribal health and safety code requirements. A service setting includes the provider's home, if services are routinely provided in that setting.

(b) Certified waiver providers shall provide services that are home and community-based in nature, which means the service setting:

(i) Assists the participant to achieve success in the setting environment and supports full access to the greater community to the same degree as individuals not receiving Medicaid home and community based services (HCBS);

(ii) Is selected by the individual from options including non-disability specific settings;

(iii) Assists the participant to advocate for him or herself, and participate in life-long learning opportunities;

(iv) Ensures an individual's rights of privacy, dignity, respect, and freedom from coercion and restraint;

(v) Optimizes, but does not regiment, individual initiative, autonomy, and independence in making life choices, including daily activities, recreational activities, physical environment, and with whom to interact;

(vi) Facilitates individual choice regarding services and supports and who provides them; and

(vii) Encourages individuals to have visitors of their choosing at any time.

(i) Any setting that is located in a building that is also a publicly or privately operated facility that provides inpatient institutional treatment;

(ii) Any setting that is in a building on the grounds of, or immediately adjacent to, a public institution; or

(iii) Any other setting that has the effect of isolating individuals receiving Medicaid HCBS from the broader community of individuals not receiving Medicaid HCBS.

(d) New provider owned or operated community living settings serving five (5) or more participants shall not be certified.

(e) Provider service setting inspections.

(i) For each location where services are provided to a participant, the provider shall obtain an inspection of the service setting by an outside entity at least once every twenty-four (24) months. The Division may require more frequent inspections if the Division suspects that the service setting would not pass the inspection.

(ii) The inspection of the service setting shall be completed by one or more of the following outside entities:

(A) A fire marshal or designee;

(B) A certified or licensed home or building inspector; or

(iii) Inspections of service settings required by this Section shall include verification that:

(A) All areas are free of fire and safety hazards, including, but not limited to, all living and service areas, as well as the garage, attic, and basement areas; and

(B) The service setting is free of any other significant health or safety concerns, including structural concerns, wiring problems, plumbing problems, and any major system concerns.

(iv) Inspections of service settings shall include a written report that describes the items inspected and recommendations to address areas of deficiencies.

(v) If the inspection of the service setting identifies deficiencies, the provider shall remediate deficiencies within thirty (30) calendar days. If deficiencies cannot be corrected within thirty (30) calendar days, a written plan on how deficiencies will be remediated, including the anticipated date of completion, shall be completed within thirty (30) calendar days of the initial report, and available to the Division upon request.

(A) The written plan shall address all identified deficiencies and the intended completion dates.

(B) The Division may request additional corrective actions or proof of corrections made, based on the inspector's report.

(vi) External inspections shall be required on all new locations before services are provided in the new location.

(A) The provider shall notify the Division of the new location at least thirty (30) calendar days before the location is to be used to provide services.

(B) The provider shall not provide services in the new location until the Division has reviewed the external inspection report and has verified that all recommendations have been addressed. The Division shall complete an on-site visit within six (6) months.

(C) Services shall not be provided in a setting that does not pass the initial inspection until all deficiencies have been corrected.

(vii) Providers that are not required to have an inspection of the home or service setting shall sign a form designated by the Division to verify they are not providing services in a provider-owned or leased service setting.

(viii) Except as described in subsection (a) of this Section, providers shall not provide services in a service setting that is owned or leased by the provider or an employee, which has not had a current inspection completed. The Division may sanction or decertify any provider if they are subsequently found to be providing services in a service setting owned or leased by the provider or employee, which has not previously passed inspection.

(f) A provider offering services in a service setting they own or lease shall complete an annual self-inspection of the service setting to verify that the provider is in compliance with this Section, and shall address any deficiencies found.

(g) Emergency plans.

(i) Providers shall have written emergency plans and procedures for:

(A) Fires;

(B) Bomb threats;

(D) Power and other utility failures;

(E) Medical emergencies;

(F) Missing person;

(G) Provider incapacity;

(H) Safety during violent or other threatening situations;

(I) Staffing shortages due to other emergency situations;

(J) Vehicle emergencies; and

(K) If applicable, how the provider is able to care for or provide supervision to both participants and any children under the age of 12 or other individuals requiring support and supervision.

(ii) The emergency plans shall include a contingency plan that assures that there is a continuation of essential services when emergencies occur.

(iii) The provider shall document the review of all applicable emergency plans, with staff and participants, at least once every twelve (12) months on routine shifts. The documentation shall include:

(A) Written identification of concerns noted during the review of plans;

(B) Written documentation of follow-up to concerns noted during the review of plans; and

(h) All service settings owned or controlled by a provider shall meet the following requirements:

(i) In community living service and day service settings, the provider shall ensure participants have access to food at all times, and provide nutritious meal and snack options. Providers shall not require a regimented meal schedule except as outlined in subsection (n) of this Section.

(ii) Raw and prepared food, if removed from the container or package in which it was originally packaged, shall be stored in clean, covered, dated, and labeled containers. Fruit and vegetable produce may remain unmarked unless partially prepared or used.

(iii) All food shall be served in a clean and sanitary manner.

(iv) Floors and floor coverings shall be maintained in good repair, with the exception of incidental stains natural to the life of the carpet, and shall not be visibly soiled, malodorous, or damaged.

(v) Walls, wall coverings, and ceilings shall be maintained in good repair and shall not be visibly soiled or damaged.

(vi) All doors, windows, and other exits to the outside shall be reasonably protected against the entrance of insects and rodents, and shall be maintained in good repair.

(vii) All windows shall be free of cracks or breaks.

(viii) All medications, chemicals, poisons, and household cleaners shall be secured in a manner that minimizes the risk of improper use or harm to individuals in the setting.

(ix) All restrooms shall contain trash receptacles, towels, hand cleanser, and toilet tissue at all times.

(x) Restrooms shall be kept clean and sanitary, and maintained in good repair.

(xi) The overall condition of the home or service setting shall be maintained in a clean, uncluttered, sanitary, and healthful manner that does not impede mobility or jeopardize a participant's health or safety, and allows physical access.

(xii) Providers shall not use video monitors in participant bedrooms or bathrooms. Other forms of remote monitoring, remote support, or sensors may be used where appropriate, and shall be documented in the participant's individualized plan of care.

(A) The consent of participants who share living quarters and may be affected shall be obtained prior to the implementation of remote support or monitoring.

(B) Consent shall be documented in each participant's individualized plan of care, which is verified by the plan of care team.

(xiii) A provider service setting with a private water supply shall have testing conducted every three (3) years to demonstrate that the water is safe to drink. The written results shall be submitted to the Division within thirty (30) calendar days of receiving test results.

(xiv) Providers shall ensure that all participants residing in a provider owned or leased service setting have:

(A) A lease or residency agreement for the location in which they are agreeing to reside. The lease or agreement shall be signed by the participant or legally authorized representative, and the provider. The lease or agreement shall allow the same responsibilities and protections from eviction as all tenants under landlord tenant law of the state, as established under W.S. 1-21-1201 through -1211, the county, and the city where the service setting is located. A participant shall not be asked to leave his or her residence on a regular basis to accommodate the provider;

(B) Freedom and support to control their schedules and activities;

(D) Freedom to furnish and decorate their sleeping and living units within the lease or other agreement;

(E) A private bedroom with no more than one (1) person to a bedroom unless a more preferred situation is identified in his or her individualized plan of care and one (1) of the following criteria is met:

(I) The participant is under two (2) years of age;

(II) The services provided are episodic;

(III) The arrangement is determined medically necessary; or

(IV) The participants request to share a bedroom.

(F) An individual bed, unless the participant is married or joint sleeping accommodations are specifically requested by the participant, and specified in the individualized plan of care;

(G) Access to appropriate egress and a lockable entrance, which can be unlocked by the participant. No devices shall be used that prohibit a participant's entry or exit from the bedroom;

(H) A secure place for personal belongings, which the participant may freely access;

(I) A key or other type of access to a lock for the housing unit, the participant's bedroom, and any form of locked storage where the participant's personal belongings are kept, with only appropriate staff having keys to doors; and

(J) Other appropriate sleeping quarters as necessary to meet health and safety needs for an emergency placement, as long as the sleeping area allows for personal privacy and immediate egress.

(I) Emergency placement, due to situations defined in Chapter 46, Section 14, shall be limited to one week. A participant may request additional emergency placement on a week-by-week basis if the emergency continues and affirmative steps to secure alternative permanent placement are not successful.

(II) Following emergency placement, the participant shall be permitted to transfer to permanent housing. If the provider is no longer able to serve the participant in permanent housing, the case manager will present the participant with options to transition to other certified providers.

(K) Providers shall notify the Division in writing within seven (7) calendar days if additional individuals move into the home or have the intent of staying in the home for a period longer than one month.

(xv) Written policies to address health, safety, and rights. Providers shall share policies with participants and the legally authorized representative before the participant formally chooses the provider. Print information shall be written in plain language. Policies shall include, but are not limited to:

(A) A smoking policy that assures protection of the health of the participant, if occupants or visitors of the home smoke;

(B) A pet policy that includes verification that pets have current vaccinations, if occupants or visitors have pets; and

(C) A weapons policy that includes the requirements that weapons are stored in a locked cabinet or inaccessible location, and ammunition is stored separately from weapons, if occupants or visitors have weapons in the home.

(i) The provider may be required to provide written verification of their organization's ability to provide support and supervision to children under the age of twelve (12) or other participants requiring support and supervision who are in the care and responsibility of the provider. This may include, but is not limited to, licensure by the Department of Family Services or other appropriate state agency.

(j) Unless otherwise directed by the participant's licensed medical professional, or it is otherwise indicated in the individualized plan of care, community living service providers shall ensure each participant receives a medical evaluation every twelve (12) months.

(k) Each provider shall identify, in writing, the potential conflicts of interest among employees, other service providers on the participant's plan, relatives to participants, or any legally authorized representative(s), and address how a conflict of interest shall be mitigated. The provider shall share this information with potential participants and legally authorized representative(s) before the provider is chosen to provide services.

(l) Any provider that is transporting participants shall comply with all applicable federal, state, county, and city laws and requirements including, but not limited to, vehicle and driver licensing and insurance, and shall:

(i) Maintain vehicles in good repair;

(ii) Keep and replenish first aid supplies in the vehicle; and

(iii) Conduct quarterly self-inspections or have the vehicle inspected by a mechanic to ensure that the vehicle is operational, safe, and in good repair.

(m) Each provider certified to provide employment services, including supported employment and group supported employment services, shall ensure that:

(i) The participant is involved in making informed employment related decisions;

(ii) The participant is linked to services and community resources that enable them to achieve their employment objectives;

(iii) The participant is given information on local job opportunities; and

(iv) The participant's satisfaction with employment services is assessed on a regular basis.

(n) Settings that include any restriction to a participant's right to food, or a non-regimented meal schedule imposed by a provider, shall be ordered by the participant's attending medical professional with evidence in the individualized plan of care that details the assessed need for the order and the protocols that shall be followed.

(o) A participant's right to visitors, communication, privacy, or other standard in this Section may only be restricted as documented in an approved individualized plan of care with the restriction being time-limited and following the requirements listed in Section 4 of this Chapter.

Section 14. Background Check Requirements.

(a) All persons providing waiver services including: managers, supervisors, direct care staff, participant employees hired through self-direction, and any other person who may have unsupervised access to participants shall complete and pass a background screening as referenced in this Section. Persons who do not successfully pass a background screening shall not supervise, provide, or bill for waiver services, or otherwise have unsupervised access to participants on behalf of a provider.

(b) Certified providers, their employees, and all legal entities supervising, providing, or billing for waiver services shall also pass and maintain documentation of successful Department of Family Services Central Registry screening and an Office of Inspector General Exclusion Database screening. Entities that do not successfully pass these screenings shall be denied certification or terminated.

(c) Any provider or participant who employs an individual or entity to supervise, provide, or bill for waiver services who has not completed all required background checks may be subject to sanctions under these rules.

(d) Providers and self-direction employees shall show evidence of current background screenings for all required persons as part of the provider or employee's certification renewal.

(e) A successful background screening shall include:

(i) A Wyoming Department of Family Services Central Registry Screening, which shows that the individual is not listed on the Central Registry.

(ii) A United States Department of Health and Human Services, Office of Inspector General's Exclusions Database search result, which shows that the individual or entity is not currently excluded.

(iii) A state and national fingerprinted criminal history record check which shows that the individual has not been convicted, plead guilty, no contest to, or does not have a pending deferred prosecution for:

(A) An Offense Against the Person, including:

(I) Homicide (W.S. 6-2-101);

(II) Kidnapping (W.S. 6-2-201);

(III) Sexual assault (W.S. 6-2-301);

(IV) Robbery and blackmail (W.S. 6-2-401);

(V) Assault and battery (W.S. 6-2-501);

(VI) Human trafficking (W.S. 6-2-701); and

(VII) Similar laws of any other state or the United States relating to these crimes.

(B) An Offense Against Morals, Decency and Family including:

(I) Bigamy (W.S. 6-4-401);

(II) Incest (W.S. 6-4-402);

(III) Abandoning or endangering children (W.S. 6-4-403);

(IV) Violation of order of protection (W.S. 6-4-404);

(V) Endangering children; controlled substances (W.S. 6-4-405); and

(VI) Similar laws of any other state or the United States relating to these crimes.

(f) At the discretion of the provider or employer of record, an individual staff member may provide unsupervised services on a provisional basis to a participant who is eighteen (18) years or older following the submission of the background screening, as long as disqualifying crimes or relevant criminal records are not disclosed on the application, until the individual staff member is cleared through successful background screenings.

(g) Persons who do not successfully pass the criminal history screenings listed in subsection (e) of this Section shall not be left unsupervised in the vicinity of any participant, except as provided by subsection (f) of this Section.

(h) Notwithstanding subsection (f) of this Section, staff shall not provide any services to participants ages seventeen (17) or younger until all successful background screenings listed in subsection (e) of this Section have come back with no findings.

(i) Each individual eighteen (18) years of age or older who is living in a provider's home where services are provided, or staying in the home for a period longer than one (1) month, shall pass a background check as listed in subsection (e) of this Section. An Office of Inspector General check is not required.

(i) Waiver participants receiving services in this location are not required to complete a background screening.

(ii) Providers shall not employ or permit individuals registered as a sexual offender to stay in the home. This requirement does not apply to waiver participants.

(j) If a criminal history screening does not include a disposition of a charge, or if an individual is charged with an offense listed in subsection (e)(iii) of this Section, the individual shall not have any unsupervised access or provide billable services to participants until the provider is able to provide proof of a successful background check.

(k) Volunteers and individuals under the age of eighteen (18) shall be under the direct supervision of an adult who has passed a background check. Individuals convicted of a sexual offense are not permitted as volunteers.

(l) Background screenings shall not be transferred from one provider entity to another.

(m) The background screening notification shall not be altered in any manner, including the crossing out of names or use of whiteout. If altered, the screening notification shall be determined null and void.

(n) The Division shall require subsequent background screenings as outlined in this subsection. Any person who fails to pass a subsequent background screening shall not supervise, provide, or bill for waiver services.

(i) Any individual required to receive a background screening under this Section shall undergo subsequent background screenings every five (5) years.

(ii) Providers and any person with an ownership or control interest or who is an agent or managing employee of the provider shall undergo subsequent monthly Office of Inspector General Database screenings.

(o) The Division may request a background screening at the Division's expense as part of an investigation.

Section 15. Provider Training Standards.

(a) In addition to the other training standards in this Chapter and the Department of Health's Medicaid Rules, providers shall ensure that employees, including management staff responsible for providing supports and services to participants, receive training in the areas specified in this Section prior to working unsupervised with participants in services.

(b) Staff responsible for providing direct services shall receive participant specific training from a trained staff member prior to working alone with participants.

(c) The provider shall maintain documentation that staff are qualified to provide waiver services through evidence of completed trainings, including the date training was completed, who conducted the training, and how the employee demonstrated understanding. The provider shall ensure that training is conducted by persons with expertise in the topic area, who are qualified by education, training, and experience, and maintain complete verification of such.

(d) All persons qualified to provide waiver services shall complete training in the following areas prior to delivering services. Providers may choose to develop their own training modules for employees or use Division modules, as long as the provider covers the key elements of each topic specified in the Division module with Division approval. General training topics include:

(i) Participant choice;

(ii) The rights of participants in accordance with state and federal laws, and any rights restrictions for each participant with whom a person works;

(iii) Confidentiality;

(iv) Dignity and respect;

(v) Preventing, recognizing and reporting abuse, neglect, intimidation, exploitation, and all other categories listed on the Division's Notification of Incident form;

(vi) Responding to injury, illness, and emergencies;

(vii) Billing and documentation of services;

(viii) Releases of information;

(ix) Grievance and complaint procedures for participants, legally authorized representatives, provider employees, and community members; and

(x) Implementing and documenting participant objectives and progress on objectives.

(e) To verify each provider and provider staff meets the qualification standards, evidence of a completed training summary or test of each training topic shall be retained in the employer's files.

(f) Participant specific training.

(i) Each provider and provider staff shall receive participant specific training prior to the individualized plan of care start date. Impacted staff shall receive participant specific training prior to changes to the individualized plan of care.

(ii) All case managers shall train one employee from each provider on the individualized plan of care. The provider shall ensure that all other employees of the provider receive plan of care training. The case manager and the participant or any legally authorized representative(s) may request verification of the provider's participant specific training. Training shall occur before the individualized plan of care start date and before each employee provides services.

(iii) A provider of waiver services shall be trained on any specific assistive technology devices, disabilities, diagnoses, or medical or risk conditions as necessary for the participants served by the provider. This training shall be unique to, and meet the needs of, the participant.

(g) Documentation of participant specific training and general training shall include:

(i) The date of the training;

(ii) The name, signature, and title of the trainer;

(iii) The name and signature of the person receiving the training;

(iv) A detailed agenda of the training topic(s), including the method of training; and

(v) How the person receiving training demonstrated understanding.

Section 16. THIS SECTION RESERVED FOR FUTURE RULEMAKING

Section 17. Positive Behavior Supports.

(a) Habilitation services shall be designed to maximize the potential of the participant. Services shall be provided in the setting that is the least restrictive for the participant.

(b) Participants shall have a positive behavior support plan in place if restraints are outlined in their individualized plan of care.

(c) A participant with a challenging behavior identified by the plan of care team shall have a current functional behavioral analysis conducted within the last year to identify what the person is trying to communicate through the behavior(s), to identify the function or possible purpose for the behavior(s), to explore antecedents and contributing factors to behaviors, and to review and describe potentially positive behavioral supports and interventions in order to develop a positive behavior support plan.

(i) Challenging behaviors may include actions by the participant that constitute a threat to the person's immediate health and safety, the health and safety of others in the environment, a persistent pattern of behaviors that inhibit the participant's functioning in public places and integration within the community, or uncontrolled symptoms of a physical or mental condition.

(ii) The functional behavioral analysis shall include data compiled regarding all challenging behaviors exhibited, and be utilized to develop the positive behavior support plan used by the provider during the provision of waiver services.

(iii) A provider or provider staff knowledgeable of the participant shall complete the functional behavior analysis, which shall include input from the team, participant, and any legally authorized representative(s).

(d) A positive behavior support plan, based upon a current functional behavioral analysis, shall be developed for a participant in order for providers working with the person to understand and recognize the communication and behaviors exhibited by the person. The positive behavior support plan shall describe agreed upon supports to assist the participant using proven support techniques and non-restrictive interventions. At a minimum, a positive behavior support plan shall:

(i) Include the components of the template provided on the Department's website.

(ii) Maintain the dignity, respect, and value of the participant;

(iii) Use a person-centered approach with the participant involved in the development of the plan on a level appropriate for that person;

(iv) Aim to minimize the use of restraints;

(v) Be specific and easily understood, so direct care employees can implement it appropriately and consistently;

(vi) Include a signature of the participant or legally authorized representative(s), which verifies informed consent;

(vii) Define the antecedents and the targeted behavior(s) that need to be replaced or reduced;

(viii) List positive behavioral supports that assist the participant in replacing targeted or challenging behaviors with appropriate replacement behaviors;

(ix) Provide protocols for providers and provider employees to recognize emerging targeted behaviors, and determine the appropriate interventions to implement positive behavioral supports;

(x) Provide protocols, which focus on positive interventions that are deemed least restrictive and most effective, for employees to use when targeted behaviors take place;

(xi) Reference the protocol for the use of any PRN medication that may be a part of the positive behavior support plan, as recommended by the treating medical professional and can be requested by the participant to help manage stress, anxiety, or behaviors;

(xii) Be reviewed every six (6) months by the provider(s) and the case manager to assess the effectiveness of the plan, or more frequently if needed;

(xiii) Include specific guidelines for tracking and analyzing the antecedents related to the occurrence of a targeted behavior, the actual behavior(s) displayed, and the results of positive behavioral interventions; and

(xiv) Be included as a formal component of the individualized plan of care.

(e) A provider employee implementing a positive behavior support plan shall receive participant specific training on the positive behavior support plan, and on specific positive de-escalation techniques and interventions, before they begin working with the participant.

(f) The case manager shall educate the participant and legally authorized representative about positive behavior supports that may be used, and the risks and benefits of any supplemental plan for the use of restraint or prescribed psychoactive medication if the positive behavior support plan fails.

(g) If restraints are used or law enforcement is contacted due to a behavioral emergency, the positive behavior support plan has failed and must be reviewed to possibly add or modify the service environment or behavioral interventions.

Section 18. Restraint Standards.

(a) Restraint includes physical, chemical, and mechanical restraints, as further defined in this Section.

(b) The entire plan of care team shall agree to the use of restraints, confirmed with a signature from the participant, legally authorized representative, and all providers involved, and be consistent with this Section.

(c) When the use of positive behavior supports is not effective in modifying or changing a participant's challenging behavior, the participant's plan of care team may implement a restraint protocol to supplement the positive behavior support plan, subject to the provisions of this Section.

(d) Providers shall not use aversive techniques to modify a person's behavior. Aversive techniques include any intervention that causes pain, harm, discomfort, or social humiliation for the purpose of modifying or reducing a behavior.

(e) A provider serving more than five (5) participants with restraints in their plans is required to have one (1) employee complete training on positive behavior supports through any program approved by the Division. An additional employee shall be certified for every ten (10) additional participants with restraints in their plan.

(f) The plan of care team shall review the participant's plan thoroughly to ensure the individualized plan of care is not so restrictive that it repeatedly provokes behaviors that lead to the use of restraints.

(g) When restraints are deemed necessary, the individualized plan of care shall include a restraint protocol that includes:

(i) If a person other than the participant authorizes the use of restraint, the legal document, court order, guardianship papers, or medical orders that demonstrate this authority; and

(ii) For any restraint imposed, demonstration that the standards outlined in Section 4(h)(i) of this Chapter are met.

(h) The case manager shall reconvene the participant's plan of care team if any restraints are used in the previous calendar quarter. When convened under this Section, the team shall review all restraints for the previous quarter and develop a plan to reduce the number of restraints performed. On a quarterly basis, the case manager shall report data received from the provider concerning the number of restraints performed on the participant.

(i) The provider shall notify the case manager within one (1) business day of any use of an emergency restraint that is not written in a participant's individualized plan of care. A case manager who receives notice of restraint under this provision shall call a team meeting within two (2) weeks to discuss the incident and decide if the individualized plan of care shall be modified to include a crisis intervention protocol and a revised positive behavior support plan.

(j) Restraints shall only be performed by an individual trained and certified in restraint usage.

(k) Providers employing restraints shall:

(i) Adopt policies and procedures that:

(A) Identify the provider's chosen certifying entity consistent with subsection (l) of this Section;

(B) Specify the types of restraints that may be used by provider staff; and

(ii) Adhere to all state and federal statutes, rules, and regulations regarding the use of restraints.

(iii) Only utilize restraints approved by the provider's chosen certifying entity recognized in subsection (l) of this Section, unless the restraints are prohibited in subsection (d) of this Section.

(l) The provider and provider staff shall maintain certification, and provider shall require ongoing training for employees in de-escalation techniques, crisis prevention and intervention, and proper restraint usage from entities certified to conduct the training, such as Crisis Prevention Intervention (CPI), MANDT, or other entity approved by the Division.

(m) Restraints shall only be used in emergency circumstances to ensure the immediate physical safety of the participant, a provider staff member, or other persons, and when less restrictive positive behavior supports have been determined to be ineffective. Providers shall only use restraints when the risk of injury without restraint is greater than the risk associated with the restraint. Restraints may include, but are not limited to, the following:

(i) A chemical restraint, which is any drug that is administered to manage a participant's behavior in a way that reduces the safety risk to the participant or others, has the temporary effect of restricting the participant's freedom of movement, and is not a standard treatment for the participant's medical or psychiatric condition.

(A) A chemical restraint shall not be used unless ordered by a licensed medical professional chosen by the participant or any legally authorized representative(s), and administered by a person licensed to administer the medication.

(B) Standing orders for chemical restraints are prohibited, except when deemed necessary to prevent extreme reoccurring behavior by a participant's plan of care team and limited to one (1) month. A standing order shall include clarification on the circumstances of its usage by the licensed medical professional.

(C) If a provider uses three (3) or more chemical restraints on a participant within a consecutive six (6) month period, the participant's plan of care team shall arrange for the participant to see his or her treating medical professional for a formal medical review in case the treatment plan needs to change. The participant's plan of care team shall meet to determine if the positive behavior support plan or crisis intervention protocol needs to change. The formal medical review shall be documented in the participant's file with the restraining provider and the case manager. If it is determined that the treatment plan or individualized plan of care will not be changed, then the case manager shall document the reasons it is not being changed in the individualized plan of care.

(D) Chemical restraints shall not be used on persons under the age of eighteen (18).

(ii) A mechanical restraint, which is any device attached or adjacent to a participant's body that he or she cannot easily move or remove that restricts freedom of movement or normal access to the body.

(A) Mechanical restraints shall only be used under the direct supervision of a licensed medical professional for the purpose of medical treatment procedures when compliance is deemed necessary to protect the health of the participant.

(B) Mechanical restraints shall not be used on persons under the age of eighteen (18).

(iii) A physical restraint, which is the application of physical force without the use of any device, for the purpose of limiting the free movement of a participant's body. Physical restraint does not include briefly holding a participant, without undue force, in order to calm or comfort him or her, or holding a participant's hand to safely escort him or her from one area to another.

(n) Seclusion is the involuntary confinement of a participant alone in a room or an area from which the participant is physically prevented from leaving. Seclusion is prohibited, and may result in sanctions, including the repayment of funds for waiver services.

(o) A provider using restraints shall:

(i) Maintain internal documentation to track and analyze each use of a restraint, its antecedents, reason(s) for the restraint, the participant's reaction to the restraint, and actions that may make future restraints unnecessary;

(ii) Implement additional supports with the participant in an effort to minimize restraints;

(iii) Use appropriate de-escalation techniques to redirect or mitigate a behavior before restraints occur;

(iv) Address and correct staff using restraints incorrectly;

(v) If an injury occurs as a result of a restraint, conduct staff retraining within five (5) business days if the injury being detected;

(vi) Hold a debriefing meeting with the participant, legally authorized representative, and case manager as soon as practicable after an incident to discuss the use of the restraint. Legally authorized representatives may be part of the participant's debrief discussion either by phone or in person;

(vii) Within five (5) business days of the event, provide case managers with a copy of the provider's completed internal tracking form, or notify the case manager that the electronic form is available for viewing;

(viii) Send a copy of the completed internal tracking form to the legally authorized representative within five (5) business days or notify the legally authorized representative that the electronic form is available for viewing;

(ix) Submit a critical incident report to the Division for each instance when a restraint is used, as outlined in Section 20(b) of this Chapter; and

(x) Regularly collect and review all available data regarding the use of restraints and work to reduce their duration and frequency, and eliminate their occurrence.

(p) The case manager shall follow-up on each incident within two (2) business days of notification of the incident to ensure the participant is safe and uninjured, ensure the participant's restraint protocol and positive behavior support plan were implemented appropriately, and verify that documentation demonstrates that less restrictive intervention techniques were used prior to the use of restraint. The case manager shall also report any suspected non-compliance to the Division.

(q) The Division may request a team meeting with the provider, case manager, and legally authorized representative to review any incident of restraint performed by a provider or provider staff.

(r) Restraints shall not be used for the following purposes:

(i) For the convenience of the provider;

(ii) To coerce, discipline, force compliance, or retaliate against a participant; or

(iii) As a substitute for a habilitation program or in quantities that interfere with services, treatment, or habilitation.

(s) The following restraints are prohibited:

(i) A restraint that is contraindicated by the person's medical or psychological condition;

(ii) A restraint procedure or device that obstructs a person's airway or constricts the person's ability to breathe;

(iii) A supine or prone restraint including, but not limited to, restraining a person on the floor, in a bed, in any form of reclined chair, or using any other horizontal flat surface; and

(iv) Any physical, mechanical, or chemical restraint not provided for in this Section.

(t) Any violation of subsection (r) or (s) may result in immediate sanctions of the provider.

(u) Any restraint shall be time-limited and removed immediately when the participant no longer presents a risk of immediate harm to self or others.

Section 19. THIS SECTION RESERVED FOR FUTURE RULEMAKING.

Section 20. Notification of Incident Process.

(a) Providers shall report the following incidents involving waiver participants to the Division, the Department of Family Services, Protection & Advocacy System, Inc., the case manager, legally authorized representative(s), and law enforcement immediately after assuring the health and safety of the participant and other individuals:

(i) Suspected abuse as defined by W.S. 35-20-102 or W.S. 14-3-202;

(ii) Suspected self-abuse;

(iii) Suspected neglect as defined in W.S. 35-20-102 or W.S. 14-3-202;

(iv) Suspected self-neglect as defined W.S. 35-20-102;

(v) Suspected abandonment as defined in W.S. 35-20-102;

(vi) Suspected exploitation as defined in W.S. 35-20-102;

(vii) Suspected intimidation as defined by W.S. 35-20-102;

(viii) Sexual abuse as defined in W.S. 35-20-102; and

(ix) Death.

(b) Providers shall report the following incidents to the Division, Protection & Advocacy System, Inc., the case manager, and legally authorized representative(s) within one (1) business day:

(i) Police involvement, such as arrests of participants or the participant's direct care provider, while they are providing services, or questioning of participants by law enforcement;

(ii) Any use of restraint;

(iii) Any use of seclusion;

(iv) Injuries caused by restraints;

(v) Serious injury to the participant;

(vi) Elopement;

(vii) Medication errors that result in emergency medical attention; and

(viii) Medical or behavioral admission and emergency room visits that are not scheduled medical visits.

(c) Providers shall report the following medication errors to the Division, the case manager, and legally authorized representative(s) within three (3) business days:

(i) Wrong medication;

(ii) Wrong dosage;

(iii) Missed medication;

(iv) Wrong participant;

(v) Wrong route; and

(vi) Wrong time, which is any deviation from the accepted standard time frame for the medication assistance.

(d) In addition to provisions of subsection (a) and (b) of this Section, if, at any time, a significant risk to a waiver participant's health and safety is identified, the provider shall report the incident to the Division.

(e) Providers shall have incident reporting policies and procedures that include the requirements of this Section and shall maintain internal incident reports for all incidents identified in this Section.

(i) Providers shall review internal incident data including the people involved in the incident, the preceding events, follow-up conducted, causes of reoccurring critical incidents, other trends, actions taken to prevent similar incidents from reoccurring, evaluation of actions taken, education and training of personnel, and internal and external reporting requirements.

(ii) Providers shall provide access of internal incident data to case managers within five (5) business days.

(f) Providers shall comply with Division or other agency requests for additional information relating to any reported incident.

Section 21. Complaint Process.

(a) A provider or provider employee who has a reasonable suspicion that a participant's health or safety is in jeopardy shall immediately contact the Division, Protection & Advocacy Systems, Inc., and other governmental agencies, such as law enforcement or DFS to report incidents or concerns.

(b) A provider shall have policies and procedures for handling complaints, including:

(i) How it will attempt to resolve the complaint;

(ii) How it will document actions, follow-up, and resolution of the complaint;

(iii) How and when information shall be shared with the complainant, legally authorized representative, and the case manager; and

(iv) How the complainant will be informed of the process to file a formal complaint with the Division.

(c) Complaints may be filed with the Division in writing or verbally. If a provider files a complaint, the complaint shall be submitted in writing unless the complaint involves a participant whose health or safety is in jeopardy. Upon receipt of a complaint from any person, the Division shall:

(i) Send written notification to the complainant, within fifteen (15) business days, that the complaint has been received. The notification shall address:

(A) Anticipated timeframes for completing the follow-up and resolution of a complaint; and

(B) The authority for taking actions.

(ii) Send written notification to the provider, within fifteen (15) business days, when a complaint involving that provider is received, unless the complaint involves significant health, safety, or rights concerns, which require an unannounced on-site visit. In these cases, the Division shall provide written documentation to the provider at the time of the on-site visit that indicates a complaint has been received, the nature of the complaint, and that complaint follow-up is being conducted.

(iii) Within fifteen (15) business days of complaint resolution, send written notification to the complainant that the complaint has been resolved.

(iv) Within fifteen (15) business days of the complaint resolution, submit a written report to the provider(s) that are the subject of the complaint summarizing the results of the complaint findings. The report may include findings, recommendations, and timeframes to address the recommendations through corrective action. If the complaint involves a specific participant, the report will also be sent to the participant and legally authorized representative.

(d) Accredited providers shall adhere to the current accreditation requirements for complaints or grievances.

(e) A provider's failure to submit and successfully implement an approved corrective action plan, as outlined in Section 29 of this Chapter, may result in sanctions per Section 30 of this Chapter.

Section 22. Transition Process.

(a) The participant or legally authorized representative may choose to change any provider at any time and for any reason.

(b) A provider who is terminating services with a participant shall notify the participant and the Division in writing at least thirty (30) calendar days prior to ending services, unless the Division approves a shorter transition period in advance. Failure to provide services during this thirty (30) calendar day period shall be considered abandonment of services and may result in decertification of the provider.

(c) When a participant or legally authorized representative chooses to change providers, they shall inform the case manager of the decision. The case manager shall notify the provider of a participant's or legally authorized representative's decision to discontinue services within three (3) business days.

(d) When a transition is requested, the case manager shall notify the Division of the request for change within three (3) business days of the request.

(i) If the participant or legally authorized representative requests a change of case manager, the case manager shall review choice and make provider lists available to the participant and legally authorized representative.

(ii) If the participant or legally authorized representative requests a change of a provider other than the case manager, the case manager shall review choice and provider lists with the participant or legally authorized representative.

(e) When a transition occurs, the case manager shall complete the transition checklist(s) as required by the Division, and schedule a transition meeting with the plan of care team.

(i) Notify all current and new providers, the participant, legally authorized representative, and the Division at least two (2) weeks prior to the meeting.

(ii) Team meetings may be scheduled sooner than two (2) weeks due to an emergency situation. The case manager shall notify the Division of any emergency requiring a faster transition schedule.

(f) After the transition meeting, the case manager shall complete and submit plan of care modifications to the Division at least seven (7) business days prior to the scheduled start date of the new services.

(g) All providers on the individualized plan of care shall share pertinent information with the case manager and the plan of care team in a timely manner.

(h) If a community living services provider requires a participant to move to another service setting, the participant shall be given the opportunity to choose from all available options, without limitation to that provider's settings.

(i) The participant may choose from other setting options that are appropriate for the participant, which may include a new provider.

(ii) The provider shall notify the participant, family, case manager, and any legally authorized representative of the move at least thirty (30) calendar days in advance so the participant can exercise the choice to find a new residence or provider.

(i) It is the responsibility of the case manager to ensure providers have received training on all participant information, including health and safety, behavioral concerns, and the individualized plan of care.

Section 23. Notice of Costs to the Participant.

(a) The provider shall develop and implement a system to notify participants and legally authorized representatives of any associated cost to the participant for a service or item, and the terms of payment.

(b) Written notice shall be given to the participant before initiation of service and before any change. Providers shall allow participants and their legally authorized representative adequate time to review the notice before the participant chooses services from the provider, or before the changes are implemented.

(c) A provider's cost notice shall specify that participants will not be charged for services or items that are covered through other funding sources. This includes, but is not limited to, items necessary to provide habilitation and transportation related to habilitation. The cost notice shall also identify:

(i) Who is responsible for replacement or compensation when the participants' personal items are damaged or missing; and

(ii) How participants will be compensated when staff, guests, or other participants in service, who do not reside in the location (i.e., respite), utilize the environment and eat food paid for by participants.

(d) Providers shall not charge participants for changes to the provider's staffing, service settings, or services, if the change is required by state or federal law.

Section 24. Participant Funds and Personal Property.

(a) Standards in this Section apply to any provider who takes responsibility for the funds or personal property of a participant. This includes:

(i) Serving as representative payee;

(ii) Managing the funds of the participant;

(iii) Receiving benefits or funds on behalf of the participant; or

(iv) Temporarily safeguarding funds or personal property for the participant.

(b) The provider shall develop and implement written policies and procedures to identify and detail the system used to protect participant's funds and property. These policies and procedures shall be communicated to the participant or legally authorized representative, including:

(i) How the participant or any legally authorized representative will give informed consent for the expenditure of funds;

(ii) How the participant or legally authorized representative may access the records of the funds;

(iii) How funds are segregated for accounting and reporting purposes to the participant, legally authorized representative, and regulatory agencies, such as Social Security Administration or the Division;

(iv) Safeguards used to ensure that funds are used for the designated and appropriate purposes;

(v) If interest is accrued, how interest is credited to the accounts of the participant;

(vi) How service fees are charged for managing funds; and

(vii) How the person's funds or personal property will be replaced or recouped in the event of theft or an unexplainable disappearance at the provider service setting, or during the provider's provision of services.

(i) As a reward or punishment, unless specified in the individualized plan of care as a restriction of rights that complies with the requirements in this Chapter and is approved by the participant and legally authorized representative;

(ii) As payment for damages, unless otherwise specified in the lease or other written agreement, evidence shows the charge is appropriate, the rationale is documented, and the participant or legally authorized representative gives written informed consent to make restitution for damages;

(iii) As payment for damages when the damage is the result of lack of appropriate supervision;

(iv) To purchase inventory or services for the provider; or

(v) As a loan to the provider or the provider's employees.

(d) Participant funds shall not be comingled with provider business accounts or monies.

Section 25. Additional Standards for Providers that Require National Accreditation.

(a) Providers that are certified in Adult Day, Case Management, Community Living, Community Support, Companion, or Supported Employment Services shall receive and maintain national accreditation in the accreditation areas specific to the service being provided if the services listed in this subsection and delivered by the provider collectively equal or exceed $150,000 per calendar year.

(b) Providers shall obtain accreditation in the area applicable to each service within eighteen (18) months of qualifying under this provision. The eighteen (18) month clock begins on the date the accreditation criteria are met.

(c) Provider accreditation options include the Council on Quality and Leadership (CQL) and CARF International. Regardless of the accreditation attained, all references to accredited providers in this rule apply to the provider.

(d) The Division shall decertify a provider who fails to obtain or maintain accreditation.

(e) If a provider fails to obtain or maintain accreditation, a transition plan shall be implemented for each participant who is leaving the provider's services.

(i) Each waiver participant shall be relocated to a different provider within ninety (90) days of the date the Division receives confirmation that the provider did not receive accreditation. If a provider fails to obtain or maintain accreditation, the Division shall complete an immediate site survey and onsite assessment.

(ii) The provider's decertification date shall begin ninety (90) days from the date of written notice from the accrediting entity that the provider did not receive accreditation.

(f) An accredited provider shall submit all national accreditation report documents to the Division within thirty (30) days of receiving the report documents from the accrediting entity.

Section 26. Mortality Review.

(a) The Division shall review deaths of participants receiving waiver services.

(b) Providers shall submit information requested by the Division. This may include, but is not limited to:

(i) Copies of documentation of services;

(ii) Copies of incident reports; and

(iii) Copies of any health related records, including assessments, results of licensed medical professional's office visits, and hospital visits.

Section 27. Initial Provider Certification.

(a) An individual or entity may apply to become a provider by completing the Division's initial provider certification process and all required trainings. The applicant shall supply evidence that the applicant meets the qualifications for each service in which the applicant is seeking waiver certification.

(b) The Division shall only certify one provider per physical location.

(i) The person or entity has an open or pending corrective action plan with the Division;

(ii) The person or entity has an open case with the Medicaid Fraud Control Unit; or

(iii) The person has not successfully passed a background screening as provided in Section 14 of this Chapter.

(d) The Division may refuse to certify an entity that has an officer, administrator, or board member who was previously sanctioned by the Division. This refusal shall apply for a period of two (2) years from the date the person was sanctioned. The Division may also refuse to certify such person related to his or her involvement in any open or pending corrective action plan, or Medicaid Fraud Control Unit case until after the two (2) year period.

(e) A person who has been convicted of Medicaid fraud shall not be certified.

(f) The Division shall refuse to certify or shall subsequently decertify a provider applicant who fails to disclose any convictions in a court of law on the Division's provider application or organization's application.

(g) Falsifications of statements or documents, or any concealment of material fact may result in a denial of certification, decertification, or referral for criminal prosecution.

(h) The Division shall initially certify a new provider or provider agency providing any service for one (1) year. The provider must complete a provider certification renewal at the end of the first year to continue providing services

(i) A person or entity may dispute an adverse action related to provider initial certification by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

Section 28. Provider Certification Renewal.

(a) The Division shall notify all providers that their waiver certification is expiring at least ninety (90) calendar days prior to the certification expiration date. The notification shall detail requirements that the provider shall meet in order to renew their certification.

(b) The Division shall renew a provider certification at least once every three years. Based on the services provided, an on-site visit may be required. If an on-site visit is required, the Division shall provide notification to the provider at least thirty (30) calendar days prior to the visit.

(c) Provider certification renewal includes a Division review of the provider's evidence of compliance with state and federal regulations for home and community based services, and a review of the provider's self-assessment of compliance. For providers who offer services in a setting they own, operate, or lease, the Division shall also review the provider's self-inspection of service settings and a current inspection report from an outside entity.

(d) At any time, the Division shall conduct an on-site visit when a concern is identified during a complaint, incident report, or internal referral, if there is an indication the provider is not complying with state or federal rules and regulation, or at the Division's discretion.

(e) Providers may sign a form verifying that they do not provide services in their home or a provider-owned, leased, or operated setting. The Division will not conduct on-site evaluations for providers signing these forms, but may verify the accuracy of these statements. Falsification of these forms may result in sanctions.

(f) The Division does not require an on-site visit for a case manager, specialized equipment, or environmental modification certification renewal.

(g) Providers shall submit verification that they have met all applicable certification renewal requirements to the Division at least forty-five (45) calendar days prior to their certification expiration date.

(h) If a provider fails to submit the applicable certification renewal requirements to the Division as described in subsection (g) of this Section, the Division shall notify the provider in writing of the expiration of the certification.

(i) If the provider does not meet the certification renewal requirements within twenty (20) calendar days of the certification expiration, the Division shall begin the decertification process.

(ii) The provider shall be notified in writing through certified mail that their certification has expired.

(i) During any certification renewal, the Division shall review provider certification requirements and compliance with all home and community based regulations, then complete a written report, including a statement of the recommendations that shall be addressed within thirty (30) calendar days in order to maintain certification.

(i) The Division may approve a certification period for up to three (3) years depending on deficiencies noted during the certification renewal process.

(ii) The Division may approve the certification for a period of less than one (1) year if deficiencies are identified that seriously affect the health, safety, welfare, rights, or habilitation of a participant, or if the provider has otherwise substantially failed to comply with the rules and standards applicable to the services they are providing.

(iii) The Division may deny the certification.

(j) Providers shall submit all certification renewal documentation and information. Providers shall not use outside entities to submit certification renewal information.

(k) A provider may dispute an adverse action related to renewal of certification by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

Section 29. Corrective Action Plan Requirements.

(a) The Division shall, to the extent practicable and consistent with the provisions of applicable law, seek the cooperation of providers in obtaining compliance with these standards. The Division may provide technical assistance to providers to help them voluntarily comply with any applicable provision of these rules.

(b) The Division may attempt to resolve any suspected noncompliance with this Chapter by requiring the provider to submit a corrective action plan.

(c) Corrective action plans shall address each area of suspected non-compliance to the Division's satisfaction. This includes identifying the suspected noncompliance area, action steps needed to address the area of noncompliance, the people in the organization responsible for each action item, due dates, and dates of completion for each recommendation.

(d) The Division may require specialized training for the provider organization or individual employees as part of a corrective action. Specialized training may include, but is not limited to, training on positioning, feeding protocols, positive behavior supports, person-centered planning, or trauma-informed care, and shall be included in the corrective action plan submitted by the provider.

(e) Suspected non-compliance that relates to the immediate health, safety, welfare, or rights of participants shall be addressed immediately after the situation is discovered. Providers addressing suspected non-compliance under this Section shall be given fifteen (15) business days from the date of the report issued by the Division to submit a corrective action plan.

(f) If a corrective action plan is not submitted and implemented to address all areas of suspected non-compliance, the Division may impose sanctions as warranted in Section 30 of this Chapter.

(g) The Division shall notify the provider in writing within thirty (30) business days after receipt of the provider's corrective action plan regarding the approval or rejection of the plan.

(i) If a corrective action plan is rejected, the provider shall receive notification in writing of the reasons for the rejection, and shall submit a revised plan within ten (10) business days from the notification of the written rejection from the Division.

(ii) The Division shall notify the provider in writing within thirty (30) business days after receipt of the provider's revised corrective action plan regarding the approval or rejection of the plan.

(iii) If the revised corrective action plan is rejected, the provider shall have ten (10) business days from the notification of rejection to submit an acceptable corrective action plan, or the Division may proceed with the sanctioning process as outlined in Section 30 of this Chapter.

(h) The provider shall complete appropriate follow-up monitoring to assure that the actions identified in their corrective action plan have been completed within the specified time frame(s) and, at the discretion of the Division, shall submit a monthly status report to the Division in the form and manner required by the Division until all action items have been satisfactorily completed. If the Division does not receive the monthly status report from the provider, the Division may proceed with the sanctioning process as outlined in Section 30 of this Chapter.

(i) The Division may complete follow-up or review additional items during the provider's certification renewal process to assure the provider has fully implemented and evaluated the corrective action plan, and that participants remain safe during the implementation.

Section 30. Sanctions.

(a) Sanctions shall be imposed in accordance with the provisions of Chapter 16 of the Department of Health's Medicaid Rules.

(b) Notwithstanding the provisions of Section 29 of this Chapter, the Division may impose sanctions or revoke provider certification for any violation of these rules.

(c) If the Division revokes a provider's certification or suspends a national provider identification number, the provider shall submit transition plans to the Division detailing the transition of each participant to other settings within twenty (20) calendar days of the date that the sanction is deemed final.

(i) The transition plans shall not be implemented until approved by the Division.

(ii) The transition plans shall be implemented and participants shall move to different certified providers or receive non-waiver supports and services from persons approved by the participants or any legally authorized representative(s) within ninety (90) calendar days of the date the Division informed the provider of the revocation of certification.

(iii) Transition plans shall adhere to the requirements in Section 22 of this Chapter.

(d) A provider who has had their certification revoked under this Section shall not provide waiver services.

(e) A provider may dispute a sanction under this Section or any other adverse action, including those related to certification or renewal of certification, by a request for an administrative hearing, which will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

Section 31. Relative Providers.

(a) The Division shall allow a participant's relative, as defined in Section 3 of this Chapter, to become a certified waiver provider and receive reimbursement for services provided to the related participant.

(b) A participant's legally authorized representative shall not directly or indirectly receive reimbursement for providing waiver services for their ward, except as indicated in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference. Direct or indirect reimbursement shall include, but is not limited to, providing direct services for, or serving as the owner or officer of, a provider organization, residing in a provider owned service setting, or being married to a person providing waiver services to the participant.

(c) A participant's spouse may receive direct or indirect reimbursement only if they present the Division with a certified copy of a court order establishing another party as the legally authorized representative of the participant.

(d) To provide waiver services to a related participant, the relative provider shall:

(i) Form a Limited Liability Company (LLC) or other corporation; and

(ii) Maintain provider certification in accordance with this Chapter.

(e) A relative provider, spouse, or legally authorized representative shall not be hired to provide services through self-direction.

(f) Services that may be furnished by a relative provider are identified in the Comprehensive and Supports Waiver Index, which is incorporated by reference.

(g) If a relative provider or legally authorized representative is providing personal care to his or her ward, the individualized plan of care shall be developed and monitored by a case manager without a conflict of interest.

(h) If the relative provider is not providing services in the best interest of the participant, the case manager shall work with the participant, appropriate team members, and the Division as needed to choose other providers as appropriate and modify the individualized plan of care to better suit the needs of the participant.

(i) Payment to a relative provider specified in subsections (f) and (g) of this Section shall only be made when the service provided is not a function that the relative would normally provide for the individual without charge as a matter of course in the usual relationship among family members, and the service would otherwise need to be provided by a qualified provider.

(j) A relative who provides services either as an owner, employee, or officer of a provider or who intends to provide services to a related waiver participant shall disclose the relationship in the participant's team meeting and acknowledge and address the safeguards set forth in documentation required by the Division.

(k) If a provider permits the hiring of a legally authorized representative of a participant receiving services from the provider, or if a provider permits the hiring of relatives of provider employees working for the organization, the provider shall have a written policy on how it addresses potential conflicts that arise from these relationships and how the conflict of interest is mitigated. The policy shall be shared with the participant and legally authorized representative(s).

Section 32. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

Section 33. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Division, including provider manuals and provider bulletins, which are inconsistent with this Chapter.

Section 34. Severability. If any portion of this Chapter is found invalid or unenforceable, the remainder shall continue in full force and effect.

Section 35. Incorporation by Reference.

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each code, rule, or regulation incorporated by referenced in these rules is further identified as follows:

(i) Referenced in Section 2 of this Chapter is Title XIX of the Social Security Act, 42 C.F.R. Part 441, Subpart G, incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(ii) Referenced in Sections 2 and 9 of this Chapter is Wyoming Medicaid's State Plan, incorporated as of the effective date of this Chapter and can be found at http://www.health.wyo.gov/healthcarefin/medicaid/spa.

(iii) Referenced in Sections 2 and 11 of this Chapter is Wyoming's Comprehensive and Supports Waiver Applications, incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/behavioralhealth/dd/bhd-public-notices/.

(iv) Referenced in Sections 2, 5, 6, 8, and 31 of this Chapter is Wyoming's Comprehensive and Supports Waiver Service Index, incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/behavioralhealth/dd/servicesandrates/.

(v) Referenced in Section 7 of this Chapter is W.S. 35-2-607, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

(vi) Referenced in Section 8 of this Chapter is W.S. 40-21-107, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

(vii) Referenced in Section 13 of this Chapter is W.S. 1-21-1201 through -1211, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

(viii) Referenced in Section 14 of this Chapter is Title 6 of the Wyoming Statutes Annotated, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

(ix) Referenced in Section 20 of this Chapter is W.S. 35-20-102, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

(x) Referenced in Section 20 of this Chapter is W.S. 14-3-202, incorporated as of the effective date of this Chapter and can be found at https://legisweb.state.wy.us/.

History

Effective 2019-12-20

Chapter 46 Medicaid Supports and Comprehensive Waivers

Wyo. Code R. 048.0037.46.12202019 Medicaid Supports and Comprehensive Waivers

Chapter 41

CHAPTER 46

MEDICAID SUPPORTS AND COMPREHENSIVE WAIVERS

Section 1. Authority. This Chapter is promulgated by the Department of Health pursuant to Wyoming Statute 9-2-102 and the Wyoming Medical Assistance and Services Act at W. S. 42-4-104 through -121.

Section 2. Purpose and Applicability.

(a) This Chapter shall apply to and govern Medicaid services provided under the Wyoming Medicaid Supports and Comprehensive Waivers.

(b) This Chapter, in addition to Chapters 44 and 45 of the Department of Health's Medicaid Rules, shall govern services and provider requirements of the Supports and Comprehensive Waivers.

(c) The Division of Healthcare Financing, hereinafter referred to as the "Division," may issue manuals and bulletins to providers or other affected parties to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals and bulletins shall be subordinate to the provisions of this Chapter.

(d) Wyoming's currently approved Centers for Medicare and Medicaid Services (CMS) Comprehensive and Supports Waiver Applications and the Comprehensive and Supports Waiver Index apply to this Chapter.

(e) The requirements of Title XIX of the Social Security Act, 42 C.F.R Part 441, Subpart G and the Medicaid State Plan apply to this Chapter.

Section 3. General Provisions.

(a) Except as otherwise specified in Chapter 1 of the Department of Health's Medicaid Rules, or as defined in this Section, the terminology used in this Chapter is standard terminology and has the standard meaning used in accounting, health care, Medicaid, and Medicare.

(b) "Case manager" means an individual who provides case management services, as established in Chapter 45, Section 9.

(c) "Level of Service score" means a participant's support needs for various parts of their everyday routine and their level of independence, which are tied to a Level of Service score ranging from 1 (lowest level of support) to 6 (highest level of support). The Level of Service scores are based on comprehensive assessments that determine an individual's level of functioning related to behavioral and health factors, and identify essential staffing and support requirements.

(d) "Relative" means a participant's biological, step, or adoptive parent(s).

Section 4. Eligibility Requirements.

(a) Eligibility under this Chapter is limited to persons who complete the application process and who meet the requirements for clinical and financial eligibility established under this Section. An individual is not eligible for the Wyoming Medicaid Supports Waiver unless the individual meets the following criteria:

(i) The individual satisfies the citizenship, residency, and financial eligibility requirements established in Chapter 18 of the Department of Health's Medicaid Rules;

(ii) The individual qualifies for the relevant institutional level of care pursuant to Section 6 of this Chapter;

(iii) The individual has received a clinical eligibility diagnosis pursuant to Section 7 of this Chapter; and

(iv) The individual has received a qualifying Inventory for Client and Agency Planning (ICAP) score pursuant to Section 8 of this Chapter.

(b) An individual is not eligible for the Wyoming Medicaid Comprehensive Waiver unless the individual meets the following criteria:

(i) The individual meets the eligibility criteria pursuant to subsection (a) of this Section;

(ii) The individual has assessed service needs in excess of the established cost limit on the Supports Waiver; and

(iii) The individual meets one of the following:

(A) The emergency criteria as approved by the Extraordinary Care Committee (ECC); or

(B) The criteria for reserved capacity as specified in Section 13(f) or (g) of this Chapter.

(c) Diagnoses and assessments used to meet initial clinical eligibility shall be accurate and shall be completed within the past five (5) years. Any assessment or reassessment for eligibility is subject to review by the Division before acceptance, and may require additional evidence or verification.

(d) Case managers shall complete all eligibility paperwork within thirty (30) calendar days of being selected. Submitted paperwork shall be reviewed by the Division within thirty (30) calendar days of receipt.

Section 5. Loss of Eligibility

(a) The Division shall determine a participant has lost eligibility for waiver services when the participant:

(i) Does not meet clinical eligibility;

(ii) Does not meet financial eligibility; or

(iii) Changes residence to another state.

(b) The Division may terminate a participant's eligibility when the participant:

(i) Voluntarily does not receive waiver services for three (3) consecutive months;

(ii) Is in a nursing home, hospital, residential treatment facility, in-patient hospice, institution, or ICF/IID for thirty (30) or more consecutive calendar days;

(iii) Is in an out-of-state placement or residence for six (6) consecutive months or resides out of state for six (6) consecutive months; or

(iv) Chooses another waiver outside of the Comprehensive or Supports waiver.

(c) If the participant is determined not to be eligible for services due to one of the criteria in subsection (b) of this Section, the participant or the participant's legally authorized representative shall be notified in writing within fifteen (15) calendar days.

(d) The Division shall notify an applicant, participant, or legally authorized representative, in writing, of the determination of clinical ineligibility or loss of clinical eligibility within fifteen (15) calendar days of the determination or loss.

(i) Upon written notification of ineligibility, the applicant, participant, or legally authorized representative may submit, in writing, a request for reconsideration within thirty (30) calendar days of the notice of ineligibility, which shall include the reasons why the participant should still be considered eligible for the services.

(ii) If the participant requests reconsideration, the Division Administrator or Designee shall review the request and make a final determination, in writing, within thirty (30) calendar days of the request. A participant who is aggrieved or adversely affected by a reconsideration decision may also request an administrative hearing within thirty (30) calendar days following the adverse reconsideration decision.

(iii) Requests for an administrative hearing will be administered pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

(iv) Services to a participant determined not to meet clinical eligibility requirements shall be terminated no more than forty-five (45) calendar days after the determination is made.

(e) Wyoming Medicaid shall send written notification of financial ineligibility.

(f) An applicant who is determined ineligible, or a participant whose eligibility is terminated under this Section, may reapply at any time.

Section 6. Institutional Level of Care Requirements

(a) An individual with a developmental or intellectual disability diagnosis is not eligible for waiver services pursuant to Section 4 of this Chapter unless the individual qualifies for an intermediate care facility for individuals with an intellectual or developmental disability (ICF/IID) level of care, as measured by the LT-104 assessment.

(b) An individual with an acquired brain injury diagnosis is not eligible for waiver services pursuant to Section 4 of this Chapter unless the individual qualifies for a nursing facility level of care, as measured by the LT-101 assessment.

Section 7. Clinical Eligibility Diagnoses

(a) An individual is not eligible for waiver services pursuant to Section 4 of this Chapter unless the individual meets one of the following clinical eligibility diagnoses:

(i) A diagnosis of an intellectual disability, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), which is incorporated by reference, and is determined by a Medicaid enrolled psychiatrist, neurologist, or clinical psychologist who is licensed in Wyoming and is free of conflicts with other providers chosen by the participant.

(A) The diagnosis shall be verified in a written and signed psychological evaluation that is submitted to the Division.

(B) The psychological evaluation shall reflect adaptive behavior scores as determined through a standard measurement of adaptive behavior using a validated test of adaptive functioning such as the most current form of the Vineland Adaptive Behavior Scales or Adaptive Behavior Assessment System.

(C) A child applicant who takes an Intelligence Quotient test shall meet a qualifying clinical diagnosis like an adult. A child too young to complete an Intelligence Quotient test may meet the criteria of a developmental disability as described in subsection (a)(i)(B) through medical records of a related condition using a standardized test of development, such as the Bayley Scales of Infant and Toddler Development or other similar instrument.

(ii) A developmental disability or a related condition determined by a Medicaid enrolled licensed medical professional, neurologist, or clinical psychologist who is licensed in Wyoming and is free of conflicts with other providers chosen by the participant.

(A) Determination shall include verification in medical records and a written psychological evaluation, which includes assessment scores. The evaluation or records shall be submitted to the Division and shall identify a severe, chronic disability, which:

(I) Manifested before the person turned age twenty-two;

(II) Reflects the need for a combination and sequence of special services, which are lifelong or of extended duration;

(III) Is attributable to a cognitive or physical impairment, other than mental illness;

(IV) Is likely to continue indefinitely; and

(V) Results in substantial functional limitations in three (3) or more of the following major life activity areas: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, and economic self-sufficiency.

(B) Individuals with a diagnosis of Autism Spectrum Disorder (ASD) shall submit a current autism evaluation accepted by the Division, which demonstrates the diagnosis of ASD. The autism evaluation shall be completed by a Medicaid enrolled psychiatrist, neurologist, or clinical psychologist who is licensed in Wyoming and is free of conflicts with other providers chosen by the participant.

(iii) An Acquired Brain Injury (ABI), as defined by Chapter 1 of the Department of Health's Medicaid Rules. An individual with an ABI shall:

(A) Be between the ages of twenty-one (21) and sixty-four (64); and

(B) Have received a qualifying score on at least one of the evaluations accepted by the Division, which shall be completed by a Medicaid enrolled psychiatrist, neurologist, or clinical psychologist who is licensed in Wyoming and is free of conflicts with other providers chosen by the participant. Accepted evaluations, which shall be submitted to the Division to confirm the diagnosis, include:

(I) A score of 42 or more on the Mayo Portland Adaptability Inventory (MPAI);

(II) A score of 40 or less on the most current version of the California Verbal Learning Test Trials 1-5 T; or

(III) A score of 4 or more on the Supervision Rating Scale.

(b) A participant shall be reassessed for clinical eligibility at least annually or more frequently should a change in circumstances occur, which requires a participant to receive a higher level of services or support to ensure the participant's health, safety, and welfare.

(i) A subsequent psychological evaluation, which shall be approved by the Division prior to scheduling, must be necessary due to the participant's change in condition or as determined by the Division.

(ii) A subsequent neuropsychological evaluation, which shall be approved by the Division prior to scheduling, shall be performed every five (5) years.

(iii) Psychological and neuropsychological reassessments shall be completed by a Medicaid enrolled psychiatrist, neurologist, or clinical psychologist who is licensed in Wyoming and is free of conflicts with other providers chosen by the participant.

Section 8. Inventory for Client and Agency Planning Assessment

(a) An individual is not eligible for waiver services pursuant to Section 4 of this Chapter unless the individual receives a qualifying Inventory for Client and Agency Planning (ICAP) assessment score for the individual's age.

(i) If an individual is age zero (0) through one (1), the adaptive behavior quotient shall be .50 or below.

(ii) If an individual is age two (2) through five (5):

(A) The ICAP service score shall be between 30 and 44, depending on age; or

(B) The adaptive behavior quotient shall be .50 or below.

(iii) If an individual is age six (6) through twenty (20):

(A) The ICAP service score shall be between 48 and 70, depending on age; or

(B) The adaptive behavior quotient shall be .70 or below.

(iv) If an individual is age twenty-one (21) or older:

(A) The ICAP service score shall be 70 or less; or

(B) The individual shall have a functional limitation in at least three (3) of the following ICAP areas: self-care, language, learning/cognition, mobility, self-direction, or independent living.

(b) The ICAP assessment shall be administered by the Division's designee, and shall be completed every five (5) years, or more frequently at the option of the Division, to provide continued verification that the participant meets waiver clinical eligibility.

Section 9. Statewide Data Registry. All individuals who have been determined eligible for waiver services shall be included in the statewide data registry used by the Division for planning, monitoring, and analysis for the waiver system. Information in the registry is considered confidential and will not be released without proper authorization, or otherwise as required by law. Providers shall submit data on programs, participant outcomes, costs, and other information as required by the Division.

Section 10. Waiver Services, Service Requirements, and Restrictions.

(a) Waiver services specified in the individualized plan of care shall be based on the participant's assessed needs; meet the service definition(s); be considered medically or functionally necessary; align with the participant's preferences for services, supports, and providers; and be prioritized based on the availability of funding in the participant's individual budget amount.

(b) Services shall have prior authorization before being provided to a participant.

(c) Waiver services shall support and assist the participant in acquiring, retaining, and improving the skills necessary for the individual to function with as much independence as possible, exercise choice and self-management, and participate in the rights and responsibilities of community membership.

(d) The individualized plan of care shall reflect the services and actual units that providers agree to provide over the plan year. The individualized plan of care shall also include details regarding the specific support, settings, times of day, and activities requiring more support than others.

(e) Providers shall not serve children under age eighteen (18) and adults at the same time unless authorized in writing by the Division.

(f) Waiver services shall not be used to duplicate the same service or a similar service that is available to the participant through one of the following programs:

(i) Section 110 of the Rehabilitation Act of 1973;

(ii) Section 504 of the Rehabilitation Act of 1973;

(iii) Individuals with Disabilities Education Act (IDEA) (20 U.S.C. 1401 et seq.); or

(iv) Medicaid State Plan.

(g) Participants may request an exemption from subsection (f) by submitting a third party liability form as part of the participant's individualized plan of care. This form shall document that the service is not available through another program or agency to meet the individual participant's assessed needs. Exemptions may be granted at the direction of the Division.

(h) Routine transportation for activities provided during the service is included in the reimbursement rate for the service regardless of the number of trips. The provider shall not charge a participant separately for transportation during these waiver activities unless the special activity is outside of the participant's community or normal routine.

(i) Participants receiving levels three (3) through six (6) community living services may receive up to an average of thirty-five (35) hours of day services per week, which include adult day, community support, and companion services.

(j) Waiver services are outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference.

Section 11. Waiver Cost Limits and Individual Budget Amounts.

(a) The allocation of Medicaid waiver funds that may be available to a participant to purchase services shall be based on his or her assessed needs.

(b) Eligible individuals shall be assigned a Level of Service score.

(c) Participants enrolled in the Supports Waiver shall be assigned a designated budget amount outlined in the most current Supports Waiver application, which is incorporated by reference. Transition to the Comprehensive Waiver shall only occur as funding and a slot on the Comprehensive Waiver becomes available.

(d) Participants shall meet criteria outlined in Section 4(d) of this Chapter to be eligible for Comprehensive Waiver Services.

(i) Participants enrolled on the Comprehensive Waiver shall be assigned an individual budget amount based on the following factors:

(A) Functional and medical assessments;

(B) The participant's age group;

(D) The participant's need for a higher level of services;

(E) An amount for annual case management services; and

(F) Any temporary or permanent increase or decrease as determined by the ECC.

(ii) The factors in subsection (d)(i) determine the participant's Level of Service score in order to plan for appropriate services and supports.

(iii) A participant's individual budget amount on the Comprehensive Waiver shall not exceed the institutional cost limit specified in the most current Comprehensive Waiver application approved by CMS, which is incorporated by reference. A participant who needs services in excess of this amount shall have the individualized plan of care and budget approved by the ECC.

Section 12. Self-Directed Service Delivery.

(a) The services that may be self-directed are outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference.

(b) At least once a year, each participant's case manager shall provide the participant or legally authorized representative information regarding the option to self-direct waiver services. Information shall include requirements of the employer of record, not limited to:

(i) Hiring, firing, and training staff;

(ii) Setting staff work schedules; and

(iii) Monitoring and working within the participant's individual budget amount.

(i) Lives in his or her own private residence or the home of a family member; or

(ii) Resides in other living arrangements where services, regardless of funding source, are furnished to three (3) or fewer persons unrelated to the proprietor.

(d) To self-direct waiver services, the participant or legally authorized representative or other designee shall act as the Employer of Record and use a Financial Management Service on contract with the Division.

(e) A participant shall only self-direct services if the Financial Management Service contractor has open slots for new people to enroll, based upon the contracted capacity.

(f) The Financial Management Service shall assist the participant in being the Employer of Record.

(g) The Division shall provide the recommended wage ranges for all self-directed services.

(h) The Employer of Record shall be responsible to recruit, hire, schedule, evaluate, and supervise self-directed employees. The Employer of Record shall have the budgetary authority to negotiate and set wages and payment terms for all services received.

(i) The Employer of Record shall hire employees to provide waiver services, and work with the Financial Management Service to determine that the potential employee meets the general and specific provider standards for the service being provided. A provider that has had their certification revoked under Chapter 45 of the Department of Health's Medicaid Rules shall not provide self-directed services.

(j) Consistent with the service definitions as outlined in the Comprehensive and Supports Waiver Service Index, which is incorporated by reference, the Employer of Record shall work with the employee hired through self-direction to determine the specific tasks to be completed during the provision of services, the employee's schedule, and how to document services and report documentation and timesheets to the Employer and Financial Management Service. The Employer of Record shall ensure documentation is available to the case manager by the tenth (10th) business day of the month following the month in which services were provided.

(k) When the Employer of Record and the employee have reached agreement on the services, schedule, and rate, the Financial Management Service shall track the rate and services authorized and ensure the employee wages are paid in accordance with state and federal laws.

(l) Employees hired through self-direction shall document services provided in accordance with Chapter 45 and the agreed upon manner between the Financial Management Service and the Employer of Record. The Employer of Record shall maintain documentation in accordance with the Department of Health's Medicaid Rules.

(m) The Employer of Record, with assistance from the case manager as needed, shall review employee documentation of the services provided and the employee timesheets to ensure accuracy with the type, scope, amount, frequency, and duration of services agreed upon in the individualized plan of care.

(n) A participant or legally authorized representative may choose to voluntarily terminate self-direction at any time during the plan year and shall work with the case manager to transition to other available services or providers. The case manager shall disenroll the participant from the Financial Management Service within thirty (30) calendar days of notification that the participant chooses to terminate self-direction services.

(o) A participant may be involuntarily terminated from the use of self-direction if:

(i) The participant or Employer of Record is found to misuse waiver funds;

(ii) The participant's health and welfare needs are not adequately being met;

(iii) The participant exceeds the budget amount for self-directed services identified in the individualized plan of care;

(iv) The Division or the Medicaid Fraud Control Unit identifies situations involving the commission of fraudulent or criminal activity associated with the self-direction of services; or

(v) The participant chooses not to receive self-directed services for ninety (90) calendar days after active enrollment begins.

(p) A participant who is involuntarily terminated from this service under subsection (o) of this Section shall receive written notice from the Division and may request an administrative hearing as provided in Chapter 4 of the Department of Health's Medicaid Rules.

Section 13. Wait List Process.

(a) The Division shall maintain a Supports Waiver wait list to add additional participants as funding is appropriated and as approved by CMS.

(b) The Division shall prioritize eligible individuals on the Supports Waiver wait list on a first come, first serve basis. Funding opportunities shall be given to the person who has waited the longest for services, based on the date that the individual was determined eligible.

(c) Before being added to the Supports Waiver wait list, the individual shall be determined eligible as specified in Section 4 of this Chapter.

(d) For people with the same date of eligibility, the Division shall use the date that the Case Manager Selection form was received by the Division to determine which individual shall receive the next funding opportunity.

(e) The Level of Service score and individual budget amount shall be determined for each individual on the wait list. An eligible individual who needs services in excess of the Supports Waiver may request placement on the Comprehensive Waiver, and may be placed on the Comprehensive Waiver wait list, if a funding opportunity is not available. Preference on the Comprehensive Waiver wait list is given to individuals with a Level of Service score of four (4) or higher.

(f) The Comprehensive Waiver shall reserve capacity each year for eligible individuals who have resided in a Wyoming institution, such as an ICF/IID, nursing home, Psychiatric Residential Treatment Facility, residential treatment facility, BOCES, or an inpatient psychiatric hospital, and who have been:

(i) In residence at the institution;

(ii) On a Division wait list; or

(iii) On a Division waiver prior to being institutionalized.

(g) The Comprehensive and Supports Waivers shall reserve capacity each year for qualifying dependents of active military service members who have been assigned to serve in Wyoming, or who are retiring or separating from active duty military service and intend to reside in Wyoming within eighteen (18) months.

(h) If additional capacity is available after the Comprehensive Waiver makes the required reservations under subsections (f) and (g) of this Section, the Comprehensive Waiver may reserve capacity for other individuals transitioning out of institutional services upon the request of the individual.

Section 14. Emergency Waiver Services.

(a) An emergency case involves an eligible person who requires immediate action or has an urgent need for waiver services, including placement in the least restrictive and most appropriate environment necessary to maintain the person's vital functions because of one of the following criteria:

(i) An immediate threat, or a high probability of immediate danger to the life, health, property, or environment of the eligible person or another individual because of the eligible person's medical, mental health, or behavioral condition.

(ii) A loss of the person's primary caregiver due to death, incapacitation, critical medical condition, or inability to provide continuous care. A caregiver is defined as any person, agency, or other entity responsible for the care, both physical and supervisory, of a person because of:

(A) A family relationship;

(B) Voluntary assumption of responsibility for care;

(D) Rendering services in a residential program;

(E) Rendering services in an institution or in a community-based program; or

(F) Acceptance of a legal obligation or responsibility of care to the person.

(iii) Homelessness, which means a situation where, for a period of thirty (30) days, a person lacks access to an adequate residence with appropriate resources to meet his or her support and supervision needs, and without such support, there is evidence of serious harm to the person's life or health.

(iv) A case involving a person removed from the home by an appropriate agency due to abuse, neglect, abandonment, exploitation, or self-neglect.

(v) A residential service request for a waiver participant or a person on the wait list not receiving 24-hour residential services, whose health or safety is at significant risk due to extraordinary needs that cannot be met in the current living arrangement because of one of following criteria:

(A) A substantial threat to a person's life or health that is corroborated by the Department of Family Services, Protection & Advocacy System, Inc., or law enforcement;

(B) A situation where the person's health condition or significant and frequently occurring behavioral challenges pose a substantial threat to the person's own life or health, or to others in the home;

(C) A situation where the person's critical medical condition requires ongoing twenty-four (24) hour support and supervision to maintain the person's health and safety that cannot be met in the current living situation; or

(D) The loss of the eligible person's primary caregiver due to death, incapacitation, critical medical condition, or inability to provide continuous care.

(b) Any person who requests that the Division consider an emergency case shall be directed to work with the person's chosen case manager, the Division, and other community resources to review options for emergency services. The case manager shall submit the request for emergency services on behalf of the person.

(d) An individual who has not been deemed eligible for waiver services may complete the eligibility process and request emergency services. No emergency services may be provided to ineligible persons.

(e) Emergency placement in waiver services shall not be made as an alternative to incarceration or jail.

Section 15. Extraordinary Care Committee.

(a) The ECC shall be composed of a Division waiver manager, a Medicaid manager, the Participant Support Specialist presenting the case, and a representative from the Department's fiscal unit. When appropriate, the ECC may also include the Division's licensed psychiatrist, the Medicaid Medical Director, the Division's registered nurse, or a behavioral specialist. Members may also consult other specialists in the field as appropriate.

(b) The ECC shall only approve additional funds for participant cases if funding is available in the Division's waiver budget appropriation.

(i) Emergency cases as defined by Section 14 of this Chapter;

(ii) Extraordinary cases that include a significant change in service need due to the onset of a behavioral or medical condition or injury including:

(A) A temporary change in circumstances, which requires a higher level of service or support to ensure the health, safety, and welfare of the participant;

(B) Temporary funding increases under Section 11(d) of this Chapter;

(D) Requests requiring ECC approval under these Rules; and

(iii) Other supplemental requests as defined in the Comprehensive and Supports Service Index, which is incorporated by reference.

(d) Emergency cases can arise for a person who is eligible for covered services but is on the wait list, or for participants currently receiving Comprehensive or Supports waiver services who may be determined to be in an emergency situation pursuant to Section 14(a) of this Chapter.

(e) The ECC shall have the authority to approve, partially approve, or deny a submitted funding request for any person deemed eligible for a waiver operated by the Division.

(f) Before submission, the participant's plan of care team shall meet and come to a consensus that an ECC request is necessary and other support or resource options have been explored. The case manager shall ensure the request contains, at a minimum:

(i) Written statements or reports from the other state or regional agencies that support the emergency case including specific incidents, notes related to the type of condition or injury, witnesses, follow-up, treatment summaries, and any documented accounts of events by witnesses;

(ii) Documentation of other approaches or supports that have been attempted;

(iii) Written statements from a credentialed professional related to the area of concern, explaining the significant change in the participant's functioning limitations that result in an assessed need for additional supports or services and how the person's life or health is in jeopardy without such supports and services;

(iv) Evidence that the person does not qualify for funding or services through any other agency that would alleviate the emergency situation; and

(v) For persons requesting services or supports due to homelessness, evidence that:

(A) Either:

(I) Other community resources, such as a victim's shelter, or other temporary residence are not available or appropriate; or

(II) Other community resources are insufficient to meet the person's immediate health and safety needs, and there is evidence of immediate and serious harm to the person's life or health; and

(B) Due to other conditions of the emergency or the person's condition, waiver services would be the necessary and appropriate intervention.

(g) A request may be made by the participant's plan of care team if they can demonstrate that a participant's Level of Service score does not reflect the participant's assessed need.

(h) A request shall be submitted on the form provided by the Division, and accompanied by additional information that the participant and the participant's plan of care team does not see adequately captured in the ICAP or in the information stored electronically by the Division.

(i) ECC requests that do not meet the criteria outlined in subsection (f) of this Section shall not be considered by the ECC.

(j) The ECC may request additional assessments, referrals, or outside consultation. The additional assessments and information may result in a level of service score increase, decrease, or no change. If the participant or plan of care team declines the additional requests, the ECC request shall be denied.

(k) Decisions of the ECC shall be by majority vote and issued in writing within twenty (20) business days of the ECC review.

(l) In cases of a tie vote among members, the Section Administrator or his/her designee shall issue the final vote.

(m) The Section Administrator or his/her designee may approve time limited funding while the ECC is rendering a final decision.

(n) An eligible individual denied services under this Section may request administrative review of that decision pursuant to Chapter 4 of the Department of Health's Medicaid Rules.

Section 16. Prohibited Use of Waiver Funds.

(a) The following services are not eligible for waiver services reimbursement:

(i) The care of individuals residing in a hospital, nursing facility, ICF/IID, or other institutional placement;

(ii) Wavier services provided by:

(A) A spouse of the participant, if the spouse is also the participant's legally authorized representative;

(B) A legally authorized representative of a participant who is eighteen (18) years of age or older; or

(C) An owner or officer of a provider organization if the organization is serving a participant for whom they are the legally authorized representative;

(iii) Room and board, except when provided as part of respite in a facility, other than a private residence, approved by Medicaid;

(iv) Services currently covered under the Medicaid State Plan;

(v) Services to an individual if it is reasonably expected that the cost of these services would exceed the institutional cost limit specified in the most current Comprehensive Waiver application approved by CMS, which is incorporated by reference; or

(vi) Service settings reimbursed by another state agency, such as the Department of Family Services or Department of Education.

(b) No direct service that is the responsibility of the school system shall be authorized as a waiver service. The Division shall not authorize direct waiver services for the hours the child is attending school or in a vocational program.

(i) Regular school hours and days apply for a child who receives home schooling or an adjusted school day.

(ii) Waiver services may be used if an individualized educational plan identifies specific times when the school system shall not cover services for the individual.

(c) Any individual eligible for funding for specialized services under the Developmental Disabilities Services Act shall apply for and accept any federal Medicaid benefits for which they may be eligible and benefits from other funding sources within the Department of Health; the Department of Education; the Department of Workforce Services and Division of Vocational Rehabilitation; and other agencies to the maximum extent possible.

Section 17. Denial of Funding for Waiver Services.

(a) The Division may deny or revoke authorization for waiver services for any of the following reasons:

(i) The individual fails to meet waiver eligibility criteria as established in Section 4;

(ii) The eligible individual has not met emergency criteria and no other waiver funding opportunities are available;

(iii) The individual or legally authorized representative has not consented to waiver services;

(iv) The individual or legally authorized representative has chosen to receive ICF/IID or nursing facility services;

(v) The individual, his or her legally authorized representative, or other person on his or her behalf has not supplied needed information;

(vi) The participant's needs are not being met through waiver services;

(vii) The individualized plan of care has not been implemented;

(viii) The legislature has not appropriated sufficient fiscal resources to fund all services for all persons determined eligible for waiver services;

(ix) Funding for requested waiver services is available as a similar service from other sources, such as a school district or the Division of Vocational Rehabilitation;

(x) The eligible individual or legally authorized representative has failed to apply for, and accept any federal Medicaid benefits for which she or he may be eligible, or benefits from other funding sources within the Department of Health, the Department of Education, Department of Workforce Services, or other agencies to the maximum extent possible.

(xi) The eligible individual or legally authorized representative has not signed documentation required by the Department;

(xii) The eligible individual or legally authorized representative has failed to cooperate with, or refused the services funded by the Division; or

(xiii) The individual could receive educational services during a regular or adjusted school day, through the end of the school year in which the individual turns twenty-one (21) years old.

Section 18. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions

Section 19. Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Division, including provider manuals and provider bulletins, which are inconsistent with this Chapter.

Section 20. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

Section 21. Incorporation by Reference.

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this Section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each code, rule, or regulation incorporated by reference in these rules is further identified as follows:

(ii) Referenced in Section 2 and 10 of this Chapter is Wyoming Medicaid's State Plan, incorporated as of the effective date of this Chapter and can be found at http://www.health.wyo.gov/healthcarefin/medicaid/spa.

(iii) Referenced in Section 2, 11, and 16 of this Chapter is Wyoming's Comprehensive and Supports Waiver Applications, incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/behavioralhealth/dd/bhd-public-notices/.

(iv) Referenced in Section 2, 10, 12, and 15 of this Chapter is Wyoming's Comprehensive and Supports Waiver Service Index, incorporated as of the effective date of this Chapter and can be found at https://www.health.wyo.gov/behavioralhealth/dd/servicesandrates/.

(v) Referenced in Section 4 of this Chapter is the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), incorporated as of the effective date of this Chapter and can be found at American Psychiatric Association Publishing, 1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209.

(vi) Referenced in Sections 10 and 11 of this Chapter is Section 110 of the Rehabilitation Act of 1973, incorporated as of the effective date of this Chapter and can be found at https://www.ssa.gov/.

(vii) Referenced in Sections 10 and 11 of this Chapter is Section 504 of the Rehabilitation Act of 1973, incorporated as of the effective date of this Chapter and can be found at https://www.ssa.gov/.

(viii) Referenced in Sections 10 and 11 of this Chapter is the Individuals with Disabilities Education Act (IDEA) (20 U.S.C. 1401 et seq.), incorporated as of the effective date of this Chapter and can be found at https://www.ssa.gov/.

History

Effective 2019-12-20

Chapter 47 Childrens Mental Health Waiver (CMHW) and Care Management Entity (CME) Rules

Wyo. Code R. 048.0037.47.09232019 § 1 Authority

This Chapter is promulgated pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 et seq. and 2006 - Enrolled Act 0021, House Bill 91, Section 4.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 2 Purpose and Applicability

(a) This Chapter applies to Medicaid services provided under the Wyoming Care Management Entity (CME) and the Children's Mental Health Waiver (CMHW) programs.

(b) The Department may issue manuals and bulletins to interpret provisions in this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this chapter. Provisions contained in manuals and bulletins shall be subordinate to the provisions outlined in this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 3 General Provisions

(a) This Chapter has been adopted to establish rules for all-inclusive Care Management Entity (CME) and Children's Mental Health Waiver (CMHW) Programs that improve clinical, functional, and cost outcomes for eligible participants.

(b) Through this Rule, the CME shall be required to collaborate with a network of providers in order to comprehensively serve the intensive care coordination needs of enrollees receiving care under the CME and CMHW Program.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 4 Definitions

(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;

(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.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 5 Eligibility

(a) Enrollment for CME 1915(b) services is mandatory for the following populations:

(i) Youth qualifying under Section 1931 of the Social Security Act and related populations, to include poverty-level related groups and optional groups of older youth;

(ii) Blind/Disabled youth and related populations, to include beneficiaries, generally under age 18, who are eligible for Medicaid due to blindness or disability;

(iii) Youth in Foster Care in the State of Wyoming, or youth receiving adoption assistance under Title IV-E, or are otherwise in out-of-home placement.

(iv) Targeting Criteria for the populations includes:

(A) Medicaid youth ages four to twenty (4-20) at risk of out-of-home placement (defined and identified as youth with two hundred (200) days or more of behavioral health services within one State fiscal year);

(B) Medicaid youth ages four to twenty (4-20) who currently meet Psychiatric Residential Treatment Facility (PRTF) level of care as outlined in Chapter 40, Psychiatric Residential Treatment Facilities;

(C) Medicaid youth ages four to twenty (4-20) who currently meet acute psychiatric stabilization hospital level of care as determined by a licensed clinician; had an acute hospital stay for mental or behavioral conditions in the last three hundred sixty-five (365) days; or are currently placed in an acute hospital stay for mental or behavioral health conditions;

(D) Youth enrolled in the Children's Mental Health Waiver (Section 1915(c) WY Waiver #0451); or

(E) Medicaid youth ages four to twenty (4-20) referred to the pre-paid ambulatory health plan (PAHP) and who meet defined eligibility, including clinical eligibility and SED criteria.

(v) Medical Eligibility Criteria is a condition for enrollment in the CME after initial targeting criteria is met. The Medical Eligibility Criteria includes:

(A) Youth ages six to twenty (6-20) who have a minimum CASII composite score of twenty (20), and youth ages four (4) and five (5) who have an ECSII score of eighteen (18) to thirty (30) or the appropriate social and emotional assessment information provided to illustrate level of service needs; and

(I) CASIIs administered for the purpose of establishing medical eligibility shall not be administered by the CME but instead be administered by a neutral third party to ensure conflict free case management.

(B) Youth who have a DSM Axis 1 or International Classification of Disease (ICD) diagnosis that meets the State's diagnostic criteria.

(b) Enrollment for CME 1915(c) services is mandatory for the following populations:

(i) Targeting Criteria for the populations includes:

(A) Medicaid youth ages four to twenty-one (4-21) at risk of out-of-home placement (defined and identified as youth with two hundred (200) days or more of behavioral health services within one State fiscal year);

(B) Medicaid youth ages four to twenty-one (4-21) who currently meet PRTF level of care as outlined in Chapter 40, Psychiatric Residential Treatment Facilities or are placed in a PRTF;

(C) Medicaid youth ages four to twenty-one (4-21) who currently meet acute psychiatric stabilization hospital level of care as determined by a licensed clinician; had an acute hospital stay for mental or behavioral conditions in the last three hundred sixty-five (365) days; or are currently placed in an acute hospital stay for mental or behavioral health conditions; or

(D) Medicaid youth ages four to twenty-one (4-21) referred to the PAHP and who meet defined eligibility, including clinical eligibility and SED/SMI criteria.

(ii) Medical Eligibility Criteria is a condition for enrollment in the CME after initial targeting criteria is met. The Medical Eligibility Criteria includes:

(A) Youth ages six to twenty-one (6-21) who have a minimum CASII composite score of twenty (20), and youth ages four (4) and five (5) who have an ECSII score of eighteen (18) to thirty (30) or the appropriate social and emotional assessment information provided to illustrate level of service needs; and

(B) Youth who have a DSM Axis 1 or primary ICD diagnosis that meets the State's diagnostic targeting criteria as specified above.

(d) A person is not considered financially eligible when the Department expects the costs of HCBS furnished to the individual would exceed the per member, per month (PMPM) amount specified by the Department in the 1915 (c) waiver's cost neutrality equation.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 6 Participant Application and Enrollment Process

(a) The Department shall automatically enroll eligible youth into the CME.

(b) A youth and his or her family may choose to disenroll at any time pursuant to Section 7 of this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 7 Participant Disenrollment Process

(a) The Department will review and approve all requests by the CME to disenroll youth based on the medical necessity of the HFWA service plan. An individual may be disenrolled from the CME if:

(i) The youth is no longer Medicaid eligible;

(ii) The youth moves out of the State;

(iii) The youth ages out of the program;

(iv) The youth is incarcerated;

(v) The youth is no longer financially eligible;

(vi) The youth is no longer clinically eligible;

(vii) The youth is determined eligible for any excluded program/population pursuant to Section 4;

(viii) The youth is in out-of-home placement longer than one hundred eighty (180) days;

(ix) The youth needs related services (for example a cesarean section and tubal ligation) to be performed at the same time; not all related services are available within the network; and the youth's Primary Care Provider (PCP) or another provider determines that receiving the services separately would subject the youth to unnecessary risk; or

(x) Other reasons, including but not limited to, poor quality of care, lack of access to services covered under the contract, or lack of access to providers experienced in dealing with the youth's specific health care needs.

(b) A participant may voluntarily disenroll from the CME without cause at any time.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 8 Loss of Eligibility

(a) A participant shall be determined no longer eligible for CME program services when:

(i) The youth is no longer Medicaid eligible;

(ii) The youth moves out of the State;

(iii) The youth ages out of the program;

(iv) The youth is incarcerated;

(v) The youth is no longer financially eligible;

(vi) The youth is no longer clinically eligible;

(vii) The youth is determined eligible for any excluded program/population pursuant to Section 4 of this Chapter;

(viii) The youth is an out-of-home placement longer than one hundred eighty (180) days;

(ix) The CME provider's agreement with CMS and the Department is not renewed or is terminated; or

(x) The CME provider is unable to offer health care services due to the loss of contracts with outside providers.

(b) An enrollee may appeal their loss of eligibility pursuant to the grievance process outlined in Section 22 of this Rule.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 9 Availability of Services/Accessibility

(a) Any youth enrolled with the CME who meets the eligibility criteria as outlined in Section 5 of this Chapter is eligible for HFWA and respite services. Each enrollee maintains full access to all Medicaid state plan services. Special health care needs shall be identified and treated through primary and specialty care providers in Medicaid fee for service.

(b) Appropriately trained, credentialed, and Medicaid-enrolled providers may contract with the CME as part of the CME's provider network for the provision of HFWA and respite services.

(i) HFWA and respite is available to all enrolled youth statewide.

(c) Respite service shall accommodate the needs of the youth and his or her family. Prior to the authorization of respite services, the youth's plan of care shall document how respite would support HFWA service goals.

(d) Service settings are either based in the provider's residence, the youth's residence, or in community locations that are not institutional. Respite providers who choose to use their home shall have their home approved for respite prior to providing services.

(e) Respite shall only be provided for one youth at a time unless the CME reviews and approves additional youth.

(f) Respite services shall be restricted to a maximum of four hundred sixteen (416) hours per calendar year for each enrolled and qualified youth.

(g) To determine clinical eligibility, youth accessing the CME through the CMHW Program shall complete an application containing all pertinent demographic and identifying information, including the LOC determination as recommended by a qualified licensed mental health professional, and the CASII/ESCII assessment completed by a qualified third party evaluator.

(i) The CASII, ESCII and LOC evaluation shall be completed upon initial application and annually thereafter prior to the plan of care development and approval. Ongoing eligibility determinations shall be made using the same criteria as the initial assessment.

(ii) If the youth meets the clinical criteria, information is uploaded into Electronic Medicaid Waiver System (EMWS) and the applicant is notified. The applicant shall then complete the financial eligibility application.

(A) Youth that are financially able are notified of either their assignment to the wait list or notification of a funding opportunity.

(I) Youth are scored and ranked on the wait list using the following criteria to determine applicants with the highest level of care scores:

(1.) Eligibility qualification acuity (CASII/ESCII score);

(2.) Threat for custody relinquishment - being denied care because of custody status;

(3.) Child in Need of Supervision (CHINS) petition is being recommended or considered;

(4.) DFS is involved;

(5.) Threat to home/school situation - expulsion or placement from school or homelessness; or

(6.) Youth who are part of a household where other members are already receiving wraparound services.

(iii) Youth may be denied if wraparound services are already being provided to immediate family.

(h) Reapplication is an option at any time, and the CME and the State reserve the right to deny reapplication if the youth's previous CME enrollment ended due to non-participation, refusal of essential plan services, or goals of their plan have been met and there has not been a subsequent change or transition in the applicant's assessed needs.

(i) Enrollment in the program for the purposes of accessing institutional care or receiving financial assistance to cover medical services or co-pays and deductibles related to insurance coverage is not a valid reason for enrollment in HFWA.

(i) Program participants may select any willing and qualified provider to furnish waiver services included in the service plan as long as they are not financially affiliated with the assessor who is performing the ECSII or CASII evaluation for that participant's enrollment process.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 10 Individualized Plan of Care

(a) An individualized plan of care (POC) shall be developed with the Family Care Coordinator (FCC), family, youth, and family team (CFT) within thirty (30) days of selection of an FCC.

(b) A crisis plan shall be included as part of the POC to assist in stabilizing the youth and family during a crisis.

(c) The POC shall be updated at least every ninety (90) days. More frequent updates may be necessary depending on the needs of the youth and his or her family.

(d) Each youth's PCP shall be documented in the POC.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 11 Benefit Plan and Covered Services

(a) Services delivered by the CME shall be appropriate in type, frequency, and duration.

(b) Services shall include HFWA services only, and be subject to the following requirements:

(i) A ratio of no more than one (1) FCC for a total of ten (10) persons (1:10) being served by that FCC regardless of the referral source;

(ii) A ratio of no more than one (1) Family Support Partner (FSP) for a total of ten (10) persons (1:10) being served by that FSP regardless of the referral source;

(iii) A ratio of no more than one (1) Youth Support Partner (YSP) for a total of twenty-five (25) persons (1:25) being served by that YSP regardless of the referral source;

(iv) Adequate capacity for FSPs and YSPs. Every family shall initially be provided a FSP and YSP until the family decides they do not need either an FSP or YSP; and

(v) Natural supports consisting of a family member, friend, or community member selected by the participant or family, or both, to participate on the CFT. Any form of supports to the family or youth by an unpaid family member, friend, or community members.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 12 Quality Reporting

(a) The Department shall perform, at minimum, quarterly monitoring of the CME 1915(b) waiver program's impact, access, and quality to ensure access to adequate services where medically necessary.

(i) The Department shall establish standards of quality for CME adherence, including, but not limited to, plan assurances on network adequacy.

(ii) The Department shall deem the CME in compliance with standards as long as the accrediting agency maintains standards as required by the Department.

(b) The Department shall perform, at minimum, annual monitoring of the CMHW 1915(c) waiver to collect information regarding waiver participants and cost effectiveness in accordance with CMS data collection plan.

(c) The Department and the Federal Health and Human Services Agency, or their designee, have the authority to perform monitoring activities as determined appropriate in accordance with the Act. The Department and the Federal Health and Human Services Agency, or their designees, shall perform remediation when necessary and to the level necessary.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 13 Provider Organization Standards

The CME and its providers shall comply with all Department standards. Through annual provider certification visits and ongoing incident and complaint management systems, the Department will assess providers for ongoing compliance with the HCBS settings. Certification requirements will be adjusted to ensure services settings for the waivers remain in settings that are not institutional or isolating in nature. Any areas of concern will be addressed by the Department's corrective action and sanctioning process pursuant to Chapter 16 of the Wyoming Medicaid Rules.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 14 Conflict of Interest

. Conflicts of interest that may result in provider practices that have an appearance of impropriety are prohibited. The Department and the CME shall issue policy regarding conflict of interest in the form of manuals and bulletins to provide guidance to providers on how to avoid practices that result in a potential conflict of interest.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 15 Provider Recordkeeping and Data Collection

For the purposes of data collection, the Medicaid Management Information System shall capture all eligibility data as well as claims and encounter data.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 16 Documentation Standards

All documentation shall be conducted pursuant to Chapter 3, Provider Participation.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 17 Background Check Requirements

(a) All service providers shall successfully complete a central registry check, a Federal Bureau of investigation (FBI)/Division of Criminal Investigation (DCI) background screening, and an Office of the Inspector General (OIG) background screening.

(i) A successful background check shall verify the person has not been convicted of an Offense Against the Person including:

(A) Homicide (W.S. § 6-2-101 et seq.);

(B) Kidnapping (W.S. § 6-2-201 et seq.);

(D) Robbery and blackmail (W.S. § 6-2-401 et seq.);

(E) Assault and battery (W.S. § 6-2-501 et seq.); or

(F) Similar laws of any other state or the United States relating to these crimes.

(ii) A successful background check shall verify the person has not been convicted of an Offense Against Morals, Decency and Family including:

(A) Bigamy (W.S. § 6-4-401);

(B) Incest (W.S. § 6-4-402);

(D) Violation of order of protection (W.S. § 6-4-404);

(E) Endangering children; controlled substances (W.S. § 6-4-405); or

(F) Similar laws of any other state or the United States relating to these crimes.

(iii) All providers and employees of providers providing services to participants pursuant to this Chapter shall complete a Wyoming Department of Family Services (DFS) Central Registry Screening (W.S. § 7-19-201). The screening shall verify that the person does not appear on the Wyoming Department of Family Services Central Registry.

(b) The CME shall verify through a provider attestation that the provider successfully completed the required background checks.

(c) The CME shall require proof of current Wyoming Medicaid provider enrollment before submitting claims to Medicaid on behalf of the provider.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 18 Provider Training and Certification Requirements

(a) Any willing and qualified agency or individual can enter into a contract with the CME for the provision of HFWA and respite services.

(b) All HFWA provider requirements are detailed in the Medicaid state plan, Targeted Case Management for Youth with SED/SMI.

(c) All HFWA providers shall comply with Department requirements for obtaining initial credentialing as a HFWA provider and shall recertify their credentials annually.

(d) To be a FCC, the individual shall:

(i) Have a Bachelor's degree in a human service area (or related field), or two years of work or personal experience in providing direct services or linking of services for youth experiencing SED/SMI;

(ii) Be at least twenty-one (21) years of age;

(iii) Complete all Department and CME-required training components;

(iv) Possess a valid driver's license, automobile insurance coverage that complies with the Wyoming Department of Insurance's required liability coverage limits, and car;

(v) Maintain current CPR and First Aid Certification;

(vi) Complete the HFWA credentialing processes as specified by Medicaid;

(vii) Be enrolled as a Wyoming Medicaid provider;

(viii) Be under contract (or have an employment agreement) with the CME; and

(ix) Successfully pass all background screenings as required by Medicaid.

(e) To be a FSP, the individual shall:

(i) Have a high school diploma or GED equivalent;

(ii) Be a parent or caregiver of a youth with behavioral health needs or have two years of experience working closely with youth with serious emotional/behavioral challenges and their families;

(iii) Have a minimum two years of experience in the behavioral health field;

(iv) Complete the credentialing requirements specified by Medicaid;

(v) Be enrolled as a Wyoming Medicaid provider;

(vi) Be under contract (or have an employment agreement) with the CME;

(vii) Be at least twenty-one (21) years of age;

(viii) Successfully pass all background screenings as required by Medicaid; and

(ix) Complete all Medicaid-required training components.

(f) To be a YSP, the individual shall:

(i) Have a high school diploma or GED equivalent;

(ii) Be a youth with behavioral health needs or have experience overcoming various systems and obstacles related to mental and behavioral health;

(iii) Successfully pass all background screenings as required by Medicaid;

(iv) Complete the credentialing requirements specified by Medicaid;

(v) Be enrolled as a Wyoming Medicaid provider;

(vi) Be under contract (or have another employment agreement) with the CME;

(vii) Be eighteen (18) to twenty-six (26) years of age; and

(viii) Complete all Medicaid-required training components.

(g) Respite. Any provider of respite care is required to attain and maintain a certification for this service from the CME and shall:

(i) Successfully pass a criminal history background check per Section 17 of this rule;

(ii) Maintain a current CPR and First Aid Certification;

(iii) Be at least twenty-one (21) years of age;

(iv) Have two (2) years of work/personal experience with youth; and

(A) Preference is given to individuals who have worked with a youth with serious emotional disturbance;

(v) Maintain auto insurance as required by state law if transporting enrolled youth.

(h) The CME shall ensure all provider qualifications are met upon initial contracting and annually thereafter.

(i) A respite provider determined to be out of compliance with Department requirements at any point in the year will receive notification from the CME regarding the nature of the non-compliance and a specified timeframe for resolution.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 19 Marketing

(a) All marketing materials produced by the CME shall be approved by the Department before disseminating.

(b) The CME may participate in indirect marketing as follows:

(i) The CME may attend health fairs, sponsor community forums, obtain radio spots, print media, and provide general outreach so long as the entity does not target its material directly to Medicaid beneficiaries.

(i) HFWA Youth and Family Handbooks issued to those automatically referred to the CME. Handbooks shall outline all Federal information requirements and include any additional HFWA educational material that may be helpful to families when being assessed for enrollment.

(d) The CME shall not provide gifts or incentives to Medicaid beneficiaries.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 20 Transition Process

(a) Transition of youth who exceed the maximum age limitation shall occur before the end of the month of their twenty-first (21st) birthday:

(i) Any and all pertinent POC shall initiate development of a plan to address transition goals before transition is expected to occur.

(A) Transition plans shall include, but not be limited to, detailed, measurable objectives to be followed by the team in support of the youth and family during the transition.

(b) If a youth loses Medicaid eligibility, the youth is no longer eligible for state plan services. The Department will reserve five (5) waiver funding opportunities per year for Medicaid state plan youth enrolled in the HFWA program who lose Medicaid eligibility to assist with the transition off or completion of their HFWA POC. This transition shall occur concurrently to the youth's loss of Medicaid to prevent a lapse in care.

(c) The Department shall reserve five (5) CMHW program funding opportunities to triage financially and clinically qualified youth with a CASII composite score of 25 or higher or an ESCII composite score of 23 or higher. Immediate service initiation shall occur to prevent or divert the youth from being admitted to an inpatient psychiatric facility for individuals under age 21 as provided in 42 CFR § 440.160.

(d) CME and CMHW participants who are placed out of their community in an out-of-home placement that results from hospitalization, detention, other types of institutionalization, or who have relocated out of their home community for any other reason, shall be disenrolled no later than one hundred twenty (120) days from the initial date of their absence from the community.

(i) Upon written request from the provider, exceptions to the one hundred twenty (120) day absence rule may be allowed when it is anticipated the youth will return to their community within one hundred eighty (180) days of the initial date of their absence, and the CME network provider has gained prior approval from the CME via the youth's current POC to extend wraparound services during this time frame to assist in transition back to the community.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 21 Childrens Mental Health Waiver (CMHW) and Care Management Entity (CME) Rules

Non-English Languages.

(a) Potential enrollee and enrollee materials shall be translated into the prevalent non-English languages, which is defined as any language spoken by approximately four percent (4%) or more of the potential enrollee/enrollee population.

(b) The Department shall maintain an active contract with a translation service. If an enrollee or provider needs translation services, he or she shall contact the CME to set an appointment with the translation service, and the cost shall be billed to the Department.

(c) All marketing and education materials shall be available in prevalent non-English languages. For language needs, other than prevalent non-English languages, the Department shall allow the enrollee or provider to use the translation service at the expense of the Department.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 22 Grievance and Complaints

(a) The CME shall have a system in place for enrollees or providers acting on behalf of enrollees to access a grievance process, an appeal process, and access to the Department's fair hearing system. The CME's grievance procedure shall meet the following requirements:

(i) Notice of the CME's grievance procedure shall be sent to enrollees once the Department informs the CME of the youth's eligibility as a program enrollee;

(ii) The CME's grievance and one-level appeal process must adhere to the timeframes specified in 42 C.F.R. §438.400 and §438.424.

(iii) An enrollee has sixty (60) calendar days from the date on the adverse action notice to file an oral or written request

(iv) The CME shall acknowledge in writing, via certified mail, the receipt of a written or oral grievance or complaint within five (5) working days of receipt;

(v) The CME shall prepare and present a proposed resolution to the complaint within forty-five (45) calendar days from the date the CME receives the grievance. If the CME's proposed resolution is not accepted by the enrollee or entity acting on behalf of the enrollee they may file a request for continuation of benefits within ten (10) calendar days of receipt of the proposed resolution or the intended effective date of the adverse action notification, whichever is later. The CME has thirty (30) calendar days to review and respond to the appeal.

(vi) An enrollee may request a State fair hearing after receiving notice under 42 C.F.R. §438.408 that the adverse benefit determination is upheld by the CME.

(vii) If the CME fails to adhere to the notice and timing requirements in §438.408, the enrollee is deemed to have exhausted the CME's appeals process. The enrollee may initiate a State fair hearing.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 23 Audits

. Audits shall be subject to the provisions of Chapter 16.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 24 Payment of Claims

(a) The CME is paid using per member, per month (PMPM) administrative services rate for HFWA service administration.

(b) The PMPM paid to the CME for administrative services is contractually negotiated.

(c) The CME network providers are paid on a fee for service basis for the HFWA and waiver services specified in the contract.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 25 Interpretation of Chapter

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of various provisions

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 26 Superseding Effect

This Chapter supersedes all prior rules or policy statements issued by Department, or its designee, including manuals and bulletins which are inconsistent with this Chapter.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 27 Severability

If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2019-09-23

Wyo. Code R. 048.0037.47.09232019 § 28 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each rule or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Sections 9, 18, and 20 of this Chapter is the Wyoming Medicaid state plan, which is incorporated as of the effective date of this Chapter and can be found at https://health.wyo.gov/healthcarefin/medicaid/spa/.

(ii) Referenced in Section 20 of this Chapter is 42 C.F.R. § 440.160, which is incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(iii) Referenced in Section 22 of this Chapter are 42 C.F.R. § 438.400, § 438.408 and § 438.424, which are incorporated as of the effective date of the Chapter and can be found at http://www.ecfr.gov.

History

Effective 2019-09-23

Chapter 49 Nursing Facility Involuntary Discharge or Transfer Hearings

Wyo. Code R. 048.0037.49.04162020 § 1 Authority

This Chapter is promulgated pursuant to the Wyoming Medical Assistance and Services Act at Wyoming Statutes § 42-4-101 through - 122.

History

Effective 2020-04-16

Wyo. Code R. 048.0037.49.04162020 § 2 Purpose and Applicability

(a) This Chapter is intended to comply with federal law directives under applicable provisions of 42 U.S.C. § 1396r, which require notice and opportunity to be heard in cases of involuntary transfers or discharges of residents of nursing care facilities.

(b) The Department may issue manuals and bulletins to providers and other affected parties to interpret the sections of this Chapter. Such manuals and bulletins shall be consistent with and reflect the requirements outlined in this Chapter. The provisions contained in manuals and provider bulletins shall be subordinate to the sections of this Chapter.

History

Effective 2020-04-16

Wyo. Code R. 048.0037.49.04162020 § 3 Involuntary Discharge or Transfer of a Resident

(a) Pursuant to 42 CFR 483.15 (c), the facility shall permit each resident to remain in the facility, and not transfer or discharge the resident from the facility unless one of the following conditions is met:

(i) The transfer or discharge is necessary for the resident's welfare and the resident's needs cannot be met in the facility;

(ii) The transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;

(iii) The safety of individuals in the facility is endangered due to the clinical or behavioral status of the resident;

(iv) The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility. Non-payment applies if the resident does not submit the necessary paperwork for third party payment or after third party, including Medicare or Medicaid, denies the claim and the resident refuses to pay for his or her stay. For a resident who becomes eligible for Medicaid after admission to a facility, the facility may charge a resident only allowable charges as outlined in Chapter 7, Wyoming Nursing Home Reimbursement System;

(v) The facility ceases to operate; or

(vi) The health of individuals in the facility would otherwise be endangered.

(b) Pursuant to 42 CFR 483.15 (c)(3) before a facility transfers or discharges a resident, the facility shall:

(i) Notify the resident and the resident's representative(s) of the transfer or discharge and the reasons for the move in writing and in a language and manner they understand. The facility shall send a copy of the notice to a representative of the Office of the State Long-Term Care Ombudsman;

(ii) Record the reasons for the transfer or discharge in the resident's medical record in accordance with 42 CFR 483.15 (c)(2); and

(iii) Include in the notice the items described in 42 CFR 483.15 (c)(5).

(c) Pursuant to 42 CFR 483.15 (c)(4) the notice of transfer or discharge required under Section 3 (c) of this chapter shall be made by the facility at least 30 days before the resident is transferred or discharged. Under the following circumstances, notice may be made as soon as practicable before transfer or discharge:

(i) The safety of individuals in the facility would be endangered under 42 CFR 483.15 (c)(1)(i)(C);

(ii) The health of individuals in the facility would be endangered, under 42 CFR 483.15 (c)(1)(i)(D);

(iii) The resident's health improves sufficiently to allow a more immediate transfer or discharge, under 42 CFR 483.15 (c)(1)(i)(B);

(iv) An immediate transfer or discharge is required by the resident's urgent medical needs, under 42 CFR 483.15 (c)(1)(i)(A); or

(v) A resident has not resided in the facility for 30 days.

History

Effective 2020-04-16

Wyo. Code R. 048.0037.49.04162020 § 4 Hearing Request

(a) A resident eligible for an administrative hearing under this Chapter shall submit the request in accordance with Chapter 4 of the Wyoming Department of Health, Medicaid Rules, within thirty (30) calendar days after a notice of transfer or discharge has been given by the facility. Failure to timely submit the request shall deprive the individual of a right to a hearing.

(b) The facility may not transfer or discharge the resident while the appeal is pending, unless failure to discharge or transfer would endanger the health or safety of the resident or other individuals in the facility. The facility shall document the danger that failure to transfer or discharge would pose.

History

Effective 2020-04-16

Wyo. Code R. 048.0037.49.04162020 § 5 Administrative Hearings

(a) The hearing and all other affiliated processes will be conducted in accordance with Chapter 4 of the Wyoming Department of Health, Medicaid Rules.

(b) The hearing shall be held within forty (40) days of the receipt of the request.

(c) The burden of proof shall be placed upon the party contesting a determination to involuntarily transfer or discharge a resident.

(d) The party contesting a facility determination shall show by a preponderance of the evidence just cause why the proposed transfer or discharge does not comply with the grounds established by Section 3 of this chapter.

(e) The Wyoming Department of Health shall not be a party to the proceedings under this Chapter.

(f) The Department shall facilitate all correspondence between the resident, the facility, and the Office of Administrative Hearings for purposes of carrying out the proceedings.

History

Effective 2020-04-16

Chapter 50 State Supplemental Payments

Wyo. Code R. 048.0037.50.09062018 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to Wyoming Statute § 42-2-103.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 2 Purpose

This Chapter has been adopted to provide uniform procedures used to determine eligibility for State Supplemental payments. In order to receive a federal match for the Medicaid program, these payments are required by 20 C.F.R § 416.2001 and Public Law 93-66, as amended by Public Law 93-233. These payments are intended to complement the federal benefit amount, thereby increasing the amount of income available to meet a client's needs.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 3 Definitions

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

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 4 Application Process

An application for Supplemental Security Income (SSI) shall be submitted to the Social Security Administration. In order to determine eligibility, the Social Security Administration shall provide the applicant's information to the Department of Health.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 5 Eligibility Factors

A client who receives an SSI payment as a sole source of income and is a resident of Wyoming, as determined by the Social Security Administration, shall be eligible to receive a State Supplemental payment.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 6 Services

State Supplemental payment amounts are determined by the Wyoming State Legislature.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 7 Administrative Hearing

If an administrative hearing is requested, it shall be conducted in accordance with Wyoming Medicaid Rules, Chapter 4, Medicaid Administrative Hearings.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 8 Superseding Effect

This Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and bulletins, which are inconsistent with this Chapter.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 9 Severability

If any of these rules are found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2018-09-06

Wyo. Code R. 048.0037.50.09062018 § 10 Incorporation by Reference

(a) For any code, standard, rule or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department and is available for public inspection and copying at cost at the same location.

(b) Each rule or regulation incorporated by reference in these rules is further identified as follows:

(i) Referenced in Section 2 of this Chapter is 20 C.F.R § 416.2001, incorporated as of the effective date of this Chapter and can be found at http://www.ecfr.gov.

(ii) Referenced in Section 2 of this Chapter is Public Law 93-66, as amended by Public Law 92-233, incorporated as of the effective date of this Chapter and can be found at http://ssa.gov.

History

Effective 2018-09-06

Chapter 51 Kid Care Child Health Insurance Program (CHIP)

Wyo. Code R. 048.0037.51.01182024 Kid Care Child Health Insurance Program (CHIP)

CHAPTER 51

Kid Care Child Health Insurance Program

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Child Health Insurance Program Act at Wyoming Statutes 35-25-101 through 35-25-108 (The Act).

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to govern the Kid Care Child Health Insurance Program ("CHIP") including eligibility, basic level of benefits, and cost-sharing.

(b) This Chapter applies to all applicants and clients for all CHIP services.

(c) The Department may issue manuals and bulletins to interpret this Chapter. Such manuals and bulletins shall be consistent with and reflect this Chapter. The provisions contained in manuals and newsletters shall be subordinate to this Chapter.

Section 3. Definitions.

(a) Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, the terminology used in this Chapter is the standard terminology and has the standard meaning used in health care, health insurance, Medicare, and Medicaid. For the purposes of this Chapter, the following shall apply:

(i) "Benefit year" means a year of benefits coverage that begins January 1 of each year and ends December 31 of the same year.

(ii) "Federal funds" means the Federal funds received by the Department pursuant to 42 C.F.R. § 457 Subpart F.

(iii) "Targeted low income child" means a child who has a household income, as determined according to 42 CFR §457.315, at or below 200 percent of the Federal poverty level for a family of the applicable size.

Section 4. Application Process, Applicant Rights and Responsibilities.

(a) Application Process.

(i) An applicant shall submit an application in the manner and form prescribed by the Department. The application shall be completed, dated, and signed by the applicant or by any person who is assisting the applicant.

(ii) The Department shall act upon an application within forty-five (45) days from the date the application was submitted.

(iii) The Department shall notify the applicant in writing of its application determination along with the reasons and regulations supporting its decision.

(iv) If the application is denied or not acted upon by the Department within forty-five (45) days, the applicant may request an administrative hearing in accordance with Medicaid Rules Chapter 4.

(b) Applicant Rights.

(i) An applicant shall be allowed the opportunity to apply for CHIP without delay.

(ii) An applicant may be accompanied, assisted, or represented by an individual or individuals of their choice during the application process.

(iii) An applicant may request assistance from the Department in completing the application or obtaining required verification.

(iv) The Department shall inform applicants of the following information:

(A) The eligibility requirements;

(B) Available CHIP services; and

(v) Applications and other personal identifying information are confidential and shall not be disclosed, except as allowed by state and federal law.

(vi) An applicant shall not be excluded, denied benefits, or otherwise discriminated against on the grounds of race, color, sex, religion, political belief, national origin, age, or disability.

(i) Applicants shall cooperate in the process of determining eligibility by providing all information and documentation requested by the Department,

(ii) Applicants shall assign to the Department any right to medical support and to payment for medical care from a third party to the extent that CHIP has paid for medical services.

(iii) Applicants who fail to cooperate or provide the information requested by the Department shall be denied eligibility.

(d) Eligibility Period and Redeterminations.

(i) CHIP eligibility begins the first day of the month in which the application was submitted.

(ii) Enrolled clients are deemed to be continuously eligible for twelve (12) months from the effective date of eligibility, or for twelve (12) months from the last redermination unless the covered child turns age nineteen (19), enters a public institution, moves out of state, becomes eligible for Medicaid, or requests to be disenrolled.

(A) An enrolled client who is pregnant is eligible during the pregnancy and through a twelve (12) month postpartum period beginning on the last day of the pregnancy, even when the client turns age nineteen (19) during this period.

(iii) The Department shall re-determine a client's eligibility every twelve (12) months, except for pregnant clients whose eligibility will be re-determined following the client's twelve (12) month postpartum period.

Section 5. General Eligibility Requirements.

(a) Applicants shall meet the following requirements to be eligible for Medicaid:

(i) Applicants shall be citizens or qualified non-citizens of the United States, and provide documentation of such;

(ii) Applicants shall provide proof of identity;

(iii) Applicants shall reside in Wyoming; and

(iv) Applicants who are citizens or nationals of the United States shall provide record of a social security number.

Section 6. CHIP Eligibility Requirements.

(a) Applicants shall meet the following additional requirements to be eligible for CHIP:

(i) Applicants must be below age nineteen (19);

(ii) Countable family income shall be between one hundred thirty-four percent (134%) and two hundred percent (200%) of the Federal Poverty Level (FPL) and calculated using the modified adjusted gross income of the household;

(iii) Applicants cannot reside in a public institution;

(iv) Applicants cannot be covered by any health insurance plan, including the State of Wyoming employee health insurance group plan; and

(v) Applicants cannot have been covered by a health insurance plan for a minimum period of one (1) month before the date of application. The minimum period can be waived when allowable exceptions exist, including the applicant's out-of-pocket health insurance premium costs.

(vi) Applicants and enrolled clients shall immediately report any changes in any of the following circumstances to the Department:

(A) Income;

(B) Household composition;

(D) Address.

Section 7. Basic Level of Benefits.

(a) The covered services provided to CHIP clients, at a minimum, shall include the following services:

(i) Inpatient hospital services;

(ii) Outpatient hospital services;

(iii) Physician services;

(iv) Surgical services;

(v) Clinic services and other ambulatory health care services;

(vi) Prescription drugs;

(vii) Laboratory and radiological services;

(viii) Prenatal care and pre-pregnancy family planning services and supplies;

(ix) Inpatient mental health services;

(x) Outpatient mental health services;

(xi) Durable medical equipment, prosthetics and orthotics;

(xii) Abortion, only if necessary to save the life of the mother or if the pregnancy is the result of rape or incest;

(xiii) Dental services;

(xiv) Medically necessary orthodontia;

(xv) Inpatient substance abuse treatment services;

(xvi) Outpatient substance abuse treatment services;

(xvii) Preventive care, screening and immunization;

(xviii) Hospice care;

(xix) Emergency medical transportation where care is administered during transportation;

(xx) Vision services;

(xxi) Dietician services;

(xxii) Hearing services;

(xxiii) Home health services;

(xxiv) Interpretation services;

(xxv) Nurse practitioner and nurse midwife services;

(xxvi) Organ transplant services;

(xxvii) Occupational, physical and speech therapy services;

(xxviii) Rehabilitation services;

(xxix) Non-emergency medical transportation services; and

(xxx) Any other services determined to be medically necessary as defined in Medicaid Rules Chapter 1.

(b) No exclusion for pre-existing conditions or a maximum life-time benefit per client shall be imposed under CHIP.

Section 8. Denial, Termination, Reduction, or Suspension of Eligibility or Services. An applicant or enrolled client who is denied or terminated from eligibility, or whose services are reduced or suspended shall be notified by the Department in writing, and may request an administrative hearing in accordance with Medicaid Rules Chapter 4.

Section 9. Cost Sharing Maximums

(a) Cost sharing shall not exceed five percent (5%) of a family's gross household income for the length of the client's eligibility period. Each family shall be notified of their cost sharing maximum for the eligibility period.

(b) Clients may request Department review of cost sharing totals if they believe their maximum has been reached.

(c) If the Department determines the family has paid more than their five percent (5%) annual cost sharing maximum the family shall be reimbursed for the excess.

Section 10. Co-payments.

(a) The Department shall determine the benefit year for cost sharing co-payments for particular services. Co-payment amounts shall be determined according to the family income reported at the time of application.

(b) Clients who are American Indians or Alaskan Natives as defined in 42 CFR 457.10 shall not have any cost sharing co-payments imposed.

(c) The Department shall include the benefit year maximum amounts for co-payments in the Client Handbook which shall be made available to each CHIP client.

(d) The Department shall not impose co-payments, coinsurance, deductibles or any other cost sharing for well-baby or well-child services, including but not limited to, immunizations and preventive services.

(e) The Department shall not terminate a client because of the failure to make co-payments.

Section 11. Provider Participation. No person or entity that provides services to a client shall receive CHIP funds unless the person or entity is a Medicaid enrolled provider pursuant to Medicaid Rules Chapter 3.

Section 12. Availability of Funding.

(a) If Department projections indicate expenditures may exceed the federal and state funds available under the Act, the Department may limit participation in the CHIP program as follows:

(i) The Department may impose a partial or total moratorium on new CHIP enrollments until funds are available to meet the needs of new clients;

(ii) For existing clients, the Department shall give priority for available funding to those families with the lowest incomes.

(b) A CHIP program reduction or termination, or the denial or termination of client eligibility or services because of a moratorium or prioritization, is not an adverse action, and shall not be subject to the administrative hearing process of Medicaid Rules Chapter 4.

History

Effective 2024-01-18

Chapter 52 School-Based Services

Wyo. Code R. 048.0037.52.10122022 § 1 Authority

The Wyoming Department of Health (Department) promulgates this Chapter pursuant to the Medical Assistance and Services Act at Wyoming Statutes §§ 42-4-101 through 124.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 2 Purpose of Applicability

(a) The Department adopts this Chapter to govern the School-Based Services (SBS) Program covered by Medicaid, the enrollment and participation of local education agencies and providers of covered school based services, and the methods and standards for reimbursement of such services.

(b) This Chapter shall apply to all SBS provided on or after its effective date.

(c) The Department may issue manuals or bulletins to interpret this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in manuals or bulletins shall be subordinate to this Chapter.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 3 Definitions

(a) Except as otherwise specified in Wyoming Medicaid Rules 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.

(b) "Free care services" means services provided to Medicaid enrolled students at no charge, and/or provided to the community at large free of charge.

(c) "Individualized Education Plan (IEP)" means a document developed pursuant to the Individuals with Disabilities Education Act (IDEA). The IEP guides the delivery of special education supports and services for a student with a disability.

(d) "Individualized Family Services Plan (IFSP)" means a document developed pursuant to the IDEA. The IFSP guides the delivery of early intervention services provided to infants and toddlers (birth to age 3) who have disabilities, including developmental delays. The IFSP also includes family supports services, nutrition services, and case management.

(e) "Local Education Agency (LEA)" means a public authority legally constituted by the State as an administrative agency to provide control of, and direction for, kindergarten through twelfth grade public education institutions.

(f) "Parental Consent Form" means a form executed by a student's parent or guardian authorizing an LEA to share information with and to bill Medicaid for the student's school health services.

(g) "Participating District" means a school district that is enrolled to provide and receive Medicaid reimbursement for SBS.

(h) "School Counselor" means a professional who meets the qualification

requirements of 42 C.F.R. § 485.904(b)(5). The school counselor must obtain a Professional Services Endorsement for School Counselor through the Professional Teaching Standards Board. A school counselor must practice under the supervision of a qualified clinical supervisor licensed in the State of Wyoming pursuant to W.S. § 33-38-102(a)(xiii).

(i) "School Health Service" means medical or health-related assistance provided to a student by a qualified provider required for the diagnosis, treatment, or care of a physical or mental disorder, which service is recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under Wyoming law.

(j) "School Psychologist" means a professional who qualifies as a Specialist in School Psychology pursuant to W.S. § 33-27-113(a)(ix). The school psychologist must obtain a Professional Services Endorsement for School Psychologist by the Wyoming Professional

Teaching Standards Board. A school psychologist must practice school psychology pursuant to the requirements of the Psychology Practice Act, W.S. §§ 33-27-113(a)(iv) and 114.

(k) "School Social Worker" means a professional who meets the qualification

requirements of 42 C.F.R. § 410.73. The school social worker must obtain the Professional Services Endorsement for School Social Worker from the Professional Teaching Standards Board. A school social worker must practice under the supervision of a qualified clinical supervisor licensed in the state of Wyoming pursuant to W.S. § 33-38-102(a)(xiii).

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 4 School District and Provider Participation

(a) To participate in the SBS Program, both the participating district and the providers shall enroll with Medicaid pursuant to Wyoming Medicaid Rules Chapter 3.

(b) Participating districts will act as the billing agent for affiliated providers. Providers may not provide SBS except under the participating districts. Providers may enroll under more than one participating district.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 5 Provider Qualifications

(a) To qualify for enrollment as a provider of SBS, an individual shall at a minimum, satisfy the following criteria:

(i) Meet applicable licensing and certification standards found in Wyoming statutes and rules, or in the statutes and regulations of the state in which the provider is located.

(ii) Not be excluded from participation in federally funded health care programs by the U.S. Department of Health and Human Services, Office of Inspector General; and,

(iii) Be assigned a National Provider Identifier (NPI) number by the National Plan and Provider Enumeration System, as applicable.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 6 Covered Services

(a) School health services will be covered for Medicaid enrolled clients under the age of 21. Services shall be medically necessary as defined by Wyoming Medicaid Rules Chapter 1, and rendered as part of the student client's IEP or IFSP.

(b) School health services shall be provided in accordance with the client's individual needs and shall not be subject to limitations as to scope, amount, or duration.

(c) School health services may be performed in the school, at the client's home, or at another appropriate site in the community.

(d) The following service categories and providers are covered services under the SBS Program as further defined in the Department's School-Based Services Program Manual:

(i) Speech and audiology services

(A) Speech-Language Pathologist; and

(B) Speech-Language Pathology Aide/Assistant.

(ii) Psychological, counseling, and social work services

(A) School Psychologist;

(B) School Social Worker;

(D) Psychologist;

(E) Marriage and Family Therapist; and

(F) Certified Mental Health Worker (CMHC).

(iii) Nursing and health services

(A) Registered Nurse (RN);

(B) Advanced Practice Registered Nurse (APRN);

(D) Certified Nurse Assistant (CNA).

(iv) Occupational therapy services

(A) Occupational Therapist; and

(B) Occupational Therapy Assistant.

(v) Physical therapy services

(A) Physical Therapist; and

(B) Physical Therapy Aide/Assistant.

(e) Evaluations and reevaluations are reimbursable only when they result in an IEP or IFSP in the specific service(s) being evaluated.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 7 Excluded Services

(a) Services billed under the SBS program are subject to the limitations and coverage

restrictions that exist for other Wyoming Medicaid services pursuant to Wyoming Medicaid Rules Chapter 26 and the applicable Medicaid Provider Manuals. Wyoming Medicaid shall not cover the following services:

(i) Services classified as educational, such as services or activities involving academic assessment, student instruction or curriculum, and supervision of students;

(ii) Services billed by a practitioner outside his or her area of expertise;

(iii) Vocational training that is related solely to specific employment opportunities, work skills, or work settings;

(iv) Services not identified in the client's IEP or IFSP;

(v) Evaluations that do not result in an IEP or IFSP;

(vi) Transportation services;

(vii) Communication and consultation with parents, other providers, and educators.

(A) Attendance at meetings;

(B) Instructional assistant contact;

(D) Parental consultation;

(E) Preparation and distribution of correspondence to parents or other professionals;

(F) Professional consultation; and

(G) Teacher contact.

(viii) Free care services.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 8 Requirements for Obtaining Reimbursement

(a) LEAs must adhere to SBS Program requirements that may exceed educational requirements.

(i) The LEA must deliver and document the service provided, based upon the needs of the client.

(ii) LEAs must authorize each client's related service needs by including the nature and extent of required services in the student's IEP or IFSP.

(iii) Schools may only provide medically necessary services and must ensure that all services meet Wyoming requirements for demonstrating medical necessity, as documented in Medicaid Rule Chapter 26.

(iv) LEAs must obtain and document consent from the client's parent or guardian to bill covered services to Medicaid.

(b) The Department shall reimburse only participating districts and not any individual enrolled providers. Medicaid reimbursement for services is limited to those furnished to enrolled clients within participating districts.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 9 Documentation Requirements

(a) A provider must maintain all records necessary to fully disclose the nature, quality, amount, and medical necessity of services billed to a client currently receiving Medicaid services. Payment for services billed to Wyoming Medicaid that are not substantiated in the client's records are subject to recoupment. Documentation must be retained for at least six years from the date of payment or until ongoing audit issues are resolved, whichever is longer, as detailed in Wyoming Medicaid Rules Chapter 3.

(b) For services covered under this Chapter, complete copies of the client's IEP or

IFSP must be maintained as part of the participating district's records. The records must clearly indicate that the school-based services are required by the client's IEP or IFSP.

(i) The IEP or the IFSP;

(ii) An evaluation performed by the provider, or the annual and current present level of performance;

(iii) Treatment notes describing the IEP or IFSP goals and objectives specific to each client met by their school-based services;

(iv) Billing information recorded in units of time, as specified in Wyoming Medicaid Rules Chapter 3; and,

(v) A copy of the signed consent form from a parent or legal guardian.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 10 Medicaid Allowable Payment

The Medicaid allowable payment for SBS shall be pursuant to the Medicaid fee schedule.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 11 Submission and Payment of Claims

Submission and payment of claims shall be consistent with the provisions of Wyoming Medicaid Rules Chapter 3.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 12 Audits

Audits will be conducted consistent with the provisions of Wyoming Medicaid Rules Chapter 16.

History

Effective 2022-10-12

Wyo. Code R. 048.0037.52.10122022 § 13 Recovery of Overpayments

The Department shall recover overpayments pursuant to Wyoming Medicaid Rules Chapter 16. In addition to using its own internal processes for recovery of overpayments, the Department may refer a matter involving suspected overpayments to the Medicaid Fraud Control Unit at any time.

History

Effective 2022-10-12

Chapter 53 Home and Community Based Services Pilot Program

Wyo. Code R. 048.0037.53.02202026 § 1 Authority

The Wyoming Department of Health promulgates this Chapter pursuant to Wyoming Statutes §§ 42-4-104(a)(iv) and 42-4-107(c).

History

Effective 2026-02-20

Wyo. Code R. 048.0037.53.02202026 § 2 Purpose

(a) The Department adopts this Chapter to conduct a pilot program to pay general fund financial incentive payments to providers and case managers who provide specialized transitional Home and Community-Based Services.

(b) The Program is designed to test a new model providing incentivized delivery of Transitional Services to a specific high-risk population.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.53.02202026 § 3 General

(a) The Department will limit the number of providers and case managers authorized to provide Transitional Services and publish those limits in a bulletin and on its website.

(b) The Department will issue a fee schedule for Transitional Services.

(c) Transitional Services shall not become an entitlement to such services for any period of time either before or after the expiration of Program funding.

(d) A provider or case manager must submit claims in accordance with Chapter 3 of the Rules and Program manuals and bulletins. If there is a conflict between Chapter 3 and a manual or bulletin requirement, the manual or bulletin governs.

(e) Chapter 4 of the Rules does not apply to the Program.

(f) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. The contents of manuals and bulletins are subordinate to the provisions of this Chapter.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.53.02202026 § 4 Definitions

Except as otherwise specified in the Wyoming Department of Health, Medicaid Rules, Chapter 1, Chapter 45, Chapter 46, or as otherwise defined in this Chapter, the terminology used in this chapter has the standard meaning used in healthcare, Medicaid, and Medicare.

(a) "Program" means the pilot program described above.

(b) "Rules" means the Wyoming Department of Health, Medicaid Rules.

(i) Transitional Services mean specialized Home and Community-Based Services that are provided to a client who is transitioning from the Wyoming State Hospital to home or community-based living.

(ii) The meaning of Transitional Services may be expanded if the Director authorizes providing specialized Home and Community-Based Services to clients who transition from another state health institution to home or community-based living, in which case, clients from that population will be included in the meaning of Transitional Services.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.53.02202026 § 5 Program Requirements

(a) To provide Transitional Services, a provider or case manager must meet and maintain the applicable qualifications stated in Chapter 45 of the Rules.

(b) To provide Transitional Services, a provider or case manager must comply with all applicable standards and requirements stated in Chapter 45 of the Rules.

History

Effective 2026-02-20

Wyo. Code R. 048.0037.53.02202026 § 6 Payment

(a) Incentive payments are subject to the availability of funds and may be adjusted or discontinued by the Department at any time.

(b) Upon completion of a transition period, incentive payments will cease.

(c) To receive Program incentive payments, providers and case managers must complete and document milestones achieved during the transition period each month in accordance with the Program manuals and bulletins.

(d) A provider, case manager, or client may appeal the denial of a payment to the Director. The appeal must be submitted in writing within ten days of the denial.

(e) The Department may remove any participant, provider, or case manager from the Program without cause by providing 30 days prior written notice. The Department may immediately remove any participant, provider, or case manager with cause by providing written notice and a statement of cause.

History

Effective 2026-02-20

395 Medical Digital Innovation

Chapter 1 Rules and Regulations for the Medical Digital Innovation Sandbox

Wyo. Code R. 048.0076.1.02062020 § 1 Authority

The Wyoming Department of Health ("Department") promulgates these rules pursuant to Wyoming Statute 40-28-108.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 2 Purpose and Applicability

These rules implement the Medical Digital Innovation Sandbox Act, W.S. 40-28-101 to -108.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 3 Definitions

(a) The following definitions apply to these rules:

(i) "Director" means the Director of the Wyoming Department of Health, including the Director's designee.

(ii) "Sandbox" means a time limited test environment or program in which innovative technologies, products or services may be developed or explored and made available to consumers prior to general authorized use or deployment, as defined under W.S. 40-28-101.

(iii) "Sandbox period" means the period of time, initially not longer than twenty-four (24) months, in which the department or the appropriate licensing board or authority has authorized an innovative medical digital assessment product or service to be made available to consumers, as defined under W.S. 40-28-101.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 4 Eligibility for the Medical Digital Innovation Sandbox

(a) A person is eligible to apply to the Department to make an innovative medical digital assessment product or service available to consumers in the medical digital innovation sandbox subject to the following conditions:

(i) The person shall own, operate, or belong to a business entity with necessary personnel and adequate medical digital and technical expertise to test, monitor, and assess the innovative medical digital assessment product or service;

(ii) The business entity shall be a domestic corporation or other organized domestic entity;

(iii) The business entity shall have a physical presence in Wyoming, other than that of a registered office or agent, as verified by the Wyoming Secretary of State's Office; and

(iv) If the person applying is only an employee of the business entity, the person shall obtain the consent of the entity to apply on its behalf.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 5 Method of Application

(a) If eligible under Section 4 of this Chapter, a person may apply to the Department to make an innovative medical digital assessment product or service available to consumers in the medical digital innovation sandbox in the form and manner publicly-posted online at the Department's website: https://health.wyo.gov.

(b) At a minimum, the application must include:

(i) A statement of:

(A) The specific statutory or rule requirements for which a waiver is sought; and

(B) The reasons why these requirements prohibit the innovative medical digital assessment product or service from being made available to consumers;

(ii) A description of the innovative medical digital assessment product or service proposed to be made available to consumers in the sandbox, including all relevant technical details;

(iii) A description of the potential risks to consumers and the methods that will be used to protect consumers and resolve complaints during the sandbox period;

(iv) A proposed prototyping, use case, or scaling plan, including a statement of arranged capital;

(v) A summary of the experiences and qualifications of the personnel who will test, monitor, and assess the innovative medical digital assessment product or service;

(vi) A description of the business entity's medical digital and technical expertise, including a summary of any products or services currently available to consumers from the business entity;

(vii) A description of the business entity's plan to test, monitor, and assess the innovative medical digital assessment product or service;

(viii) A statement whether any person substantially involved in the development, operation, or management of the innovative medical digital assessment product or services has:

(A) Been convicted of or is currently under investigation for federal or state crimes; or

(B) Had any professional license revoked or suspended;

(ix) Proof that the business entity is a domestic corporation or other organized domestic entity;

(x) Proof that the business entity has a physical presence, other than that of a registered office or agent, in Wyoming;

(xi) If the applicant is an employee of the business entity, a letter documenting the entity's consent signed by an authority authorized to act on the entity's behalf, including, as relevant, the owner, managing partner, board of directors, president, chief executive officer, or managing member; and

(xii) The five hundred dollar ($500) application fee.

(c) The Department may require the applicant and any other individuals who are substantially involved in the development, operation, or management of the innovative medical digital assessment product or service to submit to a criminal history background check pursuant to W.S. 7-19-201.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 6 Authorization or Denial of Application

(a) The Director shall authorize or deny a medical digital innovation sandbox application within ninety (90) days of receiving the application, subject to the following conditions:

(i) If the Department requires a criminal history background check under Section 5(c) of this Chapter, the application is not considered received until the Department receives the required state and national criminal history record information.

(ii) The Department and the applicant may jointly agree to extend the deadline beyond ninety (90) days.

(b) Upon receipt of a medical digital innovation sandbox application, the Department shall evaluate the application according to the following procedures and standards:

(i) The Department shall initially evaluate the application to determine if:

(A) The applicant is eligible pursuant to Section 4 of this Chapter; and

(B) The application is complete pursuant to Section 5 of this Chapter.

(ii) If the Department determines that a complete application has been submitted by an eligible applicant, the Department shall forward the application to the licensing board or authority that administers the statutory or rules requirements for which a waiver is sought, or to each of the respective licensing boards or authorities if a waiver is sought for more than one statutory or rules requirement.

(A) The licensing board or authority shall grant or deny the waiver within forty-five (45) days of receiving the forwarded application from the Department. The licensing board or authority shall promptly notify the Department of its decision in writing.

(B) The licensing board or authority may not grant a waiver unless the waiver is no broader than necessary to accomplish the purposes and standards set forth under the Medical Digital Innovation Sandbox Act, W.S. 40-28-101 to -108.

(C) If the licensing board or authority grants the waiver, the licensing board or authority shall specify in its notice to the Department:

(I) The statutory or rules requirements, or portions thereof, for which a waiver is granted; and

(II) Any minimum record keeping requirements recommended by the licensing board or authority under W.S. 40-28-105(c).

(D) The waiver is not deemed effective unless:

(I) The Director authorizes the application pursuant to subsection (c) of this Section; and

(II) A consumer protection bond is posted with the Department pursuant to Section 7(a) of this Chapter.

(iii) If the licensing board or authority grants the waiver, the Department shall convene a review committee to evaluate the medical digital innovation sandbox application. In the event that a waiver is sought for more than one statutory or rules requirement, the Department shall convene a review committee only if each of the respective licensing boards and authorities approves their respective waiver.

(A) The review committee must be comprised of at least three Department officials or employees, who possess relevant subject matter expertise and no conflicts of interest.

(B) The review committee shall evaluate the application based on the criteria established under W.S. 40-28-103(f). The review committee may request additional information from the applicant or from outside experts as needed to evaluate the application.

(C) Following its evaluation, the review committee shall recommend the Director to either authorize or deny an application in writing, explaining the basis for the committee's recommendation.

(c) Following the Department's evaluation pursuant to subsection (b) of this Section, the Director shall authorize or deny the medical digital innovation sandbox application, according to the following conditions:

(i) The Director shall deny the application if:

(A) The Department determines the applicant is ineligible;

(B) The Department determines the application is incomplete; or

(ii) If the Department determines the applicant is eligible and the licensing board or authority grants the waiver, the Director shall base the decision to authorize or deny the application on the review committee's recommendation. The Director may reach a decision contrary to the review committee's recommendation, subject to his or her discretion and an independent evaluation of the application based on the criteria established under W.S. 40-28-103(f).

(iii) If the Director authorizes an application, the Director may impose conditions on the authorization consistent with the Medical Digital Innovation Sandbox Act, W.S. 40-28-101 to -108

(iv) If the Director denies an application, the applicant is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(v) The Director shall issue his or her decision in writing.

(A) If the Director authorizes the application, the written decision must specify:

(I) The statutory or rule requirements, or portions thereof, for which the waiver is granted;

(II) The length of the initial sandbox period; and

(III) The conditions imposed on the authorization, if any.

(B) If the Director denies the application, the written decision must specify the reason for denial.

History

Effective 2020-02-06

Wyo. Code R. 048.0076.1.02062020 § 7 Operation in the Sandbox

(a) Prior to the commencement of the sandbox period, a person authorized to operate in the sandbox shall:

(i) Post a consumer protection bond with the Department in an amount established by the Department pursuant to W.S. 40-28-103(h); and

(ii) Provide the Department a copy of the written statement to consumers required under W.S. 40-28-105(b).

(b) A person authorized to operate in the sandbox shall maintain comprehensive records relating to the innovative medical digital assessment product or service pursuant to W.S. 40-28-105(c).

(c) No less than thirty days prior to the expiration of the sandbox period, a person authorized to operate in the sandbox shall:

(i) Provide notice to all consumers pursuant to W.S. 40-28-105(e); and

(ii) Provide the Department a written description of the plan to wind-down operations with existing consumers pursuant to W.S. 40-28-105(e), as well as a copy of the notice provided to consumers.

(d) The Director may revoke or suspend an authorization to operate in the sandbox at any time pursuant to W.S. 40-28-106. If the Director revokes or suspends an authorization, the person formerly authorized to operate in the sandbox is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115.

(e) A person authorized to operate in the sandbox may apply for an extension of the initial sandbox period pursuant to W.S. 40-28-107, in the form and manner publicly-posted online at the Department's website: https://health.wyo.gov. If the Director denies an application for extension, the applicant is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 to -115. An application for extension shall, at minimum, include the following:

(i) All relevant supporting information demonstrating that either:

(A) Statutory or rule amendments are necessary to conduct business in Wyoming on a permanent basis; or

(B) An application for a license or other authorization required to conduct business in Wyoming on a permanent basis has been filed with the appropriate office and approval is currently pending;

(ii) The length of time for which an extension is requested, not to exceed twelve months; and

(iii) Written approval of the extension from the licensing board or authority, or each of the licensing boards and authorities, if more than one, that approved the initial waiver.

History

Effective 2020-02-06

396 Mental Health and Substance Use Disorder Services

Chapter 1 General Provisions

Wyo. Code R. 048.0077.1.09182024 § 1 Authority

The Wyoming Department of Health (Department) promulgates these Rules under 2012 Wyoming Session Laws 93-94 (ch. 26, § 48b, n.7), Wyoming Session Laws chapter 79, section (3)(d), and Wyoming Statutes 9‑2‑102, -106, -2701; and 35-1-620(b).

History

Effective 2024-09-18

Wyo. Code R. 048.0077.1.09182024 § 2 Purpose and Applicability

(a) This Chapter establishes the Department's authority to promulgate these Rules related to mental health and substance use disorder services, the definitions of terms used in these Rules, the standards incorporated by reference in these Rules, and other general provisions.

(b) This Chapter applies to all chapters promulgated under these Rules.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.1.09182024 § 3 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

(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;

(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 free-standing 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.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.1.09182024 § 4 Incorporations by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these Rules:

(i) The Department has determined that incorporation of the full text in these Rules would be cumbersome or inefficient given the length or nature of the Rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(b) Each code, standard, rule, and regulation incorporated by reference in these Rules is further identified as follows. The Department incorporates by reference:

(ii) American Society of Addiction Medicine (ASAM), The ASAM Criteria: Treatment for Addictive, Substance-Related, and Co-Occurring Conditions (David Mee-Lee ed., 4th ed. 2023), which the Department refers to as the "ASAM Criteria" under Chapter 2 of these Rules and may be found at https://www.asam.org/asam-criteria/about-the-asam-criteria;

(iii) Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment, Technical Assistance Publication (TAP) Series 21-A: Competencies for Substance Abuse Treatment Clinical Supervisors (2013), which the Department refers to as the "SAMHSA TAP 21-A" under Chapter 2 of these Rules and may be found at https://www.samhsa.gov/resource/ebp/tap-21-competencies-substance-abuse-treatment-clinical-supervisors;

(iv) Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment, Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals (2013), which may be found at https://www.samhsa.gov/resource/ebp/principles-community-based-behavioral-health-services-criminal-justice-involved; and

(v) Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment, Treatment Improvement Protocol (TIP) Series 47: Clinical Issues in Intensive Outpatient Treatment (2013), which the Department refers to as "SAMSHA TIP 47" under Chapter 2 of these Rules and may be found at https://store.samhsa.gov/product/tip-47-substance-abuse-clinical-issues-intensive-outpatient-treatment/sma13-4182.

History

Effective 2024-09-18

Chapter 2 Behavioral Health Service Provider Certification

Wyo. Code R. 048.0077.2.09182024 § 1 Purpose and Applicability

(a) This Chapter establishes the certification criteria and process for behavioral health service providers.

(b) This Chapter applies to all behavioral health service providers.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 2 Certification Eligibility

(a) Pursuant to Wyoming Statute 9-2-2701(c), the Department may not allocate to a provider state funds for substance use disorder treatment unless the provider is certified by the Department under these Rules.

(b) In order to be certified, the following types of providers must be nationally accredited, as follows:

(i) If a provider seeks to receive funds from the Department pursuant to the Community Human Services Act and Chapter 3 of these Rules, the provider must be nationally accredited for each behavioral health service to be funded by the Department.

(ii) If a substance use disorder residential treatment services provider provides services to court-ordered clients the provider must be nationally accredited for substance use disorder residential treatment services.

(c) In order to be certified, the following types of providers must either be nationally accredited or satisfy the relevant certification standards under Section 8 of this Chapter, as follows:

(i) If a substance use disorder outpatient treatment provider seeks to provide services to court-ordered clients, and does not receive funds from the Department pursuant to the Community Human Services Act and Chapter 3 of these Rules, the provider must either:

(A) Be nationally accredited for each substance use disorder service provided to court-ordered clients; or

(B) Meet the certification standards, as relevant, under Section 8 of this Chapter.

(ii) If a substance use disorder treatment provider receives funds from the Department of Corrections, the provider must either:

(A) Be nationally accredited for each substance use disorder service provided to court-ordered clients and in a manner approved by the Department of Corrections; or

(B) Meet the certification standards, as relevant, under Section 8 of this Chapter.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 3 Certification Application

(a) In order to be certified by the Department, a provider shall submit a complete certification application in the form established by the Department through the Department's public website.

(b) A certification application must provide documentation or other evidence that the provider is nationally accredited pursuant to Section 2 of this Chapter or satisfies the applicable certification requirements established under Section 8 of this Chapter. The certification requirements under Section 8 of this Chapter are deemed satisfied if the provider is nationally accredited pursuant to Section 2 of this Chapter.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 4 Certification

(a) Upon receipt of a complete certification application, the Department shall review the application for compliance with these Rules.

(i) The Department's review may include an on-site inspection and independent verification of national accreditation with the accrediting body, if applicable.

(ii) The Department shall approve or deny a completed application within thirty (30) calendar days after receiving the application.

(b) If the Department finds the provider satisfies the eligibility criteria and certification standards of these Rules, the Department shall certify the provider for a period of up to three (3) years and shall notify the provider of the term of the certification.

(i) A certification begins upon receipt of the certification notification and expires on the due date listed on the notice of certification.

(ii) If a certified provider is nationally accredited pursuant to Section 2 of this Chapter, the provider shall adhere to national accreditation standards throughout the term of certification. A nationally accredited provider shall submit to the Department, within thirty calendar (30) days of submission to the national accrediting body, all survey reports, and reports of major unusual incidents or sentinel events, or any other reports required by the national accrediting body as requested by the Department. The provider's submission to the Department must include documentation that the reports were accepted by the accrediting body.

(iii) If a certified provider is not nationally accredited pursuant to Section 2 of this Chapter, the provider shall maintain compliance with applicable certification standards according to Section 8 of this Chapter throughout the term of certification.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 5 Renewal of Certification

(a) A renewal certification grants the same rights and imposes the same duties as an initial certification under Section 4(b) of this Chapter.

(b) In order to renew certification, a certified provider shall submit to the Department a complete renewal application in the form established by the Department through the Department's public website.

(i) A renewal application must:

(A) Be submitted to the Department no less than thirty (30) calendar days prior to the expiration date of a provider's certification; and

(B) Provide documentation or other evidence that the provider continues to satisfy the certification standards established under Section 8 of this Chapter or continues to maintain national accreditation.

(c) Upon receipt of a complete application to renew certification, the Department shall review the application for compliance with these Rules.

(i) The Department's review may include an on-site inspection and independent verification of national accreditation with the accrediting body, if applicable.

(ii) The Department shall approve or deny an application within thirty (30) calendar days after receiving the application.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 6 Denial and Revocation of Certification

(a) The Department may deny a certification application, including an application to renew certification, or revoke a certification on the following grounds:

(i) Failure to submit a complete application in the form and manner established by the Department;

(ii) Failure to comply with Section 8 of this Chapter if a provider is not nationally accredited;

(iii) Failure to maintain national accreditation if national accreditation is required under Section 2(b) of this Chapter;

(iv) Failure to provide services in accordance with the applicable standard of care for the profession involved;

(v) Existence of a condition creating serious detriment to the health, safety, or welfare of clients;

(vi) Failure to complete a resolution plan or failure to submit a resolution plan within required timelines under Chapter 4 of these Rules; or

(vii) Prior revocation of a certification by the Department within three (3) years previous to the date the renewal application is submitted.

(b) If the Department denies a certification application or revokes a certification, the Department shall notify the provider in writing of the action. The notice must:

(i) State the grounds for the action; and

(ii) Inform the provider of its right to an administrative hearing proceeding pursuant to the Wyoming Administrative Procedure Act, located at W.S. § 16-3-101 to -115, and these Rules.

(c) Prior to revoking a certification, the Department may offer a provider an opportunity to correct each deficiency that would serve as grounds for the prospective revocation, based on the following conditions:

(i) The Department's offer to correct must be in writing and state each deficiency that would serve as grounds for the prospective revocation of the provider's certification.

(ii) The provider shall submit a resolution plan to the Department within ten (10) business days from the provider's receipt of the Department's written offer to correct. A resolution plan must be in writing and provide:

(A) Who will be charged with the responsibility to correct each deficiency stated in the Department's offer;

(B) What will be done to correct each deficiency;

(D) Who will be charged with monitoring to ensure each deficiency does not occur or develop again; and

(E) The deadline by when the provider expects to correct each deficiency, which may not exceed sixty (60) calendar days after the Department's offer was issued.

(iii) The Department may reject a resolution plan if the plan fails to satisfy the criteria enumerated under subsection (c)(ii) of this Section.

(iv) The Department's offer to correct is deemed to be rescinded if:

(A) The Department rejects the provider's resolution plan; or

(B) The provider fails to timely submit a resolution plan.

(v) If the Department's offer to correct is rescinded, the provider is not entitled to challenge the rescission through an administrative hearing proceeding pursuant to the Wyoming Administrative Procedure Act.

(vi) If the Department accepts the provider's resolution plan and the provider fails to correct each deficiency by the established deadline, the provider's failure to correct may serve as independent grounds for revocation under this section.

(d) The Department may not offer a provider an opportunity to correct unless the Department finds that each deficiency:

(i) Does not include the existence of a condition creating serious detriment to the health, safety, or welfare of clients; and

(ii) Can reasonably be corrected within sixty (60) calendar days of the Department's offer.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 7 Changes in Ownership or Termination of Operations

(a) A certification is non-transferable.

(b) If there is a change or transfer in ownership of a certified provider:

(i) The provider's certification expires on the effective date of the change or transfer in ownership; and

(ii) The new owner(s) shall submit a new certification application to the Department in order to become a certified provider.

(c) If a certified provider intends to terminate operations or cease services the provider shall immediately notify the Department. The notification must:

(i) Include the anticipated effective date of the termination or cessation; and

(ii) Be provided to the Department seven (7) business days before the actual effective date of the termination or cessation.

(d) A provider's certification expires on the effective date of the provider's termination or cessation.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 8 Certification Standards

(a) To be certified or to renew certification, a provider of substance use disorder services, who is not nationally accredited pursuant to Section 2 of this Chapter, shall meet the following standards as applicable:

(i) Organizational and administrative standards according to Section 9 of this Chapter;

(ii) Clinical staff and supervision standards according to Section 10 of this Chapter;

(iii) Client case records according to Section 11 of this Chapter;

(iv) General substance use disorder service standards according to Section 12 of this Chapter;

(v) Intensive Outpatient Program (IOP) service standards according to Section 13 of this Chapter; and

(vi) Impaired driving education service standards according to Section 14 of this Chapter.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 9 Organizational and Administrative Standards

(a) If a provider is neither a county hospital nor a governmental entity, the provider shall have documentation:

(i) Filed with the Secretary of State evidencing the authority to conduct business within the State of Wyoming; or

(ii) Filed with the city or county of business evidencing authority to conduct business within the jurisdiction.

(b) A provider shall adopt, implement, and enforce written policies and procedures that address:

(i) Compliance with state and federal law and other legal restrictions affecting confidentiality of alcohol, drug abuse, and health records in all aspects of assessment, treatment, and coordination of services;

(ii) Client grievance procedure which must include review of grievances by the provider's executive director and, if the provider receives funds from the Department according to Section 2(b) of this Chapter, review by the governing board;

(iii) Clinical oversight;

(iv) Client rights pursuant to W.S. § 35-1-625(b), including consent to treatment;

(v) Continuing education of staff and cross-training;

(vi) Fiscal management in accordance with Generally Accepted Accounting Principles;

(vii) A fee schedule or written financial policy which includes a payment plan that considers the client's ability to pay, financial resources and number of dependents for clients unable to pay the established fee;

(viii) Maintenance and contents of client case records in accordance with Section 11 of this Chapter;

(ix) Placement of clients in the appropriate level of care based on American Society of Addiction Medicine (ASAM) criteria;

(x) Quality of care reviews by the client's treatment team of clinical documentation for the purpose of reviewing the client's progress in treatment and the services provided to ensure the most appropriate level of care is provided, to coordinate needed services outside the provider, and for internal quality assurance;

(xi) Relevant insurance maintenance; and

(xii) The treatment process and clinical protocols, including the type of infractions or conditions that must occur for a client's treatment to be terminated from a provider.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 10 Clinical Staff and Supervision

(a) Clinical services must be provided by qualified clinical staff capable of:

(i) Monitoring substance use disorders and stabilized mental health illnesses;

(ii) Recognizing any instability of clients with co-occurring mental health diagnoses;

(iii) Obtaining and interpreting information regarding the client's bio-psychosocial and spiritual needs; and

(iv) Demonstrating competency in working with substance use disorder clients.

(b) A qualified clinical supervisor, as defined in W.S. § 33-38-102(a)(xiii), shall provide clinical oversight.

(i) At a minimum, clinical oversight must consist of one (1) contact per month between a clinical supervisor and treatment staff or peer consultation if the provider is one person.

(ii) A clinical supervisor shall provide oversight and performance evaluation of clinical staff in core competencies based on evidence-based supervision standards of the field and may include those identified in the SAMHSA TAP 21-A.

(iii) Clinical oversight must be part of the provider's staff development plan.

(iv) Clinical oversight or peer consultation must include, at a minimum, documentation of regular meetings showing that consultation took place. This documentation may be completed by either party.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 11 Client Case Records

(a) A provider shall maintain a client case record for each client admitted for services.

(b) A provider shall maintain all client case records in accordance with professional standards of practice, including storage of records in a secure and designated area.

(c) Client case records must include the following documentation and reflect the following applicable services utilizing ASAM criteria, according to the unique needs of each individual client:

(i) Consent to receive treatment signed by the client or legal guardian;

(ii) A statement signed by the client or legal guardian affirming that confidentiality was explained to them and that they understand what information is protected and under what circumstances information can or cannot be released;

(iii) A form signed by the client or legal guardian acknowledging receipt and affirming that they understand the procedures for filing a complaint;

(iv) A form signed within the last year by the client or legal guardian acknowledging receipt and affirming that they understand client rights;

(v) A form signed by the client or legal guardian acknowledging receipt, understanding, and acceptance of provider policies and procedures governing the treatment process;

(vi) Clinical assessments, based on the following criteria:

(A) A provider serving adults shall utilize an evidence-based assessment tool which includes comprehensive information regarding the client's bio-psychosocial and spiritual needs;

(B) A provider serving adolescents shall utilize a bio-psychosocial assessment tool which, at a minimum, includes the following domains: medical, criminal, substance use, family, psychiatric, developmental and academic history; intellectual capacity; physical and sexual abuse history; spiritual needs; peer, environmental, and cultural history; and, assessment of suicidal and homicidal ideation;

(C) A provider shall utilize the ASAM criteria including the dimensional criteria for each domain in the assessment process;

(D) A provider shall adequately assess the client's need for case management services according to subsection (ix) of this section; and

(E) When a client is transferred from another provider which completed the assessment, a receiving provider shall complete a transfer note showing that the assessment information was reviewed. Further, a provider shall determine if the client's needs are congruent with this assessment, make needed adjustments to treatment recommendations, and note the adjustment in the client file;

(vii) Diagnosis and diagnostic summary utilizing diagnostic tools which are standard for the field and which are acknowledged by the Department and payer sources;

(viii) Treatment plans, which must:

(A) Be completed when treatment is initiated and updated at a minimum of every ninety (90) calendar days;

(B) Be developed utilizing the assessment information, including the diagnosis and ASAM criteria;

(C) Integrate mental health needs if included as part of the assessment and diagnosis, if identified as part of the assessment process, or at any point during the course of treatment; and

(D) Include:

(I) Evidence the client or guardian participated in the development of the treatment plan, signed the treatment plan, and received a copy of the treatment plan;

(II) Outcome driven goals and measurable objectives;

(III) Changes in the client's symptoms and behaviors that are expected during the course of treatment in the current level of service, expressed in measurable and understandable terms;

(IV) The desired improved functioning level of the client utilizing the assessment; and

(V) Documentation of appropriate actions taken following specific program infractions, which do not require immediate termination, with appropriate timeframes for clients to address infractions prior to terminating the client;

(ix) A case management plan, based on the following criteria;

(A) A provider shall provide case management services directly or through written formal agreement among multiple agencies or providers;

(B) Upon determination from the client's primary qualified clinical staff that the case management services would benefit the client, case management services must include collaboration with other available agencies, providers, and services to meet individual client needs based on ongoing assessments when applicable; and

(C) Special emphasis must be placed on coordinating with other entities including, but not limited to, education institutions, vocational rehabilitation, recovery supports, and workforce development services to enhance the client's skill base, chances for gainful employment, housing, community resource supports, and other options for independent functioning;

(x) Progress notes, which must:

(A) Document the symptoms and condition of the client, response to treatment, and progress or lack of progress toward specific treatment goals;

(B) Be detailed enough to allow a qualified clinical staff to follow the course of treatment;

(C) Be completed as they occur for individual, IOP, and group therapy sessions. The dates of services shall be documented as part of each individual or group therapy session progress note; and

(D) Be signed by the staff providing services to the client. If the staff is not a qualified clinical staff the progress notes shall also be signed by a qualified clinical supervisor;

(xi) Releases of client confidential information completed in full and signed by the client or legal guardian and the provider;

(xii) Referrals;

(xiii) Quality of care reviews by the client's treatment team of clinical documentation for the purpose of reviewing the client's progress in treatment and the services provided to ensure the most appropriate level of care is provided, to coordinate needed services outside the provider, and for internal quality assurance;

(xiv) Correspondence relevant to the client's treatment, including all letters and dated notations of telephone conversations conducted by provider staff;

(xv) Documentation of any prescribed medication, to include:

(A) The client was fully apprised about the medication;

(B) The assessment for the medication;

(D) Medication monitoring; and

(E) If the client is receiving Medication Assisted Treatment (MAT) through a different MAT practitioner, documentation of collaboration and attempts to collaborate with the MAT practitioner;

(xvi) Evidence the client was given information regarding communicable diseases, referred for screening, and provided linkages to appropriate counseling; and

(xvii) Documentation of continued stay, transition, and discharge planning, including the ASAM level of care recommendation. Discharge summaries must contain a summary of pertinent case record information and any plan for continuing care, referral, or admission to another level of care.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 12 General Substance Use Disorder Service Standards

(a) A provider shall deliver therapies and intervention services in an amount, frequency, and intensity appropriate to the client's individualized treatment plan.

(i) A provider shall utilize family therapy when indicated by client needs and, with the consent of the client, shall involve family members, guardians, or significant other(s) in the assessment, treatment, and continuing care of the client.

(ii) If a provider delivers group therapy, the group must be composed of two (2) or more unrelated clients for the purpose of implementing each client's treatment plan. A provider shall deliver group therapy consistent with evidence-based practice. 12-Step meetings are not considered group therapy.

(iii) For clients with co-occurring mental health concerns, a provider shall address the issues of psychotropic medication, mental health treatment, and the client's relationship to substance use disorders. A provider shall employ intervention strategies, as needed. Co-occurring treatment must include therapies to actively address, monitor, and manage psychotropic medication, mental health treatment, and the interaction with substance use related disorders.

(b) A provider of outpatient substance use disorder treatment to adults referred or ordered to receive services by the court shall follow evidence-based practice guidelines, including those contained in the SAMHSA guide called "Principles of Community-Based Behavioral Health Services for Criminal Justice Involved Individuals."

(c) The qualified clinical staff responsible for treatment shall review the client's ASAM level of care a minimum of every ninety (90) days, or whenever the client's condition changes significantly.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 13 Intensive Outpatient Program (IOP) Service Standards

(a) IOP services must:

(i) Consist of nine (9) to nineteen (19) hours per week of structured programming for adults consisting primarily of counseling, psychoeducation, psychotherapy to address addiction and co-occurring mental health conditions, and six (6) hours per week of structured clinical treatment programming for adolescents, except while the client is being transitioned into a lower level of care;

(ii) Vary in intensity and duration based on ASAM Criteria and the SAMHSA TIP 47;

(iii) Begin services within two (2) weeks of the initial clinical assessment. If the provider is unable to begin services within the two (2) week time frame, the provider shall complete a referral and warm hand-off; and

(iv) Address the client's needs for psychiatric and medical services through consultation and referral.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 14 Impaired Driving Education Service Standards

(a) A provider of impaired driving education services shall:

(i) Provide a minimum of eight (8) hours of services, which may be delivered through telehealth, utilizing an evidence-based curricula that is appropriate to age and developmental levels;

(ii) Ensure services are provided by qualified clinical staff or trained health educators supervised by qualified clinical staff;

(iii) Maintain records documenting client attendance and curricula completion or failure to attend or complete;

(iv) Provide adult and adolescent services separately; and

(v) Assess each client according to Section 11(c)(vi) of this Chapter, subject to the following conditions:

(A) If an assessment was conducted by another certified provider within the three (3) months prior to receiving impaired driving services, the provider is not required to conduct another assessment, however, the provider shall obtain a copy of the report and recommendations resulting from the prior assessment.

(B) If the assessment results indicate a need for additional services, the provider shall complete a referral and warm hand-off, if the provider is unable to deliver needed services.

(C) An assessment must include documentation of a review of the blood alcohol level at the time of arrest and the driving record of the client.

(b) A provider shall require clients, as a condition of completion of the curricula, to develop a written personal action plan based on evidence-based practices setting forth actions the client will take in the future to avoid violations. The provider shall maintain a copy of the written plan as part of the client file.

(c) Upon completion of the curricula, the provider shall provide a certificate of completion to the client. It is the client's responsibility to notify the court of completion.

(d) A report shall be made by the provider to the court, supervising or probation agent, or Wyoming Department of Transportation, Driver Services Program within ten (10) business days of the end of the services, if the client fails to follow the court order or follow or does not complete the curricula.

(e) An authorization to release medical records, including substance use disorder treatment records to the court and the Wyoming Department of Transportation, Driver Services Program, must comply with state and federal law.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 15 Waivers

(a) A behavioral health service provider may be granted a waiver from the Department of any standard imposed under Sections 9 to 14 of this Chapter if the Administrator determines that requiring immediate compliance with a particular standard would create an undue hardship on a provider and that temporary noncompliance would not impair the quality of the services being provided.

(b) A request for a waiver must be made in writing and may be made to the Administrator at any time the provider deems a standard represents an undue hardship.

(i) Set a time limit on the effective duration of the waiver; and

(ii) Require the provider to submit a written plan to the Administrator setting forth proposed methods of achieving compliance with the standard within the time frame of the waiver.

(d) The Administrator reserves absolute discretion in considering and granting a request for a waiver.

(i) The Administrator shall communicate to the provider in writing the Administrator's decision on a waiver request and if denied, the grounds for denial.

(ii) If the Administrator grants a waiver request, the requesting provider shall keep a copy of the Administrator's decision as part of the provider's records.

(iii) If the Administrator denies a waiver request, the Administrator's denial is final and not subject to administrative review.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.2.09182024 § 16 Variances

(a) A behavioral health service provider may request a variance from the Department of any standard imposed under Sections 9 to 14 of this Chapter.

(i) A request for variance must be made in writing and, if the provider receives funds from the Department under Section 2(b) of this Chapter, signed by the chair of the governing board.

(ii) A request for variance must establish how the variance will maintain or enhance the quality of a provider's operations and client services.

(b) The Administrator reserves absolute discretion in considering and granting a request for a variance.

(i) The Administrator shall communicate to the provider in writing the Administrator's decision on a variance request and if denied, the grounds for denial.

(ii) If the Administrator grants a variance request, the requesting provider shall keep a copy of the Administrator's decision as part of the provider's records.

(iii) If the Administrator denies a variance request, the Administrator's denial is final and not subject to administrative review.

History

Effective 2024-09-18

Chapter 3 Application for Funds and Selection of Providers

Wyo. Code R. 048.0077.3.09182024 § 1 Purpose and Applicability

(a) This Chapter establishes the process and criteria to apply for and receive funding from the Department under the Community Human Services Act, Wyoming Statutes 35-1-611 to ‑627.

(b) This Chapter applies to all providers seeking Department funding under the Community Human Services Act.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.3.09182024 § 2 Eligibility for Funding

(a) A provider is eligible to apply to the Department for funding to provide behavioral health services within an identified service area if the provider:

(i) Meets the definition of a behavioral health center under W.S. 35-1-613(a)(xvi); and

(ii) Is certified according to Chapter 2 of these Rules.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.3.09182024 § 3 Request for Application to Provide Services

(a) The Department shall provide notice that it is seeking applications to provide funded services on the Department's public website. The notice must include:

(i) The eligibility requirements for funding as specified in Section 2 of this Chapter;

(ii) The date applications must be received at the Department;

(iii) Where to submit applications;

(iv) Where to locate a copy of these Rules online;

(v) A list of comprehensive range of services, as determined by the Department;

(vi) The application packet; and

(vii) Scoring criteria.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.3.09182024 § 4 Evaluation and Scoring of Applications

(a) Eligible providers may apply for funding.

(b) The Department shall give preference to current providers who are in compliance with contract requirements pursuant to W.S. 35-1-620(b)(vi) and shall begin contract negotiations.

(c) If two (2) or more applicants propose to provide the same services in the same service area and each applicant meets the criteria in Section 2 of this Chapter, they may be considered a competing applicant.

(d) If the conditions to grant preference under subsection (b) of this Section are not satisfied, the Department will score the competing applications according to the scoring criteria. When evaluating and scoring an application, the Department may consider information not included in the application but otherwise possessed by the Department.

(i) The Department will begin contract negotiations with the highest scoring applicant.

(ii) If the competing applicants' scoring results in a tie, the Administrator shall review and evaluate the competing applications. The Department will begin contract negotiations with the Administrator's highest scoring applicant.

(e) The Administrator may not award any application that:

(i) Does not meet the criteria according to Section 2 of this Chapter; or

(ii) Proposes to serve only a portion of an existing service area and if funding the application would jeopardize the continued services in the remainder of the service area.

(f) If the Administrator finds an applicant ineligible or does not award an applicant, the Administrator shall document the reasoning and shall notify the provider in writing of the denial.

(g) The Department may solicit additional applications to provide services in the service area. If the Department solicits additional applications, an applicant whose application was previously not awarded may resubmit an application to the Department.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.3.09182024 § 5 Application for Funding that is not Available Statewide or Regionally

(a) If funding is available for projects or services which cannot be purchased on a statewide basis, the Department shall:

(i) Define the purpose of the funding;

(ii) Develop an application and funding process; and

(iii) Notification of available funds must be posted on the Department's public website. The Department shall include how funding decisions will be made in the application for the funding.

History

Effective 2024-09-18

Chapter 4 Complaints

Wyo. Code R. 048.0077.4.04092020 § 1 Purpose and Applicability

(a) This Chapter provides the complaint and investigation processes regarding providers of behavioral health services certified by the Department.

(b) This Chapter applies to all clients and providers of behavioral health services certified by the Department.

History

Effective 2020-04-09

Wyo. Code R. 048.0077.4.04092020 § 2 Filing Complaints

(a) If an entity or individual has exhausted a provider's established client grievance procedure and is not satisfied with the resolution, the entity or individual may file a complaint with the Department.

(b) A complaint filed with the Department must be in writing. The complaint must be filed within one (1) year of the alleged violation and must provide the following information:

(i) The name, address and telephone number of the complaining party;

(ii) The party, individual, or agency the complaint is against; and

(iii) A clear and complete statement of the alleged violation of the law, order, rule, or standard, together with the facts which give the Department a clear and full understanding of the nature of the alleged violation.

(c) The Department shall confirm with the complainant and provider that the complaint was originally filed with the provider, with an unsatisfactory resolution for the complainant. The Department shall refer an individual or entity to the provider if the complaint was not originally filed with the provider.

(d) The Department shall ensure that complaints are properly evaluated, documented, acknowledged, and handled in a timely and appropriate manner, to include notification by the Department to the complainant and the provider in writing within ten (10) business days of the receipt of a complaint. If the nature of the complaint is not related to certification or contracting requirements, the Department shall refer the complainant to the appropriate authority, if any, including Wyoming Medicaid, the Wyoming Mental Health Professions Licensing Board, or an ombudsman program.

History

Effective 2020-04-09

Wyo. Code R. 048.0077.4.04092020 § 3 Investigations

(a) The Department, on its own initiative or upon receipt of a complaint including substantive information alleging detriment to the health, safety or welfare of clients, fraud, or ethical misconduct, may conduct an investigation of a provider. If an investigation is initiated by the Department, the Department shall provide a summary of the Department's concerns to the provider in writing within ten (10) business days of initiating the investigation.

(b) The executive director of the provider against whom the investigation is being conducted shall file a response to the complaint with the Department no later than twenty (20) business days after receipt of the copy or summary of the complaint from the Department. If the executive director provides the Department with good cause, the Department may extend the time to respond to the complaint.

(c) If the Department determines that the provider has failed to respond or the complaint is not sufficiently resolved by the provider's response under subsection (b) of this Section, the Department may continue the investigation.

(i) The provider shall allow the Department access to all pertinent information concerning the operations of the provider.

(ii) The Department's investigation may include on-site inspections, off-site reviews, and consultations with the executive director, governing board, program staff, the complainant, and other pertinent sources of information.

(d) If a provider fails to comply with this Chapter, the Department may sanction the provider. Sanctions may include, but are not limited to, adverse inferences related to any denials made by the provider, the immediate suspension of contract payments to the provider, and decertification.

(e) The Department shall issue a final written report and disposition of the investigation to the provider within ninety (90) business days of the closure of the investigation. The report must include:

(i) The Department's findings and the corrective actions required, if any; and

(ii) A determination whether each deficiency relates to the health, safety, welfare, or rights of clients.

(f) The Department shall provide a written summary of the results and disposition of the investigation to the complainant within ninety (90) business days of the closure of the investigation.

History

Effective 2020-04-09

Wyo. Code R. 048.0077.4.04092020 § 4 Resolution Plans

(a) A provider shall submit to the Department a resolution plan for each corrective action required in the final written report of an investigation.

(i) If the Department's final report notes a deficiency relating to the health, safety, welfare, or rights of clients served, the provider shall submit a resolution plan to the Department within ten (10) business days of receipt of the written report from the Department.

(ii) If the Department's final report does not note a deficiency relating to the health, safety, welfare, or rights of clients served, the provider shall submit a resolution plan to the Department within thirty (30) business days of receipt of the written report from the Department.

(iii) A resolution plan must provide the following information:

(A) Who will be charged with the responsibility to correct each deficiency;

(B) What will be done to correct each deficiency;

(D) Who will be charged with monitoring to ensure each deficiency does not occur again; and

(E) The deadline by when the provider expects to correct all deficiencies.

(b) The Department shall notify the provider in writing of the approval or disapproval of the provider's resolution plan within thirty (30) business days after receipt of the plan.

(c) If the Department disapproves of a resolution plan, the Department shall provide the provider written notification of the reasons for the disapproval. The provider shall submit a revised plan within ten (10) business days of receipt of the written disapproval from the Department.

(d) The Department shall monitor the provider to assure the actions identified in the provider's resolution plan have been completed within the specified time frame. The Department shall verify completion of a resolution plan in writing.

History

Effective 2020-04-09

Chapter 5 Behavioral Health Centers: Professional Standards for Personnel and Service Quality

Wyo. Code R. 048.0077.5.09182024 § 1 Purpose and Applicability

(a) This Chapter:

(i) Establishes professional standards for personnel providing behavioral health services purchased in whole or in part by the Department in a behavioral health center; and

(ii) Prescribes standards for the quality of behavioral health services provided by behavioral health centers purchased in whole or in part by the Department.

(b) This Chapter applies to all behavioral health centers whose services are purchased by the Department, in whole or in part, under the Community Human Services Act, Wyoming Statutes § 35-1-611 to -627.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 2 Personnel Standards

(a) A behavioral health center shall employ an executive director on a full-time basis.

(b) A behavioral health center shall ensure that:

(i) Only qualified clinical staff provide the clinical services purchased in whole or in part by the Department; and

(ii) All qualified clinical staff receive training necessary for billing services to Wyoming Medicaid and all other health insurers.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 3 Service Quality

(a) A behavioral health center shall:

(i) Be certified according to Chapter 2 of these Rules;

(ii) Utilize evidence-based practices and promising practices;

(iii) Guarantee each client's right to an individualized plan of appropriate services which provides for treatment in the least restrictive environment that may reasonably be expected to benefit the client;

(iv) Develop processes to manage wait lists or practice same day access;

(v) Develop practices which result in high quality services as demonstrated in positive, cost effective client outcomes that are determined by the Department in collaboration with providers;

(vi) Provide integrated mental health or substance use disorder treatment services that are coordinated with primary care as applicable;

(vii) Gather and use client feedback to improve the quality of care; and

(viii) Not deny eligibility to clients or individuals seeking services based on the behavioral health center's inability to deliver services.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 4 Behavioral Health Center Allowable Payment

(a) The Department shall establish payment policies for Department-funded services in accordance with W.S. § 35-1-620(b)(iii).

(b) Any payment which exceeds the behavioral health center allowable payment for the service may be recovered by the Department.

(c) A behavioral health center may not request an administrative hearing regarding a recovery of payment which exceeds the behavioral health center allowable payment.

(d) Except as otherwise specified by the Department, the behavioral health center allowable payment shall not exceed the Department's established fee schedule in effect on the date services were provided. The fee schedule is available upon request from the Department.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 5 Payment of Claims

(a) A behavioral health center may not seek payment from the Department for services delivered to a client until payment from third parties is sought and exhausted.

(b) A behavioral health center may not request, receive or attempt to collect any payment from the client or the client's family for services covered by the BHC-Full or BHC-Screen benefit plans. The behavioral health center shall accept the allowable payment as payment in full for the services.

(c) A behavioral health center that provides services not covered by the BHC-Full or BHC-Screen benefit plans to a client may seek payment from the client if the behavioral health center informed the client in writing of the client's potential liability before providing the service, and the client agreed in writing to pay for such services before they were furnished.

(d) All health insurers, including all self-insured plans, group health plans as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, service benefit plans, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service, shall agree, as a condition of doing business in the state of Wyoming, to provide, with respect to the individuals who are eligible for behavioral health services purchased by the Department pursuant to W.S. § 35-1-620 et. seq., information to determine the period during which the individual or the individuals' spouses or dependents may be or may have been covered by a health insurer and the nature of the coverage provided, including the name and address of the insurer and identifying number of the plan, in a manner prescribed by the Department.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 6 Waivers

(a) A behavioral health center may be granted a waiver from the Department of any standard imposed under Section 2 of this Chapter if the Administrator determines that requiring immediate compliance with a particular standard would create undue hardship and that temporary noncompliance would not impair the quality of services being provided.

(b) A request for a waiver must be made in writing and may be made to the Administrator at any time the behavioral health center deems a standard represents an undue hardship.

(i) Set a time limit on the effective duration of the waiver; and

(ii) Require the behavioral health center to submit a written plan to the Administrator setting forth proposed methods of achieving compliance with the standard within the time frame of the waiver.

(d) The Administrator reserves absolute discretion in considering and granting a request for a waiver.

(i) The Administrator shall communicate to the provider in writing the Administrator's decision on a waiver request and if denied, the grounds for denial.

(ii) If the Administrator grants a waiver request, the requesting behavioral health center shall keep a copy of the Administrator's decision as part of the behavioral health center's records.

(iii) If the Administrator denies a waiver request, the Administrator's denial is final and not subject to administrative review.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.5.09182024 § 7 Variances

(a) A behavioral health center may request a variance from the Department of any standard imposed under Section 2 of this Chapter.

(i) A request for variance must be made in writing and signed by the chair of the governing board.

(ii) A request for variance must establish how the variance will maintain or enhance the quality of a center's operations and client services.

(b) The Administrator reserves absolute discretion in considering and granting a request for variance.

(i) The Administrator shall communicate to the provider, their decision in writing on a variance request and if denied, grounds for denial.

(ii) If the Administrator grants a variance request, the requesting provider shall keep a copy of the Administrator's decision as part of the provider's records.

(iii) If the Administrator denies a variance request, the Administrator's denial is final and not subject to administrative review.

History

Effective 2024-09-18

Chapter 7 Behavioral Health Center Benefit Plan Eligibility

Wyo. Code R. 048.0077.7.09182024 § 1 Purpose and Applicability

(a) This Chapter has been adopted to establish the criteria for Behavioral Health Center (BHC) benefit plans eligibility and renewal processes.

(b) This Chapter applies to individuals seeking treatment services through a BHC benefit plan.

(c) The Department may issue manuals, bulletins, or policies to interpret this Chapter. Such manuals, bulletins, or policies shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals, bulletins, or policies shall be subordinate to this Chapter.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.7.09182024 § 2 Behavioral Health Center Benefit Plan Eligibility

(a) An individual may present at a BHC seeking treatment services or be referred by sources set forth in W.S. 35-1-611 through W.S. 35-1-627 to be screened for BHC benefit plan eligibility.

(b) The BHC shall assess the individual to determine BHC benefit plan eligibility and will bill the Department for screening. If an individual does not qualify for the BHC-Full benefit plan, the individual may receive treatment services with insurance or self-pay. BHCs may not seek other payment sources for BHC-Screen benefit plan assessments.

(i) BHC-Screen Benefit Plan. Individuals who are not eligible for statutorily defined priority populations at W.S. 35-1-620(b)(ix).

(ii) BHC-Full Benefit Plan.

(A) Household income is less than or equal to two hundred percent (200%) of the federal poverty level; or

(B) The individual meets criteria for one or more of the statutorily defined priority populations at W.S. 35-1-620(b)(ix).

(d) The individual shall be notified in writing of the reasons for the approval, denial, reduction, or closure; the specific regulation supporting the action; the effective date of action; and an explanation of the right to request a hearing.

(e) Responsibilities for Individuals Seeking Services.

(i) Individuals seeking services shall participate in the eligibility process by providing all information and documentation requested by the BHC, including, but not limited to, intake documentation, clinical assessment, income, and financial resources.

(ii) Individuals seeking services who fail or refuse to participate or provide the information requested by the BHC shall not be considered for eligibility.

(iii) Individuals seeking services may be required by BHCs to provide Wyoming Medicaid financial eligibility determination.

(f) Eligibility Period and Redeterminations.

(i) BHC Benefit Plan eligibility begins the first day of the month in which the individual is eligible. Eligibility shall be reviewed by the Department for continued eligibility every twelve (12) months.

(ii) The Department shall send a written BHC benefit plan renewal notice sixty (60) calendar days before the expiration of eligibility.

(g) Clients shall be allowed to receive retroactive benefits not to exceed ninety (90) calendar days prior to the intake documentation if the individual received benefit covered services at any time during that period and would have been eligible had they applied, unless restricted by other federal or state laws and regulations.

History

Effective 2024-09-18

Chapter 8 Administrative Hearings

Wyo. Code R. 048.0077.8.09182024 § 1 Purpose and Applicability

(a) This chapter governs the administrative hearing procedures of the Department with respect to behavioral health services.

(b) The Department may issue manuals, bulletins, or policies to interpret this Chapter. Such manuals, bulletins, or policies shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals, bulletins, or policies shall be subordinate to this Chapter.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 2 Notice of Right to a Hearing

(a) Individuals seeking services and clients. The Department shall provide notice at the time of any adverse action. The notice shall include:

(i) The individual's right to request a hearing;

(ii) The method for requesting a hearing;

(iii) The individual's right to be represented by an attorney licensed to practice law in the State of Wyoming;

(iv) The intended action;

(v) The effective date of the intended action;

(vi) The reasons for the intended action;

(vii) The specific regulations that support that action.

(b) Providers. The Department shall notify a provider of the right to a hearing. The notice shall include:

(i) The right to request a hearing;

(ii) The method for requesting a hearing;

(iii) The right to be represented by an attorney licensed to practice law in the State of Wyoming;

(iv) The intended action;

(v) The effective date of the intended action;

(vi) The reasons for the intended action;

(vii) The specific regulations that support that action.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 3 Request for an Administrative Hearing

(a) A client or individual seeking services may request an administrative hearing. The request must be made in writing within ten (10) calendar days after the date of the determination letter. The request must be submitted via certified mail to the Wyoming Department of Health, Behavioral Health Division, Mental Health and Substance Use Disorder Services Section.

(b) A provider has the right to a hearing regarding an adverse action. The request must be made in writing ten (10) calendar days after the date of the determination letter. The request must be submitted via certified mail to the Wyoming Department of Health, Behavioral Health Division, Mental Health and Substance Use Disorder Services Section.

(c) Upon receipt of a request for an administrative hearing, the Department may pursue an informal conference within five (5) business days.

(d) Upon receipt of a request for an administrative hearing, the Department shall transmit the administrative hearing request to the Office of Administrative Hearings. The hearing shall be conducted in accordance with Rules, Office of Administrative Hearings, General Agency, Board of Commission Rules, Chapter 2, Section 6 (2017), incorporated herein by reference.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 4 Maintaining Services Pending Appeal

. The Department may not terminate or reduce services until the final decision is rendered after the hearing.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 5 Timing of Hearing

. A hearing shall be held within forty (40) calendar days from the date of the request for hearing unless otherwise provided by law.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 6 Decisions

(a) The hearing officer shall make proposed findings of fact and conclusions of law within thirty (30) calendar days of the close of the hearing and forward them to the Director of the Department for the final decision. This time may be extended if the parties or other interested persons are to submit briefs; but may not be extended by more than ten (10) business days, unless the parties stipulate, in writing or on the record at the hearing, to a later date.

(ii) Within ten (10) business days after the issuance of the hearing officer's proposed findings of fact and conclusions of law, any of the parties may submit exceptions. Such exceptions shall be filed with the Director of the Department and served on all parties.

(b) Within ten (10) business days after the period for submitting exceptions, the Director of the Department shall make and enter into the record the final decision. The final decision shall be served on all parties to the proceedings.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 7 Appeals

. Appeals from a final decision of the Department shall be in accordance with W.S. §§ 16-3-114 through 16-2-115, and Rule 12 of the Wyoming Rules of Appellate Procedure.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 8 Transcripts and Record

(a) When a contested case is set for hearing, the Office of Administrative Hearings shall assign a docket number to the case and enter the case with its number and date of filing on a docket. The Department shall maintain a separate file for each docketed case in which all pleadings, transcriptions, correspondence, papers, and exhibits for that case shall be maintained. All items shall have noted thereon the assigned docket number and the date of filing.

(b) All contested case hearing proceedings shall be recorded, electronically, through the use of a qualified court reporter, or any other appropriate means determined by the Department or the hearing officer. Transcriptions of oral proceedings or written transcripts of a witness's testimony may be obtained by the contestant from the Department upon payment of cost.

(i) In a nonpublic investigatory proceeding, requests for copies or transcripts may be limited to testimony of the requesting party.

(ii) Where a contestant can demonstrate indigence and cannot effectively perfect the appeal without a transcript, the Department may waive the payment of the fee.

History

Effective 2024-09-18

Wyo. Code R. 048.0077.8.09182024 § 9 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these Rules:

(i) The Department has determined that incorporation of the full text in these Rules would be cumbersome or inefficient given the length or nature of these Rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this Section; and

(iii) The incorporated code, standard, rule, or regulation may be found at https://health.wyo.gov/behavioralhealth/mhsa and is maintained and made available by the Department for public inspection and copying at cost at the same location.

(b) The Department incorporates the following codes, standards, rules, and regulations into these Rules by reference. These incorporated references are identified as:

(i) Referenced above is Rules, Office of Administrative Hearings, General Agency, Board of Commission Rules, Chapter 2 (2017), also known as the Uniform Rules for Contested Case Practice and Procedure adopted by the Office of Administrative Hearings, effective July 20, 2017, and found at: https://health.wyo.gov/behavioralhealth/mhsa/about-us/rules-and-regulations/.

History

Effective 2024-09-18

163 Mental Health Division

Chapter 1 Psychiatric Advance Directives & PAD Form

Wyo. Code R. 048.0039.1.06262000 Psychiatric Advance Directives & PAD Form

RULES AND REGULATIONS FOR PSYCHIATRIC ADVANCE DIRECTIVES

CHAPTER 1

Section 1. Purpose. The Department of Health has promulgated these regulations relating to psychiatric advance directives to ensure the timely and appropriate implementation and application of the Wyoming Psychiatric Advance Directives Statute.

(a) Any adult who has decisional capacity to provide informed consent to or refusal of psychiatric restabilization measures or any other person who is, pursuant to the laws of this state or any other state, authorized to consent to or refuse psychiatric restabilization measures on behalf of a person who lacks the decisional capacity, may execute a psychiatric advance directive. The principles of autonomy and personal dignity of the person having capacity are morally and ethically binding for physicians and other health care providers.

Section 2. Reason. To directly involve individuals in addressing health care decisions should they lose capacity due to symptoms subsequent to a serious and persistent mental illness. To insure compliance with Wyoming Statute on Psychiatric Advance Directives, W.S. §35-22-301 through W.S. §35-2-308.

Section 3. Authority. The specific statutory authority is W.S. 35-22-310 through W.S. 35- 22-308.

Section 4. Definitions. Unless the context otherwise requires, the following definitions shall apply in the interpretation and enforcement of these rules and regulations:

(a) "Act" shall mean W.S. 35-22-301 through W.S. 35-22-308 relating to psychiatric advance directives.

(b) "Adult" shall mean a person at or over the age of 18 or an emancipated minor who is competent to execute a directive.

(c) "Agent" means any person authorized in the psychiatric advance directive to make decisions on behalf of the person who executed the directive.

(d) "Attending Physician" shall mean a person licensed by the State of Wyoming to practice medicine and who is the physician that assists the declarant in executing a psychiatric advance directive by explaining the purposes and countersigning the form.

(e) "Decisional capacity" means a person's ability to receive and evaluate information regarding treatment issues, and to communicate, either verbally or nonverbally, a decision. Capacitation is determined by a psychiatrist, unless a person has already been legally adjudicated as incapacitated.

(f) "Declarant" shall mean an adult who has the decisional capacity to provide informed consent to or refusal of psychiatric treatment or any other person who is, pursuant to the laws of this state or any other state, authorized to make psychiatric treatment decisions on behalf of a person, including minor, who lacks such decisional capacity and who has executed a psychiatric advance directive, and which declaration remains unrevoked.

(g) "Division" shall mean the Mental Health Division Office of the Wyoming Department of Health.

(h) "Health Care Provider" shall mean a person who is licensed, certified or otherwise authorized by the law of this state to administer health care in the ordinary course of business or practice of a profession.

(i) "Mental Health Professional" means a Psychiatrist, Physician, Licensed Psychologist, Licensed Clinical Social Worker, Licensed Addictions Therapist, Licensed Professional Counselor, or Advanced Practice Psychiatric Registered Nurse.

(j) "Person" shall mean an individual and shall include any trustee, receiver, assignee, or other legal representative thereof but shall not include any agency of the United States Government.

(k) "Psychiatric advance directive" or "PAD" means an advance medical directive pertaining to the administration or refusal of psychiatric restabilization for the care and treatment of mental illness.

(l) "Psychiatric advance directive form" means the document provided by the Department that is printed on distinctive security paper and is filled out by the declarant and attending physician to execute a psychiatric advance directive.

(m) "Psychiatric health care facility" shall mean any hospice, hospital, intermediate care facility, psychiatric hospital, mental hospital, and community mental health center or as defined in W.S.35-2-901.

(n) "Psychiatric Restabilization" means measures to restore mental function or to support mental health in the event of destabilization of mental health due to lack of appropriate treatment. Psychiatric restabilization measures may include administration of prescribed liquid medication orally, physical restraint, seclusion or crisis psychiatric counseling, or other measures as stipulated in the document.

Section 5. Procedure.

(a) Persons admitted to psychiatric health care facilities such as hospitals, group homes, or long-term care facilities must be offered information about psychiatric advance directives and how to complete such directives.

(b) A mental health professional will review this material with the individual and his/her desires regarding execution of a psychiatric advance directive.

(c) If the person desires to create a psychiatric advance directive, assistance will be offered by a mental health professional in completing the directive.

(d) The Division shall prepare a standard form for use by those wishing to prepare and execute a psychiatric advance directive. The Division shall provide the form to anyone requesting a copy. Such forms shall be kept at the Mental Health Division, the Wyoming State Hospital, and the Division shall make copies available to community mental health centers and other health care facilities, at their request. i. Any form for a psychiatric advance directive must include the following data:

A. The person's name, date of birth, and sex.

B The person's eye and hair color.

C. The person's race or ethnic background.

D. The person's social security number.

E. The name of the current and last treating facility.

F. The name, address and telephone number of the person's attending physician and/or primary mental health professional(s).

G. The person's signature or mark, or, if applicable, the signature of a person authorized by law to execute a psychiatric advance directive.

H. The date on which the psychiatric advance directive was signed.

I. The person's directive concerning the administration or refusal of psychiatric restabilization measures, countersigned by the person's attending physician or mental health professional.

J. The name, address and telephone number of the person designated as an agent, if applicable, to consent to or refuse psychiatric restabilization measures for the person who has executed a psychiatric advance directive and the signature of that person indicating acceptance of this appointment.

K. Information that a psychiatric advance directive may be revoked at any time by the person who is the subject of the directive unless he/she is mentally incapacitated, as attested to by two mental health professionals, one of whom is the person's attending physician; or at any time by any other person who is, pursuant to state law, authorized to consent to or refuse psychiatric restabilization measures on behalf of the person who is the subject of the directive.

L. Completed advance directives will be witnessed by two persons who are not family members or employees of the psychiatric facility where the person is being treated.

(e) The "agent" identified in the psychiatric advance directive may not make mental illness treatment decisions unless the subject of the directive lacks capacity as attested to be two mental health professionals (one of whom is the attending physician) or by a court of law.

(f) Except to the extent that the right is limited by the declaration of any federal law, an agent has the same right as the declarant to receive information regarding the proposed mental illness treatment, and to receive, review, and consent to disclosure of medical records relating to that treatment.

(g) An agent may withdraw by giving notice to the declarant. If the declarant is incompetent at the time of the withdrawal, the agent may withdraw by giving notice to the attending physician or mental health professional. That person shall note the withdrawal in the medical record and on the psychiatric advance directive form. This person may rescind their withdrawal by executing an acceptance after the date of withdrawal reaffirming their acceptance of this responsibility. The agent will again give notice to the patient and attending physician or mental health professional.

(h) Mental health professionals shall comply with the psychiatric advance directive to the extent medically indicated under the direction of the attending physician or psychiatrist.

(i) Mental health professionals who in good faith comply with a psychiatrist advance directive shall not be subject to civil or criminal liability or regulatory sanction for such compliance.

(j) Compliance with a psychiatric advance directive shall not affect the criminal prosecution of any person otherwise charged with the commission of a criminal act.

(k) In the absence of a psychiatric advance directive, a person's consent to psychiatric restabilization measures shall not be presumed.

(l) A psychiatric advance directive for any person admitted to a psychiatric health care facility shall be implemented as directed by the psychiatric advance directive, pending further physician's orders. The psychiatric advance directive shall be deviated from only with the consent of the admitted person, his/her agent, the district court or when adherence to the directive threatens permanent physical injury.

(m) Neither a psychiatric advance directive nor the failure of a person to execute one shall affect, impair or modify any contract of life or health insurance or any annuity or be the basis for any delay in issuing or refusing to issue an annuity or policy of health insurance or any increase or premium thereof.

(n) A psychiatric advance directive may be revoked at any time by the person who is the subject of the directive unless he is mentally incapacitated or at any time by any other person who is, pursuant to the laws of this state or any other state, authorized to consent to or refuse psychiatric restabilization measures on behalf of the person who is the subject of the directive.

(o) A psychiatric advance directive shall be valid for a period not to exceed two (2) years from the date of execution unless reaffirmed by the person who executed the directive, in which case it shall be valid for two (2) more years from the date of reaffirmation.

(p) When a mental health professional is not willing to follow a person's advance directive, he/she is obligated to transfer patient care to a mental health professional who can and will follow the advance directive.

(q) Psychiatric health care facilities shall provide education for their staff and volunteers on issues regarding psychiatric advance directives.

(r) Revocation may be accomplished by:

i. written revocation signed by the person or legal designate;

ii. by verbal expression in the presence of an adult witness who signs and dates a written confirmation of the person's or legal designate's verbal expression to revoke the advance directive;

iii. by verbal expression over the telephone with a witness who signs and dates a written confirmation of the verbal expression to revoke the psychiatric advance directive.

PSYCHIATRIC ADVANCE DIRECTIVE DECLARATION TO MY FAMILY, MY PHYSICIAN, MY LAWYER AND ALL OTHERS WHOM IT MAY CONCERN

Declaration made this day of, 20 .

I, being of sound mind, willfully and voluntarily make known my desires for mental health treatment(s) to be followed should it be determined by two physicians, one of whom is my attending physician, that my ability to receive and evaluate information effectively or communicate decision is impaired to such an extent that I lack the capacity to refuse or consent to mental health treatment. I understand that any treatments would be toward the goal of psychiatric restabilization as a way of restoring my capacity and optimal mental health functioning. I further understand that psychiatric restabilization may include administration of prescribed liquid medication by mouth or injection, administration of prescribed medication orally, physical restraint, seclusion or crisis psychiatric counseling and that in the statements below I may give or refuse consent to any of these or other treatment options to which I stipulate.

I understand that I may revoke this declaration at any time unless I have been declared to lack capacity to give or withhold treatment by two physicians, one of whom is my attending physician.

I understand that I may become incapable of giving or withholding informed consent for mental health treatment due to symptoms of a diagnosed mental disorder. The symptoms may include the following:

If I become incapable of giving or withholding informed consent for mental health treatment, my wishes regarding medications are as follows:

I consent to the administration of medications.

I consent to the administration of the following medications:

I do not give consent to the administration of medications.

I do not give consent to the administration of the following medications:

Conditions or limitations:

Should I become incapable of giving or withholding informed consent for mental health treatment due to the symptoms of a diagnosed mental disorder and my behaviors become dangerous to myself or others, or should I become incapable of providing for my basic need. In this case I would give consent for the following treatment(s):

Physical Restraint Seclusion Crisis Psychiatric Counseling Other:

In this case I would not give consent for:

Physical Restraint Seclusion Crisis Psychiatric Counseling Other:

Should I become incapable of giving or withholding informed consent for mental health treatment due to the symptoms of a diagnosed mental disorder I hereby appoint: Name Address Telephone Number(s) to act as my agent in making decisions regarding my mental health treatment. I understand that this person will gain this appointment only if I am declared to lack capacity by two physicians, one of whom will be my attending physician.

My agent is authorized to make decisions that are consistent with the wishes I have expressed in this declaration, or, if not expressed, as are otherwise known to my agent. If my wishes are not expressed and are not otherwise known by my agent that person is to act in what he or she believes to be in my best interest.

ACCEPTANCE OF APPOINTMENT AS AGENT

I accept this appointment and agree to serve as the agent to make decisions about mental health treatment for, . I understand I have a duty to act consistent with the desires of this individual as expressed in this appointment. I understand this document gives me the authority to make decisions about mental health treatment only while this person is incapable as determined by a court or two physicians. I understand that he or she may revoke this declaration in whole or in part at any time and in any manner when he or she has capacity to make decisions.

Signature of Agent Date

This document has significant medical, legal and possible ethical implications and effects. Before you sign this document, you should become completely familiar with these implications and effects. The operation, effects, and implications of this document may be discussed with a physician, a lawyer, and a clergyman of your choice.

Signed Date Address

City, County, and State of Residence

The declarant has been made personally known to me and I believe him or her to be of sound mind. I did not sign the declarant's signature above for or at the direction of the declarant. I am not related to the declarant by blood or marriage, entitled to any portion of the estate of the declarant according to the laws of intestate succession or under any will of declarant or codicil thereto, or directly financially responsible for declarant's medical care.

Witness Date

MENTAL HEALTH PROFESSIONAL STATEMENT REGARDING CAPACITY

It is my professional opinion at this time that this person has the capacity to make this declaration:

Yes No

Signature of Psychiatrist/Mental Health Professional Date

Name of Provider/Institution Telephone Number of Provider/Institution Name, Address, and Telephone Number of Attending Physician/Psychiatrist

Please complete the following information to assist your physician and other psychiatric personnel to rapidly identify you as the declarant of this Psychiatric Advance Directive:

Date of Birth Sex Eye Color Hair Color Racial or Ethnic Background Social Security Number Copies of this document are in the following places (i.e., family members, doctors office, hospitals, mental health centers....)

History

Effective 2000-06-26

Chapter 13 Bereavement Counseling

Wyo. Code R. 048.0039.13.03202007 Bereavement Counseling

RULE AND REGULATIONS FOR

Wyoming Mental Health Division Bereavement Counseling

CHAPTER 13

Section 1. Authority. These rules and regulations are promulgated by the Department of Health pursuant to 2006 Budget Session Law, Chapter 40, Section 5, Enrolled Act No. 0021 to establish bereavement counseling rules for the payment of bereavement counseling services provided to surviving family members of deceased emergency responders who died while in the performance of their official duties responding to a civil or military emergency, or natural or human caused disaster.

Section 2. Purpose and Applicability.

(a) These rules have been adopted to ensure the availability of bereavement counseling services to the target population. These rules will establish a process by which funds authorized for bereavement counseling may be distributed and ensure quality care is provided.

(c) 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 these rules and regulations.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and visa versa. Throughout these rules 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 these rules, the following shall apply:

(a) "Bereavement counseling" means focused individual or group therapy or interaction designed to mitigate the effects of traumatic events resulting from a civil or military emergency, or a natural or human caused disaster.

(b) "Civil or military emergency" means an unforeseen combination of circumstances or the resulting state that calls for immediate action.

(i) Peace officer who has qualified pursuant to W.S. 9-1-701 through 9-1-709;

(ii) Firefighter working for a paid or volunteer fire department;

(iii) Emergency medical technician certified under W.S. 33-36-110 and working for a private or volunteer ambulance service, but not including employees of industrial ambulance services except when responding to assist in a civil or military emergency or a natural or human caused disaster.

(d) "Qualified provider" means a private, not-for-profit agency providing mental health services under contract with the Mental Health Division (MHD) that is nationally accredited to provided outpatient mental health services and who is certified by the Mental Health Division as meeting all applicable federal, state, and local laws, rules, regulations and standards for mental health service delivery under the Rules and Regulations of the Division of Behavioral Health.

Section 5. General Provisions.

(a) Qualified providers are eligible to receive funding for bereavement counseling.

(b) Upon providing bereavement services, qualified providers must submit, on a form prescribed by the MHD, information describing the services provided, and information verifying that services were rendered to individuals of the target population. Services will be paid at the rate MHD has assigned to services under its contract with the provider.

(c) The Department of Health will verify that professional bereavement counseling services were provided through the review of client files and billing records.

(d) All other contract requirements are governed by current Rules already in place for the Department of Health, Rules and Regulations of the Division of Behavioral Health, Chapter I-XII.

History

Effective 2007-03-20

379 Naloxone Policy and Reporting

Chapter 1 Naloxone Policy and Reporting

Wyo. Code R. 048.0072.1.03202018 § 1 Authority

The Wyoming Department of Health (Department) promulgates these rules under the authority granted by Wyo. Stat. Ann. § 35-4-904(b).

History

Effective 2018-03-20

Wyo. Code R. 048.0072.1.03202018 § 2 Purpose & Applicability

These rules establish additional requirements for the drug overdose treatment policy that an entity prescribed an opiate antagonist by standing order is required to establish under Wyo. Stat. Ann. § 35-4-904(b). These rules also provide the required manner and form for reporting the administration of an opiate antagonist to the Department.

History

Effective 2018-03-20

Wyo. Code R. 048.0072.1.03202018 § 3 Treatment Policy

In addition to the requirements of Wyo. Stat. Ann. § 35-4-904(b)(i), the drug overdose treatment policy must include a procedure for the designation of individuals to receive training and instructional materials on how to safely store and handle an opiate antagonist and used medical material.

History

Effective 2018-03-20

Wyo. Code R. 048.0072.1.03202018 § 4 Reporting

(a) An entity prescribed an opiate antagonist by standing order shall report to the Department the administration of an opiate antagonist according to the following.

(i) The entity shall submit a complete Naloxone Report form to the Department, electronically or in another manner approved by the Department. The Naloxone Report form is available at [[www.health.wyo.gov]].

(ii) A report must be submitted to the Department within 72 hours of the administration of the opiate antagonist.

History

Effective 2018-03-20

168 Pharmacy Services

Chapter 2 Medication Donation Program

Wyo. Code R. 048.0044.2.05252021 § 1 Authority

This Chapter is promulgated by the Department of Health pursuant to the Drug Donation Program Act, at Wyoming Statues §§ 35-7-1601 through 35-7-1606.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 2 Purpose and Applicability

(a) This Chapter has been adopted to govern the process and procedures pertaining to the Wyoming Medication Donation Program (Program), including but not limited to, eligibility, site requirements, and donation criteria.

(b) The Department may issue manuals, bulletins, and/or forms to interpret the sections of this Chapter. Such manuals, bulletins, and forms shall be consistent with and reflect the rules contained in this Chapter. The provisions contained in manuals, bulletins, or forms shall be subordinate to the sections of this Chapter.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 3 General Provisions

(a) Nothing in this Chapter shall be construed as providing an individual with an entitlement to this program.

(b) Donated medications shall be dispensed upon a valid prescription of a licensed health care practitioner.

(c) Hard or electronic copies of all prescriptions dispensed shall be maintained by the facility where the dispensing occurred.

(d) If a medication is recalled and there is no lot number on the label to differentiate between the recalled and non-recalled drug, it shall be assumed part of the recall and all such donated medications shall be destroyed and documented using standard procedures.

(e) Any location dispensing donated medications shall verify recipient eligibility and retain all records of eligibility for at least two (2) years and shall use application forms provided by the program.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 4 Definitions

(a) "Central collection facility." Refers to the program's main location where all donated medications are processed before being dispensed directly to a recipient or given to a participating dispensing site for dispensing.

(b) "Dispense." Means to deliver a drug to an ultimate user by or pursuant to the lawful order of a practitioner, including the prescribing, administration, packaging, or labeling necessary to prepare the substance for that delivery.

(c) "Health care professional." A person who holds a certification, license, or registration in a health care field of practice, including but not limited to, dentists, nurses, nurse practitioners, pharmacists, pharmacy technicians, medical assistants, practitioners, physician assistants, occupational therapists, and psychiatrists.

(d) "Practitioner." A person licensed to offer health care services who is authorized to issue prescriptions.

(e) "Recipient." Refers to an individual who receives donated medications.

(f) "Site." Refers to a physician, pharmacy, or health care facility that participates in the program to collect donated medications (donation site) or dispense donated medications (dispensing site). Sites shall be located within Wyoming.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 5 Requirements for Participating Donation and Dispensing Sites

(a) A participating site may either be a donation site or a dispensing site, or both.

(b) A participating site may withdraw at any time upon written notification to the program and any contracts, agreements, or memorandum of understanding between the Department and the site shall be rendered terminated.

(c) It is the responsibility of the participating site to notify the program of any contact information changes, including but not limited to, primary contact person, site business name, address, telephone number, and e-mail (if available).

(d) Participating sites may register with the program and registration will be renewed annually in June.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 6 Eligibility Requirements for Acceptable Donated Medications

(a) The medication packaging shall not have any physical signs of tampering.

(b) The expiration date of the medication shall be one (1) year from the original dispensed date, if no expiration date is listed on the medication.

(i) If no expiration date or original dispense date can be identified, the medication shall not be accepted for donation.

(c) Controlled substances, temperature sensitive medications, and compounded medications shall not be donated to the program, except when the program obtains the donated medication directly from the manufacturer.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 7 Standards and Procedures for Participating Donation Sites

(a) Participating donation sites shall collect donated medication and ensure that donor forms are completed. All acceptable donated medications shall be shipped to the central collection facility for processing.

(b) The participating donation site shall ensure that donated medications are kept separate from normal stock in a secure location.

(c) Identifying information on the medication label, such as patient name and prescription number, will be obliterated from the packaging by the participating donation site.

(i) Drug related information, including but not limited to, drug name and strength, expiration date and/or original dispensed date, lot number, NDC number, and quantity, shall remain visible on the medication packaging.

(d) Donated non-controlled substances that are not suitable for dispensing shall be destroyed or returned to the original donor.

(i) Destruction shall be performed by a health care professional and documented.

(ii) If accepted in error, controlled substances shall be destroyed or returned to the original donor. Two individuals (at least one health care professional) shall witness and document the destruction of any controlled substances.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 8 Standards and Procedures for Participating Dispensing Sites

(a) Participating dispensing sites shall be responsible for any costs associated with the dispensing process of donated medication stock received from the central collection facility.

(b) Sample medications shall be acquired from the central collection facility in its original packaging as required under federal law.

(c) Donated medication stock from the program that cannot be dispensed shall be destroyed or disposed of according to the site's protocols.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 9 Eligibility Criteria and Requirements for Recipients

(a) A recipient shall meet the following requirements to be eligible to receive donated medication from the program:

(i) Resident of Wyoming.

(ii) Has limited resources to purchase or has limited access to prescription medication.

(iii) Has a valid prescription from a physician/practitioner.

(iv) Each recipient shall sign a release form stating they understand the immunity provisions of the program and acknowledging that the medication they will be receiving was originally dispensed to another patient.

(v) Recipients shall notify the location that dispensed the recipient the donated medication of any changes to the following:

(A) Address or phone number.

(B) Health insurance status.

(D) Income.

(E) Resources.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 10 Record Keeping Requirements for Participating Sites

(a) Sites shall keep records in conformance with the record keeping requirements of the program, and all applicable federal and state laws, rules, and regulations.

(b) Destruction forms shall be kept of unacceptable donated medications for two (2) years by the site.

(c) Any location that dispenses donated medications shall maintain records of recipient eligibility, prescriptions dispensed, and handling fees collected for two (2) years.

(i) Dispensing sites shall report statistical information to the program. Sites that do not report are subject to termination of participation as determined by the program.

(ii) Dispensing sites are subject to recipient applications, dispensed prescriptions, and handling fee record audits from the program upon the program's request.

(A) Audit requests shall be made in writing and the dispensing site shall have up to thirty (30) days from the date of the written request to produce items to the program for review.

(B) Failure to produce audit items may result in termination of participation as determined by the program.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 11 Forms

(a) Forms will be provided by the program to be utilized by participating sites, donors, or recipients. This includes, but is not limited to, the following form types.

(i) Donor forms.

(ii) Application forms.

(iii) Registration forms for participating sites.

(iv) Destruction forms.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 12 Handling Fee

(a) Handling fee may be charged to the recipient to whom the donated medication is dispensed. The handling fee shall be determined by the program to cover dispensing or distributing costs per prescription.

(b) Donated medications and supplies may not be sold.

(c) Participating dispensing sites shall obtain approval from the program prior to collecting handling fees from recipients.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 13 Over-the-Counter Medications and Medical Supplies

(a) Over-the-Counter medications may be accepted for donation.

(b) Medical supplies, including but not limited to, bandages, drainage bags, syringes, and medical tubing, shall not be accepted for donation to the program.

History

Effective 2021-05-25

Wyo. Code R. 048.0044.2.05252021 § 14 Participating Sites Registry

(a) The program shall establish and maintain a participating site registry.

(i) The registry shall include the participating site name, site type, address, and telephone number.

(ii) The registry shall be posted on the program's website for public view.

History

Effective 2021-05-25

169 Pioneer Home

Chapter 1 General Provisions

Wyo. Code R. 048.0045.1.11151988 General Provisions

CHAPTER I

GENERAL PROVISIONS

Section 1. Authority. These Wyoming Pioneer Home Admission rules and procedures are promulgated by the Board of Charities and Reform, State of Wyoming, in accordance with Wyoming Statute 25-8-102.

Section 2. Definitions.

(a) "Ambulatory" means able to get about and not bedridden.

(b) "Applicant" means person making application for admission to the Wyoming Pioneer Home.

(d) "Level I" means occupancy of 100 or more residents.

(e) "Level II" means occupancy of 75 to 99 residents.

(f) "Level III" means occupancy of less than 75 residents.

(g) "Mentally Competent" means alert and oriented to person, place and time, and able to conduct himself/herself independently within society.

(h) "Qualifications" means conditions for admission to the Wyoming Pioneer Home.

(i) "Resident" means a person who currently is residing within the jurisdiction of Wyoming with the intent of remaining.

History

Effective 1988-11-15

Chapter 2 Application

Wyo. Code R. 048.0045.2.11151988 Application

CHAPTER II

APPLICATION

Section 1. Eligibility. Persons seeking admission to the Wyoming Pioneer Home must meet the certain requirements.

(a) Level I Admission:

(i) At least 65 years of age (except the blind)

(ii) Ambulatory

(iii) Mentally Competent

(b) Level II Admission:

(i) At least 62 years of age (except the blind)

(ii) Ambulatory

(iii) Mentally Competent

(i) At least 62 years of age (except the blind)

(ii) Ambulatory

(iii) Mentally Competent

Section 2. Application Forms.

(a) Personal Data

(b) Mortician Instruction Sheet

(d) General Medical Examination

(e) Support Payment Policy

(f) Financial Status

(g) Wyoming Pioneer Home Brochure

Section 3. Application Procedures.

(a) A typed or legibly written application shall be received at the Wyoming Pioneer Home.

(b) The application shall be reviewed by the administrative office to determine completeness of information.

(d) If possible the applicant shall go to the Wyoming Pioneer Home for the scheduled inter- view.

(i) Applicant can tour the facility to assess living arrangements.

(ii) Director of Nursing can meet with the applicant to discuss any health concerns.

(e) If the applicant meets the admission requirements the superintendent can offer admission to the Wyoming Pioneer Home.

(i) The superintendent shall write a letter to the applicant stating a room is available and offer admission.

(ii) The Board of Charities and Reform shall grant final approval to the applicant.

History

Effective 1988-11-15

167 Prescription Drug Assistance Program

Chapter 1 Prescription Drug Assistance Program

Wyo. Code R. 048.0043.1.08152004 Prescription Drug Assistance Program

DEPARTMENT OF HEALTH

PRESCRIPTION DRUG ASSISTANCE PROGRAM

CHAPTER 1

Section 1. Authority. This Chapter is promulgated by the Department pursuant to the Prescription Drug Assistance Act, 2002 Wyoming Senate Bill No. 34, to be codified as W.S. 42-4-118, and the Wyoming Administrative Procedures Act as W.S. 16-3-101 et seq.

Section 2. Purpose and applicability.

(a) This Chapter shall apply to and govern all aspects of the Prescription Drug Assistance Program. This Chapter shall become effective for services provided on or after July 1, 2002.

(b) The Department shall issue Manuals, Bulletins, or both, to interpret the provisions of this Chapter. Such Manuals and Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Manuals or Bulletins shall be subordinate to the provisions of this Chapter.

(c) 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.

Section 3. General Provisions.

(a) This Chapter is intended to be read in conjunction with the Prescription Drug Assistance Act, 2002 Wyoming Senate Bill No. 34, to be codified as W.S. 42-4- 118, and the Wyoming Medicaid Rules, except as set forth below.

(b) In accordance with Section 1 of 2002 Wyoming Senate File 34, W.S. 42- 4-118(a), nothing in this Chapter shall be construed as providing an individual with an entitlement to this program.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules 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.

(a) "Act." The Prescription Drug Assistance Act, 2002 Wyoming Senate Bill No. 34, to be codified as W.S. 42-4-118.

(b) "Adverse action." The denial, suspension, or termination of benefits, other than a suspension or termination caused by a suspension of the Program pursuant to Section 12 or a change in State law, including an amendment to this Chapter.

(d) "Applicant." An individual on whose behalf an application for coverage by the Program has been submitted, but there has been no final determination of eligibility.

(e) "Application." The form, specified by the Department, on which an applicant indicates in writing the desire to receive benefits.

(f) "Application date." The date an application is received and date stamped by DFS.

(g) "Approve." To determine an applicant is eligible for program benefits.

(h) "Assistance unit." The financially responsible persons living together whose income is considered in determining eligibility for program benefits.

(i) "Benefit month." The calendar month for which program eligibility will be approved.

(j) "Benefits." Coverage under the program.

(k) "Benefit year." The twelve month period following the benefit start date, and each twelve month period thereafter so long as an insured remains eligible.

(l) "Biennium." The period covering two State fiscal years following each regularly scheduled budget session of the Wyoming Legislature.

(m) "Change in income." An increase of one-third or more in the monthly income of an assistance unit.

(n) "Change report." A form, as prescribed by the Department, used to report change in income to DFS.

(o) "Chapter 1 of the DFS rules." Chapter 1 of the DFS rules.

(p) "Chapter 1 of the Medicaid Rules." Chapter 1, Medicaid Fair Hearings, of the Wyoming Medicaid Rules.

(q) "Chapter 3 of the Medicaid Rules." Chapter 3, Provider Participation, of the Wyoming Medicaid Rules.

(r) "Chapter 16 of the Medicaid Rules." Chapter 16, Medicaid and State Funded Program Integrity, of the Wyoming Medicaid Rules.

(s) "Chapter 39 of the Medicaid Rules." Chapter 39, Recovery of Excess Payments, of the Wyoming Medicaid Rules.

(t) "Claim." A request by a provider for payment of PDAP funds for services provided to a recipient.

(u) "Contested case." Contested case as defined in Chapter 1, which definition is incorporated by this reference.

(v) "Copayment." A charge to a recipient for receiving covered services.

(w) "Countable." A category of income, or resources, which is used to determine program eligibility.

(x) "Covered service." Services provided to a recipient that may be reimbursed out of program funds as provided in this Chapter.

(y) "Department." The Wyoming Department of Health, its agent, designee, or successor.

(z) "Department of Family Services (DFS)." The Wyoming Department of Family Services, its agent, designee, or successor.

(aa) "Prescription Drug Assistance Program (PDAP)" The Prescription Drug Assistance Program established by the Act.

(bb) "Prescription Drug Assistance Program (PDAP) allowable payment." The maximum reimbursement for covered services as specified by this Chapter.

(cc) "Prescription Drug Assistance Program (PDAP) funds." That State general funds appropriated by the Wyoming State Legislature and available to the Department to make payments to providers for furnishing covered services to recipients.

(dd) "Effective date of eligibility." A recipient will be covered for services as of the first day of the month in which the recipient submitted an application.

(ee) "Eligible." An applicant who is approved.

(ff) "Excess payments." "Excess payments" as defined in Chapter 39, which definition is incorporated by this reference. Except that the phrase "Medicaid Funds" in Chapter 39 is replaced with "Program funds." (gg) "Federal poverty level." The poverty line as specified in the federal poverty guidelines as published and updated annually in the Federal Register pursuant to Section 673(2) of OBRA.

(hh) "Financial records." All records, in whatever form, used or maintained by provider which are necessary to substantiate or understand a claim submitted to the Department.

(ii) "Formulary." "Formulary" as defined in Chapter 10, which definition is incorporated by this reference.

(jj) "Income." Earned income, unearned income, or in-kind payments received from any source, excluding money classified as a resource or exempt income:

(i) Earned income includes:

(A) Any payment received by an employee or agent in cash or in-kind as wages, salary, tips, commissions, or pursuant to a contract.

(B) Net profits received from activities in which the individual is engaged. "Net profits" means the total sum before deductions for personal or employment expenses and excludes the meal allowance used by the Federal Insurance Contribution Act (FICA).

(ii) Exempt income. Money set aside or free from program policy limits and not counted against program income limits. The following income is exempt:

(A) Income which is required to be excluded under a federal statute;

(B) Unearned income paid in-kind to a household member, such as payments made to a third party for food, shelter, clothing, or other needs;

(C) Educational income, such as grants, scholarships, fellowships, education loans, and work-study income paid to a person who is enrolled in an educational program;

(D) Needs-based veteran's benefits;

(E) Reimbursement for expenses incurred by the individual; and

(F) Child care assistance paid under Title XX of the Social Security Act.

(iii) In-kind income. Goods or services received in lieu of cash. In-kind income is countable when the individual has a legal right to liquidate such goods or services to cash.

(iv) Unearned income. Income received which is neither earned by providing goods or services nor defined as a resource.

(kk) "Income disregard." Income which is not included in countable income.

Income disregards shall be determined as follows:

(i) Each working member of a household shall receive a $200.00 per month disregard, except that a married couple shall be entitled to a $400.00 per month disregard;

(ii) All earned income of a full-time high school student under age eighteen (18) who is living with a caretaker relative;

(iii) Twenty-five percent of the assistance unit's gross self-employment income or a deduction of actual business expenses; and

(iv) Fifty ($50.00) dollars of child support per assistance unit.

(ll) "Inmate of a public institution." "Inmate of a public institution" as defined in 42 C.F.R. 435.1009, which definition is incorporated by this reference.

(mm) "Medicaid." Medical assistance and services provided pursuant to Title XIX of the Social Security Act or the Wyoming Medical Assistance and Services Act of 1967, as amended. "Medicaid" includes any successor or replacement program enacted by Congress or the Wyoming Legislature.

(nn) "Medically necessary." Medically necessary as defined by Chapter 3, which definition is incorporated by this reference.

(oo) "Medical records." All records, in whatever form, in the possession of or subject to the control of a provider which describe a recipient's diagnosis, treatment or condition.

(pp) "Medical supplies." Disposable, semi-disposable or expendable medical supplies.

(qq) "Medicare approved Discount Card." A card that provides a discount on prescription drugs specifically for Medicare recipients that is approved by the Centers for Medicare and Medicaid Services.

(rr) "Month." A calendar month.

(ss) "Notice of action." A written notice mailed to a recipient which informs the recipient of intended action affecting eligibility for benefits. The notice shall include the action to be taken, the effective date of the action, and the legal authority for the action. Notice shall be timely if mailed, by first-class United States mail, ten days before the effective date of the intended action.

(tt) "OBRA." The Omnibus Budget Reconciliation Act of 1981, Pub. L. No.

(uu) "Overpayments." Program funds received by a provider as the result of fraud or abuse, as those terms are defined in Chapter 16 of the Medicaid Rules, which definitions are incorporated by this reference.

(vv) "Periodic review." A review of a recipient's eligibility. A periodic review shall be conducted every twelve months after the effective date of eligibility. A periodic review is timely if it is conducted within one-month before or one month after the effective date of eligibility.

(ww) "Physician." A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners.

(xx) "Prescription." "Prescription" as defined by Chapter 10, which definition is incorporated by this reference.

(yy) "Program," The Prescription Drug Assistance Program.

(zz) "Provider." A provider as defined by Chapter 3, which definition is incorporated by this reference.

(aaa) "Recipient." An individual who has been determined and is currently eligible for the program.

(bbb) "Residence." The place a recipient uses as his or her primary dwelling place and intends to continue to use indefinitely for that purpose.

(ccc) "Resident." A person who lives in the State of Wyoming and has the intention of establishing a permanent residence in the State.

(ddd) "Resource." Real or personal property in which an individual has a legal or equitable interest.

(i) Exempt resources. A category of resources not subject to program policy or limits and is not counted. The following resources are exempt:

(A) Any resource for which:

(I) A legal barrier exists; or

(II) A restriction exists, such as:

(1.) The resource is jointly owned and the co- owner (if the co-owner must legally consent to sale) cannot be located;

(2.) The resource is jointly owned and the co- owner (if the co-owner must legally consent to sale) has provided a statement of refusal to sell; or

(3.) Legal documents include a barrier to sale or inability to convert to cash.

(B) Term insurance policies;

(D) The household furnishings belonging to the assistance unit;

(E) Trade-in value less than fifteen thousand dollars ($15,000) for one vehicle. Value of each additional vehicle is a countable resource; and

(F) Real property when the client is making a bona fide effort to sell the property.

(G) Vehicles and other resources used for self-employment purposes.

(H) Resources which the assistance unit is making a bona fide effort to sell when:

(I) The bona fide effort to sell was initiated at least fifteen (15) days prior to application; and

(II) The bona fide effort to sell has not lasted more than ninety (90) days.

(eee) "Services." Health or medical services, medical supplies, or medical equipment.

(fff) "State fiscal year." July 1st through June 30th of the following calendar year.

(ggg) "State general funds." The dollar amount of the state funds appropriated by the Wyoming Legislature for the program and available for the Department to reimburse providers for furnishing covered services to recipients.

(hhh) "Termination." To remove a recipient from the program.

(iii) "Utilization controls." The standards and procedures established pursuant to Chapter 16 of the Medicaid rules, which are incorporated by this reference to deter and detect fraud or abuse by beneficiaries or providers.

(jjj) "Usual and customary charge." A provider's charge to the general public for the same or a similar service.

Section 5. Eligibility.

(a) Introduction. This section is intended to provide uniform procedures for determining eligibility for the PDAP.

(b) Application process. DFS shall follow the process described below when an individual makes a request for the PDAP program:

(i) An application form shall be provided;

(ii) A separate application shall be required for each assistance unit, and the applicant shall be notified, in writing, of the result;

(iii) The application shall be accepted when complete, and date stamped;

(iv) Applicants shall be informed of the eligibility criteria and their rights and responsibilities for and services available under the program;

(A) An application shall be approved if the applicant is found to be eligible; or

(B) An application shall be denied if the applicant: (1) is found to be ineligible; (2) does not provide all required information; (3) has withdrawn the application; (4) is an inmate of a public institution; or (5) is not a resident of Wyoming.

(v) Documentation of the action taken and the reasons for the action shall be placed in the applicant's case file.

(vi) DFS shall provide written notice, delivered by first-class United States mail, to the applicant of the determination.

(vii) A completed application shall be acted upon within forty-five (45) calendar days from the date it is received;

(i) To apply without delay at the DFS office of choice;

(ii) To be accompanied or assisted by the person of choice in requesting or completing an application;

(iii) To request assistance from DFS in completing an application;

(iv) To apply for PDAP in the DFS office of choice, either in person or by mail, to leave the application at that DFS office, to have eligibility determined and maintained in that DFS office;

(v) The application and all personally identifiable information shall be kept confidential and shall not be disclosed except as necessary to determine or verify eligibility or in accordance with the rules of the Department.

(vi) To be treated with respect and nondiscrimination in accordance with applicable federal and state laws.

(vii) Persons requesting program assistance shall be informed:

(A) Orally or in writing of the program eligibility factors and required verifications;

(B) In writing of the effective date of eligibility; and

(viii) The denial of an application for benefits is an adverse action and an applicant is entitled to reconsideration and an administrative hearing pursuant to W.S. 16-3-102 and W.S. 9-2-104(a)(vii).

(d) Responsibilities of applicants.

(i) An applicant must complete an application in the form and in the manner specified in writing by the Department. The application must be:

(A) Completed;

(B) Dated; and

(ii) An applicant must cooperate fully in the process of determining eligibility, including the following:

(A) Provide any and all necessary information required by the application; and

(B) Promptly provide a notice of change to reflect change in income, a change of address, or a change in health insurance coverage.

(iii) An applicant who is eligible for the Medicare approved prescription drug discount card, if cost effective, must:

(A) Upon application, provide the cardholder information; and

(B) Use the subsidy provided by the card.

(e) Verifications. The following information shall be documented, and such documentation shall be maintained in the individual's case file:

(i) Wyoming residence; and

(ii) The reasons for the denial of eligibility.

(f) Residents. Eligibility is limited to residents of Wyoming.

(g) Eligible persons. Eligibility shall be limited to persons whose income is less than or equal to the Federal poverty level.

(h) Income. Eligibility shall be determined using the countable income of the assistance unit in which the applicant lives.

(i) Except as specified in paragraph (ii), eligibility shall be determined based on the applicant's family's countable income during the most recently completed calendar month.

(ii) Income from self-employment shall be based on the monthly average of the assistance unit's annual countable income for the previous twelve month period.

(i) Resources. Eligibility shall be limited to those with countable resources less than Two Thousand Five Hundred Dollars ($2,500).

(j) Eligibility redetermination. DFS shall conduct twelve month periodic reviews to determine continuing eligibility. Such reviews shall be done on forms and in accordance with procedures developed and specified in Manuals or Bulletins by the Division.

(k) Duration of eligibility. After being determined eligible, a recipient shall remain eligible for twelve months following the effective date of eligibility, or until the recipient becomes eligible for Medicaid or the recipient enters a public institution, whichever comes first, unless there is a change in income which renders the recipient ineligible.

(l) Copayments. Each recipient will be responsible for making co-payments pursuant to this subsection.

(i) Generic prescription drugs: $10.00 per prescription; and

(ii) Brand name prescription drugs: $25.00 per prescription.

(iii) Copayments may be adjusted pursuant to W.S. 42-4-118.

Section 6. Provider Participation.

(a) Payments only to providers. No individual or entity that furnishes covered services to a recipient shall receive PDAP funds unless the individual or entity is a provider.

(b) Eligible providers. An individual or entity that furnishes covered services to a recipient must meet the provider participation requirements of Chapter 3, Provider Participation of the Wyoming Medicaid Rules which are incorporated by this reference.

(c) Compliance with Chapter 3. An individual or entity which wishes to receive PDAP funds for covered services furnished to a recipient must meet the provider participation requirements of Chapter 3 Provider Participation of the Wyoming Medicaid Rules, which are incorporated by this reference.

Section 7. Provider Records. A provider must comply with the record keeping requirements of Chapter 3, Provider Participation of the Wyoming Medicaid Rules, which are incorporated by this reference.

Section 8. Verification of Recipient Data.

(a) PDAP identification notices. DFS issues PDAP identification notices to recipients. Such notices are valid only for the month and year shown of the notice.

(b) Failure to notify provider of eligibility. If a provider furnishes services to an individual who fails to notify the provider that he or she is a recipient, the provider may submit a claim to the Department or seek reimbursement or payment from the recipient. A provider that seeks PDAP reimbursement must accept such payments as payment in full, except that the provider may assess and seek to collect a copayment as provided in Section 5.

Section 9. Covered Services.

(a) PDAP will reimburse for the services provided in subsection (b) if the services are:

(i) Medically necessary; and

(ii) Prescribed by a health care provider licensed to prescribe and acting within the scope of his or her licensure.

(iii) Services contained in the formulary.

(b) Service limitations. PDAP shall not reimburse:

(i) More than a 31 day supply of medication per prescription;

(ii) Medical supplies, except diabetic supplies.

(iii) Dispensing limitations. The dispensing limitations of Chapter 10, Pharmaceutical Services of the Wyoming Medicaid Rules, are incorporated by this reference.

(iv) Additional service limitations. In no event shall the program reimburse for otherwise covered services:

(A) In excess of the service limitations established pursuant to the Wyoming Medicaid Rules; or

(B) In excess of the PDAP budget as established by the Wyoming Legislature.

(c) Dissemination of formulary. The Wyoming Department of Health Pharmacy Unit shall disseminate the formulary, along with any updates, to providers through Manuals or Bulletins.

Section 10. PDAP allowable payment.

(a) In General. The PDAP allowable payment for covered services shall be the lower of the providers usual and customary charges or the payment specified in this Section.

(b) Pharmaceutical services.

(i) The PDAP allowable payment for pharmaceutical services shall be determined pursuant to the Medicaid allowable payment provisions of Chapter 10, Pharmaceutical Services of the Wyoming Medicaid Rules, which are incorporated by this reference, except that there shall be no exemptions from copayment, and the term "PDAP" shall be substituted for the term "Medicaid" in that rule.

(ii) Copayment. PDAP services shall be subject to a copayment pursuant to Section 5.

Section 11. Submission and payment of claims. Payment of claims shall be pursuant to the payment of claims provisions of Chapter 3, Provider Participation of the Wyoming Medicaid Rules, which are incorporated by this reference, except that the term "PDAP" shall be substituted for the term "Medicaid" in that rule.

Section 12. Contingent on funding.

(a) Payment contingent on funding. Payment to providers is contingent on the availability of PDAP funds. The Department shall not be obligated to make payments in the absence of such funds.

(b) Projection of costs. The Department shall project costs of the program at least quarterly and compare those projected costs against PDAP funds. If the funds available to the program are insufficient to meet the projected costs of the program, the Department shall take action to prevent the program from incurring costs beyond available funds, including taking any of the following actions:

(i) Imposing a moratorium on enrolling new recipients in the program;

(ii) Reducing the income eligibility level specified in section 4 below the federal poverty level;

(iii) Imposing higher prescription drug copayments not to exceed twenty-five dollars ($25.00) per prescription;

(iv) Eliminating specified drugs from the formulary;

(v) Carrying claims into the next biennium if the amount of claims is less than one twentyfourth (1/24) of the appropriation that has been enacted for the next biennium.

(c) Automatic termination of PDAP. PDAP shall be automatically discontinued, and reimbursement for services shall be suspended, when and if PDAP funds become exhausted. Claims for services which have not been paid at the time PDAP is discontinued shall be suspended until such time as additional funds are appropriated. If additional, appropriated PDAP funds become available, claims which were suspended shall not be retroactively paid unless otherwise specified by the statute or appropriation which provides for additional PDAP funds.

(d) Automatic Reinstatement of PDAP. PDAP shall be automatically reinstated, and reimbursement for services shall be reinstated, when and if the Legislature appropriates additional funds. Claims which were suspended shall not be retroactively paid unless otherwise specified by the statute or appropriation which provides for additional PDAP funds.

(e) Notice of program reduction or termination. The Department shall provide thirty days written notice, if possible, to participating providers and recipients of any program reductions or termination of the program.

(f) No appeal. A program reduction, termination, suspension, or the denial of eligibility because of a moratorium, shall not be adverse actions and shall not be subject to reconsideration pursuant to this Chapter or an administrative hearing pursuant to Chapter 1, Administrative Hearing of the Wyoming Medicaid Rules.

Section 13. Audits

(a) Financial audits. The Department may audit a provider's financial records at any time to determine the accuracy and appropriateness of claims submitted to the Department.

(b) The Department may recover excess payments pursuant to Chapter 39, Recovery of Excess Payments of the Wyoming Medicaid Rules, which is incorporated by this reference.

(c) The Department may recover overpayments pursuant to Chapter 16, Medicaid and State Funded Program Integrity of the Wyoming Medicaid Rules, which is incorporated by this reference.

Section 14. Reconsideration. A provider may request that the Department reconsider a decision to recover excess payments or overpayments. The request for reconsideration, the reconsideration, and any administrative hearing shall be pursuant to the reconsideration provisions of Chapter 3, Provider Participation of the Wyoming Medicaid Rules, which are incorporated by this reference.

Section 15. Disposition of recovered funds. The Department shall dispose of recovered funds pursuant to the provisions of Chapter 16, Medicaid and State Funded Program Integrity of the Wyoming Medicaid Rules, which provisions are incorporated by this reference.

Section 16. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) The text of this Chapter shall control the titles of its various provisions.

Section 17. Superseding effect. When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including provider manuals and provider bulletins, which are inconsistent with this Chapter.

Section 18. Severability. If any provision of these rules or the application thereof to any person, program, service, or circumstance is held invalid, the invalidity shall not affect other provisions or applications of these rules. To the extent that these rules can be given effect without the invalid provision; the provision of these rules are severable.

History

Effective 2004-08-15

Chapter 3 Prescription Drug Consumer Information and Technical Assistance Program

Wyo. Code R. 048.0043.3.06272008 Prescription Drug Consumer Information and Technical Assistance Program

Department Of Health

PRESCRIPTION DRUG CONSUMER INFORMATION TECHNICAL ASSISTANCE PROGRAM

Chapter 3

Section 1. Authority. This Chapter is promulgated by the Wyoming Department of Health pursuant to the Prescription Drug Consumer Information and Technical Assistance Program, codified as W.S. § 9-2-124, et seq., and the Wyoming Administrative Procedures Act, W.S. §16- 3-101, et seq. and W.S. § 9-2-106, et seq.

Section 2. Purpose and Applicability.

(a) This Chapter shall apply to and govern all aspects of the Prescription Drug Consumer Information Technical Assistance Program.

(b) It is the purpose of this program to provide Wyoming residents with advice on the prudent use of prescription drugs and how to access government and private prescription drug programs and discounts. The program shall include consultation by Wyoming licensed pharmacists for individuals with respect to how the individuals may, with the approval of the appropriate prescribing healthcare professional, avoid dangerous drug related problems and substitute more cost effective drugs for the drugs prescribed. In addition, the Department may identify clients whose prescription benefit is paid for through Medicaid, or another state funded program, such as Prescription Drug Assistance Program, for detailed medication reviews.

(c) The Wyoming Department of Health may issue materials to providers and/or other affected parties to interpret the provisions of this Chapter. Such materials shall be consistent with and reflect the rules and regulations contained with this Chapter. The provisions contained in the materials shall be subordinate to the provisions of this Chapter.

(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.

Section 3. General Provisions.

(a) This Chapter is intended to be read in conjunction with the Prescription Drug Consumer Information and Technical Assistance Program, W.S. § 9-2-124, et seq.

Section 4. Definitions. 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 number 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 distribution. Words in each gender shall include individuals of the other gender.

(a) "Application." The form, specified by the Department, on which a client indicates in writing the desire to receive a consultation.

(b) "Client." An individual on whose behalf an application for consultation by the Program has been submitted.

(d) "Client Representative." A person who is authorized to submit an application on behalf of someone else; i. e., a spouse, parent, child, guardian, or someone with Power of Attorney.

(e) "Consultation." Review of client information by a Wyoming licensed Pharmacist contracted with the State of Wyoming, including a face- to- face or verbal interaction with client or their client representative.

(f) "Department." The Wyoming Department of Health, its agent, designee, or successor.

(g) "HIPAA." Health Insurance Portability and Accountability Act of 1996, Title II. Provides standards for patient health, administrative and financial data interchange and governs the privacy and security of health information records and transactions.

(h) "Participating Pharmacist." Pharmacist who has contracted with the Department of Health to perform consultations for the Prescription Drugs Technical Assistance Program.

(i) "Physician." A person licensed to practice medicine or osteopathy by the Wyoming State Board of Medical Examiners.

(j) "Pharmacist." Any pharmacist defined by W.S. § 33-24-118, licensed by the Wyoming Board of Pharmacy to prepare and dispense drugs, and contracted with the Department.

(k) "Prescribing Healthcare Professional." Anyone licensed and authorized to prescribe in the State of Wyoming.

(l) "Prescription." An order for medication which is dispensed to or for an ultimate user, but does not include an order for medication which is dispensed for immediate administration to the ultimate user.

(m) "Resident." A person, who resides in the State of Wyoming, and who is a legal citizen of the United States of America.

Section 5. Eligibility.

(a) Any Wyoming resident, regardless of age or income, may request a consultation.

Section 6. Client Application Process.

(a) A toll-free number, 888-792-0067, has been established for prospective clients to call with questions and to receive an application packet.

(b) A request by a prospective client may be made through the Wyoming Department of Health for a medication review and application, which will include:

(1) Client Inventory forms

(2) HIPAA forms

Section 7. Consultation Process.

(a) After the Department receives a completed client information packet, the Department will review the submitted information. Based on the submitted information, the Department will then make the determination if a consultation is warranted. The Department reserves the right to determine if the client is eligible.

(b) The Department will refer the client information to a participating pharmacist.

(i) Review all client information provided by the client and, at a minimum, analyze it for possible drug interactions, therapeutic duplications, and possible cost saving alternatives.

(ii) Conduct a thorough consultation with the client, including a comprehensive interview of current health practices and an in-depth review of all medications.

(iii) Provide written recommendations to the client and health care team regarding the patient's current use of medications.

(iv) Refer qualifying clients to applicable drug manufacturer assistance programs.

(v) Provide to the Department, in a timely manner, a copy of client recommendations, including estimated monthly medication cost savings. When possible, provide the Department with a summary of cost savings resulting from serious side effect or contraindication discoveries in the analysis.

(vi) Obtain drug manufacturer patient assistance forms for clients when indicated.

(vii) Assist the client in completing the patient assistance forms in order for client to transfer them to his/her prescribing provider for signature.

Section 8. Pharmacists.

(a) Must be licensed to practice Pharmacy in the State of Wyoming by the Wyoming Board of Pharmacy, and reside in Wyoming.

Section 9. HIPAA.

(a) State of Wyoming, Department of Health, Notice of Privacy Practices will be enclosed with the Client Inventory form for the client to sign.

(b) State of Wyoming, Department of Health, Acknowledgement of Receipt of Notice of Privacy Practices will be enclosed with the Client Inventory form for the client to sign.

Section 10. Fees.

(a) Pharmacists will be paid a fee per consultation. The fee is determined by the Office of Pharmacy Services and is based on the current market rate for Pharmacy consultations. The Pharmacist will be paid in the following manner:

(i) A portion of the fee will be paid by the Department.

(ii) The client is responsible for five dollars ($5.00) per consultation. The Wyoming Department of Health will make the determination of whether the client is able to pay. If $5.00 is considered cost prohibitive, the Department will waive this fee.

Section 11. Availability of Funds. Each payment obligation of the Department is conditioned upon the availability of government funds which are appropriated or allocated for the payment of this obligation. If funds are not allocated and available for the continuance of the services performed by the Pharmacist, the contract may be terminated by the Department at the end of the period for which the funds are available. The Department shall notify the Pharmacist at the earliest possible time of the services which will or may be affected by a shortage of funds. No penalty shall be accrued to the Department in the event this provision is exercised, and the Department shall not be obligated or liable for any future payments due or for any damages as a result of termination under this section. This provision shall not be construed to permit the Department to terminate this Contract to acquire similar services from another party.

Section 12. Interpretation of Chapter.

(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any one provision is more or less important than any other provision.

(b) Text of this Chapter shall control the titles of its various provisions.

Section 13. Superseding Effect. When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including provider manuals and provider bulletins, which are inconsistent with this Chapter.

Section 14. Severability. If any provision of these rules or the application thereof to any person, program, service, or circumstance is held invalid, the invalidity shall not affect other provisions or applications of these rules. To the extent that these rules can be given effect without the invalid provision, the provision of these rules are severable.

History

Effective 2008-06-27

170 Preventive Health & Safety Division

Chapter 1 Reportable Diseases & Conditions - Pharmacist Reporting

Wyo. Code R. 048.0046.1.06262001 Reportable Diseases & Conditions - Pharmacist Reporting

RULES AND REGULATIONS FOR REPORTABLE DISEASES AND CONDITIONS

CHAPTER 1

Section 1. Statutory Authority. Pursuant to W.S. 35-1-240, W.S. 35-4-107, and W.S. 35-4-108, the Wyoming Department of Health is authorized to make rules and regulations pertaining to a list of reportable diseases and conditions. The Wyoming Department of Health is generally authorized pursu- ant to W.S. 35-1-229 to adopt rules as necessary to enforce reportable disease and condition reporting.

Section 2. Definitions. These rules and regulations shall use the following terms as defined within this section:

(a) "Acquired Immune Deficiency Syndrome" (AIDS) is the end result of HIV infection supported by documented opportunistic infections, malignancies, or selected systemic diseases in asso- ciation with HIV seropositivity.

(b) "Body Fluid" includes any fluids that have been identified by the Center for Disease Control as potentially infectious and capable of facilitating the transmission of reportable diseases and conditions, including HIV/AIDS.

(c) "Confidential" means the restriction of information and records relating to a known or suspected case of a reportable disease or condition which has been reported, acquired, and maintained under W.S. 35-4-107 and 35-4-108, unless otherwise required by law.

(d) "Contagious" is the transmission of a disease by direct or indirect contact.

(e) "Designee" is an individual appointed by the Health Officer and conducting official business for and on behalf of the Wyoming Department of Health, a county, city or district health office.

(f) "Health Care Employee" is a general term used to identify an individual (employee) of health care facility involved in the supervision, care and treatment of patients commensurate with the employee's qualifications and training.

(g) "Health Care Facility" is a public or private hospital, dispensary, or other facility or institution offering and/or providing medical services.

(h) "Health Care Professional" shall include licensed physicians, nurses, physician's assis- tants, nurse practitioners, dentists, dental hygienists, and dental assistants.

(i) "Health Care Provider" is a general term used to identify a health care facility and/or medical professional (e.g., physician, nurse, physician's assistant) providing, directing, supervising or recommending a schedule of medical services to or on behalf of an individual.

(j) "Health Care Worker" includes all personnel involved in the care of a patient including first responders, such as law enforcement, rescue personnel and those individuals acting as good Sa- maritans.

(k) "Health Officer" is the physician or authorized designee selected by the appointing au- thority for a specific jurisdiction: state, county, and/or city.

(l) "Hospital" is a facility with an organized medical staff with a capacity to conduct pa- tient health care needs on a continuous and/or extended basis.

(m) "Infectious" is the capacity to rapidly spread infection to other individuals.

(n) "Isolate" is the restriction of an individual's freedom which is necessary to ensure indi- vidual and/or public health and welfare.

(i) A person may be advised by the Health Officer and/or authorized designee to voluntarily restrict his or her freedom of movement so as to limit contact with other persons.

(ii) Action may be taken by the Health Officer and/or authorized designee for the protection of public health and welfare to legally and formally restrict a person's freedom of movement or performance of an activity.

(o) "Laboratory" is a facility involved in the collecting, processing, analyzing, storing or passing of patient specimens to reference laboratory facilities for the purpose of identifying infectious, microbiological, serological, chemical, hematological, biophysical, cytological or pathological speci- mens from the human body.

(p) "Life Threatening" means the potential for loss of life due to the known or suspected presence of medical condition(s) that may result in or lead to imminent death.

(q) "Penal Institution" is any public or private facility authorized by law to incarcerate indi- viduals as ordered by the court.

(r) "Positive Test Result" is a test that concludes a person is infected with a reportable disease or condition.

(i) Positive test results for reportable diseases and conditions may include but not be limited to the following test methods:

[A] Culture [B] Serology [C] Direct Slide [D] EIA (Enzyme Immunoassay) [E] DNA Probe (Deoxyribonucleic Acid) [F] Other FDA Technology

(s) "Prisoner" is an individual confined or imprisoned in any state penal institution, county or city jail or any community correctional facility.

(t) "Reportable Disease" is a disease and/or condition designated as nationally notifiable by the Centers for Disease Control and Prevention, as well as additional diseases and conditions con- sidered notifiable by the Wyoming Medical and Public Health Community.

(u) "Treatment" is the actual passing or prescribing of medications or a schedule of health care procedures established by current medical standards to effect a cure for a disease or in the case of incurable reportable diseases or conditions, enhance and/or sustain the patient's life expectancy.

Section 3. Confidentiality of Information.

(a) All records pertaining to reportable diseases and conditions are confidential and except as otherwise required by law shall not be disclosed unless the disclosure:

(i) Is for statistical purposes and the information is released in a manner that does not reveal personal identifiers; or

(ii) Is necessary for the exclusive administration and enforcement of these rules and regulations and/or Wyoming state statutes; or

(iii) Is preceded by the written consent of the infected individual specifying where the information shall be sent; or

(iv) Is for notification of health care employees as necessary to protect life and health.

(v) Is pursuant to a civil action for negligent or intentional infection of or exposure to a listed reportable disease or condition.

(vi) Is pursuant to a criminal prosecution for the criminal infection of or exposure to listed reportable disease or condition.

(b) Regardless of patient consent, the Health Officer and/or authorized designee shall have access to medical records and other information pertaining to individuals covered by this Act.

Section 4. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 5. Reporting Required.

(a) The following is a list of individuals and facilities which have an independent duty to report the occurrence of listed reportable diseases and conditions:

(i) A physician or other health care provider diagnosing or treating a person having listed reportable disease or condition;

(ii) The administrator of a health care facility or penal institution in which there is a listed reportable disease or condition case;

(iii) The administrator or operator of a laboratory performing a positive test for listed reportable diseases or conditions.

Section 6. Reporting Procedures/Methods.

(a) The physician must report or cause a report to be made using an official State Disease Case Report or equivalent format, a report via telephone, or a report via secured fax.

(b) The administrator of a health care facility or penal institution must report or cause a report to be made of the diagnosis or treatment of reportable diseases and conditions.

(c) The administrator or operator of a laboratory must report or cause a report to be made of test findings for reportable diseases and conditions.

(i) Notification shall be verbal.

(ii) Notification shall take place within 24 hours or as soon as possible.

(e) Only summary statistical reports are required to be submitted from facilities designated by the State Health Officer as anonymous HIV testing sites.

Section 7. Submission of Reports. All listed reports of reportable diseases and conditions made by the physician or other health care provider, administrator of a hospital, director or supervisor of a laboratory facility, dispensary or penal institution, or any other health care facility shall be for- warded to:

Wyoming Department of Health Epidemiology Section Hathaway Building, 4th Floor Cheyenne, Wyoming 82002

Fax: (307) 777-5573

Phone: (307) 777-3593

All written reports mailed utilizing a mail carrier shall be in an envelope marked "CONFIDENTIAL".

Section 8. Report Forms. Reporting forms may be obtained from the Wyoming Department of Health, Epidemiology Section.

Section 9. Penalty for Failure to Report or for False Report. Any practicing, licensed physician or other person required to report who fails to report to the state health officer or his authorized desig- nee any case of listed reportable disease or condition in the manner provided in W.S. 35-4-107, or who willfully makes any false report regarding any case, shall be guilty of a misdemeanor, punishable by a fine of not more than one thousand dollars ($1,000.00), or imprisonment in the county jail not more than six (6) months, or both.

Section 10. Public Health Action. Upon receipt of a report or notice of a listed reportable disease or condition case within a respective jurisdiction, a Health Officer may take any or all of the following actions:

(a) If examination has not been performed, may provide for the examination of the infected individual(s) or the individual(s) reasonably suspected of suffering from a listed reportable disease or condition and shall report the examination results to the individual(s);

(b) May require the infected individual(s) to seek adequate medical assistance for treatment of said infection either privately or if necessary at public expense;

(c) To the extent possible, provide for and/or arrange for the education and counseling of the infected individual(s) and/or their partner(s) as to the medical significance of the listed reportable disease or condition;

(d) To the extent possible, identify, locate and refer the individual(s) with whom the in- fected individual(s) may have had contact for medical evaluation and treatment if necessary;

(e) Shall follow procedures (a) through (d) (Section 10) above with any individual(s) with whom the infected individual(s) may have had contact.

(f) May isolate the individual(s) when that individual(s) fails to comply with medical rec- ommendations pertaining to an infection with or exposure to a dangerous or life-threatening reportable disease or condition.

Section 11. Public Health Notification.

(a) To the extent possible, the Health Officer shall make every reasonable effort to locate and notify any individual identified as having been exposed to a listed reportable disease or condition within the prescribed public health standard for critical dates of exposure.

(b) Notification may include:

(i) The name of the listed reportable disease or condition to which the individual may have been exposed;

(ii) The approximate date of exposure;

(iii) The nature of the disease (method of transmission, effects of the disease or con- dition, etc.);

(iv) The available sources for education and counseling as to the medical signifi- cance of the disease or condition;

(v) A recommendation to the individual about seeking medical assistance to deter- mine if he or she is infected and obtaining treatment for known or suspected infection if necessary.

(c) The notice shall not provide any information that may be construed to identify the specific identity of the originally infected individual, unless the Health Officer has received written authorization for the release of information from the originally infected individual.

Section 12. Individuals Under Eighteen. Individuals under eighteen years of age may give legal consent for examination and treatment for any listed reportable disease or condition, without the consent of parents or guardians.

Section 13. Health Officer or Authorized Designee Action. The health officer shall take any or all of the following steps:

(a) Determine whether a prisoner or other confined individual is at risk for a listed report- able disease or condition based on the individual's record and/or personal interview.

(b) Isolate prisoner(s) or other confined individuals with treatable listed reportable diseases or conditions within the facility to prevent the spread of infection until the individual is cured.

(c) Provide prisoner(s) or other confined individuals infected with a curable listed report- able disease or condition with the minimum medical care and treatment to affect a cure.

(d) In the case of an individual(s) infected with an incurable listed reportable disease or condition, provide for the minimum care and treatment of the individual(s).

Section 14. Care and Treatment. Minimum care and treatment for incurable listed reportable diseases and conditions requires that a prisoner or other confined individual shall be afforded equal provision of services available to any other member of the confined population.

(a) The facility shall furnish or arrange for the provision of minimum medical care and/or medication pursuant to current medical practice in response to the specific disease.

Section 15. Interference with Judiciary Action. These Rules and Regulations shall not be construed to interfere with the service of any sentence or other judicial action.

History

Effective 2001-06-26

Chapter 11 Reportable Diseases and Conditions

Wyo. Code R. 048.0046.11.10142003 Reportable Diseases and Conditions

Rules and Regulations For Reportable Diseases and Conditions

Chapter 11

Section 1. Authority. Pursuant to W.S. 33-24-155 the Wyoming Department of Health is authorized to make rules and regulations pertaining to reports required to the State Health Officer. The Wyoming Department of Health is generally authorized pursuant to W.S. 35-1-229 to adopt rules as necessary to enforce reportable disease and condition reporting.

Section 2. Purpose and Applicability.

(a) This chapter shall apply to and govern Pharmacist Reporting. This Chapter shall become effective upon final filing with the Secretary of State's office.

(b) The Department may issue Manuals, Bulletins, or both, to interpret the provisions of this Chapter. Such Manuals and Bulletins shall be consistent with and reflect the policies contained in this Chapter. The provisions contained in Manuals or Bulletins shall be subordinate to the provisions of this Chapter.

(c) 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.

Section 3. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules 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.

(a) "Public health emergency" means an occurrence or imminent threat of an illness or health condition caused by an epidemic or pandemic disease, a novel and highly fatal infectious agent or a biological toxin that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability. The governor shall declare when a public health emergency exists or has ended.

(b) "Confidential" means the restriction of information and records relating to known or suspected case of a reportable disease or condition which has been reported, acquired, and maintained under W.S. 35-4-107 and 35-4-108, unless otherwise required by law.

(c) "Designee" is an individual appointed by the Health Officer and conducting official business for and on behalf of the Wyoming Department of Health, a County, City or District Health Office.

(d) "Health Officer" is the physician or authorized designee selected by the appointing authority for a specific jurisdiction: state, county, and/or city.

(e) "Pharmacist" means any individual licensed and registered with the State Board of Pharmacy.

(f) "Infectious" is the capacity to rapidly spread infection to other individuals.

(g) "Reportable Disease" is a disease and/or condition designated as nationally notifiable by the Centers for Disease Control and Prevention, as well as additional diseases and conditions considered notifiable by the Wyoming Medical and Public Health Community.

(h) "Treatment" is the actual passing or prescribing of medcations or a schedule of health care procedures established by current medical standards to effect a cure for a disease or in the case of incurable reportable diseases or conditions, enhance and/or sustain the patient's life expectancy.

Section 4. Confidentiality of Information.

(a) All records pertaining to reportable diseases and conditions are confidential and except as otherwise required by law shall not be disclosed unless the disclosure:

(i) Is for statistical purposes and the information is released in a manner that does not reveal personal identifiers; or

(ii) Is necessary for the exclusive administration and enforcement of these rules and regulations and/or Wyoming state statutes; or

(iii) Is preceded by the written consent of the infected individual specifying where the information shall be sent; or

(iv) Is pursuant to a civil action for negligent or intentional infection of or exposure to a listed reportable disease or condition; or

(v) Is pursuant to a criminal prosecution for the criminal infection of or exposure to a listed reportable disease or condition.

(b) Regardless of patient consent, the Health Officer and/or authorized designee shall have access to medical records and other information pertaining to individuals covered by this Act.

Section 5. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 6. Reporting Required.

(a) Any pharmacist in Wyoming has an independent duty to report the occurrence of unusual trends that the pharmacist has reason to believe might be related to public health emergency, including:

(i) pharmacy visits,

(ii) any type of prescription filled, or

(iii) nonprescription medication sales.

Section 7. Reporting Procedures/Methods.

(a) Within 24 hours of identification of an unusual trend, the pharmacist must report or cause a report to be made using an official State Disease Case Report or equivalent format, a report via telephone, or a report via secured fax.

Section 8. Submission of Reports. All listed reports made by the pharmacist shall be forwarded to:

Wyoming Department of Health Epidemiology Section Hathaway Building, 4th Floor Cheyenne, Wyoming 82002

All written reports mailed utilizing a mail carrier shall be in an envelope marked "CONFIDENTIAL".

Reports may also be forwarded by fax or phone to:

Fax: (307) 777-5573 Phone: (307) 777-3593

Section 9. Report Forms. Reporting forms may be obtained from the Wyoming Department of Health, Epidemiology Section, at (307) 777-3593.

Section 10. Public Health Action. Upon receipt of a report or notice of an unusual pharmacy trend within a respective jurisdiction, a Health Officer may take any or all of the following actions:

(a) Notify other health care providers in the respective jurisdiction of possible public health emergency through blast fax or other means.

(b) If individual information is known,

(i) May require the infected individual(s) to seek adequate medical assistance for treatment of said infection either privately or if necessary at public expense;

(ii) To the extent possible, identify, locate and refer the individual(s) with whom the infected individual may have had contact for medical evaluation and treatment if necessary.

Section 11. Individuals Under Eighteen. Individuals under eighteen years of age may give legal consent for examination and treatment for any listed reportable disease or condition, without the consent of parents or guardians.

History

Effective 2003-10-14

171 Procedures for Conduct of Contested Case Hearings

Chapter 1 Procedures for Contested Case Hearings

Wyo. Code R. 048.0047.1.08041983 Procedures for Contested Case Hearings

CHAPTER I

PROCEDURES FOR THE CONDUCT OF CONTESTED CASE HEARINGS

Section 1. Authority. These rules are promulgated pursuant to the Wyoming Administrative Procedure Act, W.S. 16-3-101 through 16-3-115, and W.S. 9-2-106(a)(vii).

Section 2. Purpose. These rules have been adopted to provide uniform procedures for the con- duct of all contested case hearings.

Section 3. Applicability. Contested case hearings within the Department and its Divisions shall be conducted in accordance with these rules, unless specifically provided otherwise by statute, unless this procedure would conflict with federal regulations, or unless the agency has adopted its own rules for contested cases.

Section 4. Definitions. The definitions set forth in the Wyoming Administrative Procedure Act, W.S. 16-3-101, are incorporated by reference, and for the purposes of a contested case hearing, the following definitions shall apply:

a. "Affidavit" - a written notarized statement of facts made voluntarily under oath.

b . "Contestant" - the person, or person's representative, bringing the complaint against the Department or its Divisions.

c . "Contested case" - a proceeding by the Department, or its divisions, involving, but not re- stricted to, rate making, price fixing, benefit determination or level of benefits, and licensing, in which legal rights, duties or privileges of a party are required by law or regulation to be determined by the Department.

d. "Department" - the Department of Health and Social Services.

e . "Director" - Director of the Department of Health and Social Services.

f . "Ex parte matter" - matters which may be heard by the hearing officer in the absence of and without notice to the adverse party.

g. "Hearing officer" - any employee of the Department or other individual designated by the Director to serve as the presiding officer at a hearing held under these rules.

h . "Indispensable party" - any person whose joinder as a party is so important to a just resolution of the contested case that if he cannot be joined the action should not be allowed to proceed. The hear- ing officer will determine who is an "indispensable party".

i. "Person" - any individual, partnerships corporation, association, municipality, governmental. subdivision, public or private organization of any character, other than an agency.

j . "Respondent" - the Department of Health and Social Services or one of its divisions.

k. 11WAPA11 - the Wyoming Administrative Procedure Act, W.S. 16-3-101 through 16-3-115.

Section 5. Request for Hearing _2. Any person, or his representative, may make a request to the Department, either orally or in writing, for a hearing in a contested case. Any hearing request made orally shall be reduced to writing by the Department and entered in the Contestant's record.

a. The request shall contain at least:

(1) Name, -address, and telephone number of the person requesting the hearing; and

(2) The reason for the request, including the nature of - the departmental action, order,- or determination being contested.

b. The request shall be directed to the Department within twenty- (20) days of the date of the action that is the basis of the contested case.

(1) The Department shall evaluate the request and, within 20 days of receipt of the-request:

(a) Notify the requesting party that a determination in his or her favor has been made and specify the action to be taken by the agency; or

(b) Give notice to the requesting party that a hearing will be held; or

(c) Notify the requesting party of the denial of a hearing as requested and the reasons for the denial. A hearing may be denied if the request for a hearing does not meet the definition of a contested case. A denial of a request for a hearing is a final decision of.the Department which may be appealed to the district court pursuant to the Wyoming Administrative Procedure Act.

Section 6. Notice of Hearing.

a . In any contested case, the Director shall afford reasonable notice of the hearing to all parties.

(1) Reasonable notice, as used in this section, shall be not less than 20 days prior to the hearing date. The time period specified herein may be waived by the Contestant upon written or oral notification to the Director. Where notification of waiver is made orally it shall be reduced to writing by the Director and entered in the Contestant's record.

(2) Notice shall be served personally or by certified mail to the last known address of the party.

(3) Where the necessary and indispensable parties are composed of a large class, notice shall be:

(a) Served upon a reasonable number of representatives of the class; or

(b) Published in newspapers of the State in reasonable numbers and times, and at a minimum in the county in which the Contestant resides, and in at least one newspaper with state- wide circulation. In any county in which more than one newspaper is published notice shall be pub- lished in the official paper of the county designated pursuant to W.S. 18-3-517.

b. A notice of hearing shall contain, at least, the time, place, and nature of the hearing; the legal authority and jurisdiction under which the hearing is being held; the particular sections of the statutes or rules involved; a short and plain statement of the matters asserted; the docket number assigned to the case; and the right to be represented by an attorney.

(1) If the Respondent is unable to state the matters in detail at the time notice is served, the initial notice may be limited to a statement of the issues involved, and thereafter, upon request of any party, a more definite and detailed statement shall be furnished within ten (10 ) days of receipt of that request by the party.

(2) Upon request by the party served, the Director or his designee shall, upon a showing of good cause, allow the party an alternative time and place for the hearing, provided such request is made within ten (10) days of receipt of the notice of hearing. When such a request is granted, the Director or his Assignee shall reissue the notice in accordance with these rules except that reasonablenotice as used in this subsection shall be five (5) days prior to the hearing date.

(a) Only one request for rescheduling of a hearing shall be honored unless, in the Director's judgment, additional changes must be allowed to avoid manifest injustice. Notice shall be issued as provided by Section 6. b.(2) above.

(b) A hearing shall be held within (90) ninety days of the agency action which gives rise to the complaint, unless otherwise provided-by law.

Section 7. Failure to Appear. If a Contestant fails to appear. at the place, date, and time specified in -a notice, the hearing officer may, within his discretion:

a . Continue the hearing to a later date and provide notice as prescribed by Section 6. b.(2) herein; or

b . Proceed to conduct the hearing without the contestant and dispose of the contested case as provided herein.

Section 8. Discovery. All discovery in a contested case shall be governed by the Wyoming Rules of Civil Procedure, as described in , the - WAPA W. S. 16-3-107 (g) and (h) . , -The party . for whom any depositions are taken W3 11 ensure that the original transcripts are placed - in the record by filing them with the Director or his designee. All other records of discovery shall likewise be filed with the Director or his designee by the party originating such discovery.

Section 9. Prehearing Conference.

a. At a time on or before the.day of the hearing, the hearing officer, on his own or either party's motion, may meet with the parties for a conference to consider@simplification of the issues, stipulations and admissions of fact, clarification or limitation of evidence, -and any other matters that may expedite the proceeding and assure a just conclusion of the case.

b. Any stipulations, limitations or agreements made at a preheating conference shall be recited in the, record and shall control the course of the proceedings, unless modified during the hearing to prevent manifest injustice.

Section 10. Informal Disposition. Settlement of a contested case by any informal means (i.e.stipulation, agreed settlement or consent order) shall be allowed at any time, unless precluded by law. Such settlements shall be in writing by both parties and included as a part of the record. The Director or his designee shall enter an order dismissing the contested case proceeding upon such settlement, and such order shall be considered a final order of the Department.

Section 11. Hearing Officer.

a. The Director or his designee shall appoint a hearing officer to preside over contested case hearings on a case-by-case basis, or for a scheduled period of time, as he sees fit.

b . The hearing officer shall be an employee of the Department, or other individual determined by the Director to be qualified to serve in such a capacity, who has not taken part in the investigation, preparation, or earlier disposition of the case to be heard.

(1) The hearing officer shall withdraw himself from consideration of a case at any time he deems himself disqualified providing there are other qualified presiding officers available to act. Withdrawal shall be made in writing to the Director.

(2) Any party may request in writing that the Director remove and replace the hearing officer in a contested case. This request must be accompanied by a statement and affidavits, if appropri- ate, setting forth the alleged grounds for disqualification. The Director may deny a party's request for removal and shall issue a written statement explaining the grounds for his denial which shall be made a part of the record. If the request is granted, the Director shall appoint a new hearing officer as soon as is practicable.

(3) The Contestant may object to the appointment of the hearing officer in the record at. the hearing. The objection shall set forth the alleged grounds for disqualification.

c. The hearing officer shall have all powers necessary to conduct a fair and impartial hear- ing, including but not necessarily limited to, the following authority:

(1) To administer oaths and affirmations;

(2) To subpoena witnesses and require the production of any books, papers or other documents relevant or material to the inquiry.

(3) To rule upon offers of proof and relevant evidence;

(4) To provide for discovery and determine its scope;

(5) To regulate the course of the hearing;

(6) To hold conferences for the settlement or simplification of the issues;

(7) To dispose of procedural requests or similar matters; and

(8) To take any other action authorized by the Department's rules.

d. Failure or refusal to appear or obey orders of the hearing officer may result in the sanc- tions provided in W.S. 16-3-107(c) and (f).

e . Except to the extent required for the disposition of ex parte matters authorized by law, the hearing officer shall not consult with any individual or party on any fact at issue except as allowed in W.S. 16-3-111.

Section 12. Evidence and Testimony.

a. Except as may be otherwise ordered by the hearing officer, the Contestant bears the burden of proof.

b. Admissibility of evidence

(1) The parties shall be entitled to present any oral or documentary evidence, submit rebuttal evidence and conduct cross-examinations, as may be required for a full disclosure of the facts. All documentary or physical evidence submitted for consideration shall be marked as exhibits. Respondent's exhibits shall be marked by letters of the alphabet beginning with "A". Contestant's exhibits will be marked by numbers beginning with 111".

(2) The hearing officer shall allow any oral or documentary evidence, except that he may exclude irrelevant, immaterial, or unduly repetitious evidence.

c. Objections

(1) The grounds for objection to any evidentiary ruling by the hearing officer shall be briefly stated. Rulings on all objections shall,appear in the record. Only those objections made before the hearing officer, specifically stipulated to by both parties, may-be relied on in a subsequent proceeding.

(2) Formal exception to an adverse ruling is not required.

d. Privileged and confidential information

(1) Any privilege at law shall be recognized by the hearing officer in considering evidence.

(2) No employee of the Department shall be compelled to testify or to divulge information which is confidential or privileged at law and which is contained within the records of the Department or acquired within the scope of his employment except as provided in W.S. 16-3-107. 1

e . Judicial notice may be taken of any material fact not appearing in evidence in the record that is of the nature of traditional matters of judicial notice or within the special technical knowledge or files of the Department. Parties shall be given an opportunity to contest matters judicially noticed prior. to a final : decision by the Department in accordance with W.S. 16-3-108: Each witness who is present to.give testimony will identify. himself, or -herself by stating :his or her name and address, indicate on whose behalf he or she -will testify, and be administered the following oath by the hearing officer: , "Do you swear or affirm to tell the truth, the whole truth, and nothing but the truth?"

Section 13. Representation.

a. All parties have a right to represent themselves, to be represented by an attorney-licensed- to.practice law in Wyoming, or any other person chosen by the Contestant to appear on his behalf. If the Contestant is represented by an attorney, payment of attorney's fees and cost are the responsibility of the Contestant. Contestant may, be eligible for legal services available through the Legal Services Corpora- tion if he or she meets the applicable guidelines of-that agency.

(1) Only the individual party, his attorney, or his representative may examine or cross- examine witnesses.

(2) The hearing officer may examine witnesses.

b. Respondent may request the Attorney General to assist in contested case hearings to the extent required by W.S. 16-3-112(c). - -

Section 14. Order of Procedure.

a . As nearly as practicable, the following order of procedure shall be followed:

(1) The hearing officer shall announce the hearing is open and call by docket number and title the case to be heard. The hearing officer shall ask if parties are ready to proceed and will allow parties an opportunity to dispose of any preliminary matters.

(2) The hearing officer shall administer the oath to all witnesses who will present testi- mony.

(3) The hearing officer may, in his discretion, allow evidence to be heard in an order other than that prescribed here and shift the burden of proof accordingly.

(4) Opening statements will be made, Contestant first, then Respondent.

(5) Evidence will be heard, Contestant first, then Respondent. Contestant may then offer rebuttal evidence. Parties may each exercise the right to cross-examine.

(6) No testimony shall be received by the Hearing Officer unless given under oath/ affirmation administered:by the Hearing Officer.

(7) Closing statements will be made, Contestant first, then Respondent, then the Contes- tant in rebuttal.

(8) The hearing officer may limit. the time for opening and closing statements.

(9) The hearing officer may recess-the proceedings as appropriate.

(10) After all parties have had an opportunity to be heard, the hearing officer shall xcuse all witnesses and close the evidence.

(a) Evidence may be reopened only upon a motion by a party to the proceeding on a showing of good cause.

b. Upon their own motion, all parties or other interested persons may submit legal briefs after the close of the hearing. The hearing officer shall allow a reasonable time, not less than ten (10) working days from the date of hearing, for preparation of the briefs. The time may be extended upon agreement between the parties with the approval of the hearing officer.

Section 15. Decisions

a. The hearing officer shall make proposed findings of fact and conclusions of law within twenty (20) working days of the close of the hearing and forward them to the Director for final determi- nation. This time may be extended if the parties or other interested persons are to submit. briefs; but, in no event may this time be extended by more than ten (101 working days, unless a later date is stipulated, in writing, by Contestant and Respondent.

(1) Within ten (10) working days of the close of the hearing, or such additional time as the hearing officer may allow, each party shall be allowed to file with the hearing officer any proposed findings of fact and conclusions of law, together with a supporting brief. Such-proposals and-briefs shall be served on all other parties.

b. Within ten (10) working days of receipt of the hearing.officer's proposed findings of fact and conclusions of law, the@Director or his designee will make and enter in the record the final decision in the case. This decision shall be made and served on all parties to the proceeding. The decision shall include:

(1) A statement of the findings of fact and conclusions of law, stated separately, with a concise and explicit statement of the underlying facts supporting the findings; and

(2) The., appropriate, rule, order, relief :or denial thereof. The decision shall be based upon a consideration of the whole contested case record or any portion stipulated to by the parties. The decision shall state all facts judicially noticed and relied upon as provided by W.S. 16-3-108(d). It shall be made on the basis of a preponderance of reliable and probative evidence contained in the record.

c . Final -decisions of the Department shall be effective immediately after being entered in the record and served upon all parties. Service shall be accomplished either personally or by mailing-a copy of any decision or order to each party or to his attorney - of record within-a reasonable time following the entry of the decision into the record.

Section 16. Appeals. Appeals from a final decision of the Department shall be taken in accordance with W.S. 16-3-114 and Rule 12 of the Wyoming Rules of Appellate Procedure.

Section 17. Transcripts and Record.

a. When a contested case is set for hearing, the Director or his designee shall assign a docket number to each case and enter the case with its number and date of filing in a docket book main- tained by the Director or his designee. The Director or his designee shall maintain a separate file for each docketed case in which all pleadings, transcripts, correspondence, papers, and exhibits for that case shall be maintained. All such items shall have noted thereon the assigned docket number and the date of filing.

b. The Department shall record all contested case proceedings electronically, through the use of a qualified court reporter or any other appropriate means determined by the agency, or the hearing officer. Transcriptions of oral proceedings or written transcripts of a witness's testimony may be ob- tained by Contestant upon payment of the cost.

(1) In a nonpublic investigatory proceeding, requests for copies or transcripts may be limited to testimony of the requesting party.

(2) Where Contestant can demonstrate that he is indigent and that he can not effec- tively perfect his appeal without such transcription the Department may waive the payment of the fee.

c. The record of the hearing shall contain:

(1) All formal or informal notices, pleadings, motions, intermediate rulings;

(2) Evidence received or considered, including matters judicially noticed;

(3) Questions and offers of proof, objections and rulings;

(4) Any proposed findings and exceptions thereto; and

(5) The report of the hearing officer to the Director and the final decision of the Director.

Section 18. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 1983-08-04

192 Provider Orders for Life Sustaining Treatment (POLST)

Chapter 1 Provider Orders for Life Sustaining Treatment Act

Wyo. Code R. 048.0068.1.04122016 Provider Orders for Life Sustaining Treatment Act

WYOMING DEPARTMENT OF HEALTH AGING DIVISION

CHAPTER 1

RULES FOR PROVIDER ORDERS FOR LIFE SUSTAINING TREATMENT (POLST)

Section 1. Authority. These rules are promulgated by the Wyoming Department of Health pursuant to W.S.§ 35-22-501 through 509.

Section 2. Definitions.

(a) "Cardiopulmonary resuscitation bracelet" means the unique, immediately recognizable bracelet of uniform size and design issued by the Department to the declarant, to be worn for immediate identification of the declarant by emergency medical service (EMS) personnel and health care providers. The bracelet shall be considered the same as and have the same effect as an apparent, immediately available and identified cardiopulmonary resuscitation (CPR) directive.

(b) "Cardiopulmonary resuscitation directive form" means the document provided by the Department that is printed on distinctive security paper and is filled out by the declarant and attending physician to execute a CPR directive.

(c) "POLST" means Provider Orders for Life-Sustaining Treatment, the statewide method of identifying a patient's wishes regarding medical treatment when faced with life limiting illnesses, and converting those wishes into a set of medical orders.

(d) "POLST Form" is the standardized and easily identifiable document, approved by the Department, which converts a patient's goals of care and treatment preferences into a provider order that transfers across health care settings.

(e) "Primary Health Care Provider" per W.S. § 35-22-402.

Section 3. Provider Orders for Life Sustaining Treatment (POLST) Forms.

(a) An individual who wishes to execute a POLST Form must use the form approved by the Department. The form may not be altered in layout or style, including font style and size.

(b) Any person, health care provider or health care facility may obtain a POLST Form from the Department and from the Department's website.

(c) A health care provider, licensed health care facility or EMS provider shall act upon a copy of a POLST Form as if it were original.

(d) The standardized POLST Form shall contain:

(i) The person's name, date of birth, and gender;

(ii) Standard protocols, recognized nationally, regarding end-of-life care;

(iii) Medical condition and patient goals;

(iv) An area allowing the person, executing the form, to forbid any changes to be made by the surrogate;

(v) Printed name, address, and telephone number of the Primary Health Care Provider;

(vi) Signature of Primary Health Care Provider;

(vii) Signature of person executing the POLST Form; and

(viii) Dates of signatures;

Section 4. Method of Identification.

(a) The POLST Form shall be printed on gold paper in order to be easily identifiable for patients and caregivers.

(b) Individuals, who have executed a POLST Form, shall be instructed to post a copy of the form in a visible area in their place of residence.

Section 5. Prior Orders and Out of State Orders.

(a) A POLST Form from another state, absent actual notice of revocation or termination, shall be presumed to be valid in this state.

(b) A POLST Form executed prior to this rule, from this state and other states, absent actual notice of revocation or termination, shall be presumed to be valid in this state.

(c) All previously issued CPR bracelets and CPR directive forms, from this state and other states, shall be considered valid.

Section 6. Responsibilities.

(a) A Primary Health Care Provider who is completing a POLST Form with a patient shall ensure that the patient:

(i) Receives an explanation of the expected consequences of choices made for each section of the POLST Form;

(ii) Is informed that if the POLST Form is not apparent and immediately available, interventions may be initiated by EMS personnel; and

(iii) Receives an explanation of how and by whom the POLST Form may be revoked or changed.

(b) The person executing a POLST Form is:

(i) Responsible for making informed decisions concerning the choices made within each section of the POLST Form;

(ii) Encouraged to post the completed POLST Form in a visible location in their place of residence; and

(iii) Responsible for notifying family members, next of kin, and the surrogate named within the POLST Form, of the existence of a completed POLST Form.

History

Effective 2016-04-12

172 Public Health Laboratory

Chapter 1 Public Health Laboratory Testing Fees

Wyo. Code R. 048.0048.1.01132016 Public Health Laboratory Testing Fees

CHAPTER 1

Rules and Regulations for Public Health Laboratory Testing Fees

General Provisions

Section 1. Authority. The Wyoming Department of Health is promulgating this Rule pursuant to requirements in 2012 Wyoming Session Laws, Chapter 26, Section 048, Department of Health, Footnote 4, and the Wyoming Administrative Procedure Act at W.S. § 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) These Rules establish the fees charged by the Public Health Laboratory for providing laboratory testing services to other State of Wyoming agencies, local law enforcement entities and other individuals or organizations.

(b) The Department may issue Manuals or Bulletins to providers and/or other affected parties to interpret the provisions of this Chapter. Such manuals or bulletins shall be consistent with and reflect the policies contained in the Chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

(c) 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.

Section 3. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules, where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules gender pronouns are used interchangeably. The drafters have attempted to utilize each gender pronoun in equal numbers, in random distribution. Words in each gender include individuals of the other gender.

(a) "Facility" is defined as a location that submits samples to the public health laboratory for testing.

(b) "Public Health Laboratory" is defined as the Department of Health Public Health Laboratory located at 208 South College Drive, Cheyenne, WY 82002.

(c) "Submitter list" is defined as all submitting locations currently included in the Microbiology and Chemical laboratory information systems.

Section 4. Facilities and programs.

(a) Facilities and programs already on the submitter list that have submitted samples for Public Health Laboratory analysis will receive a monthly or quarterly invoice for all analytical services completed according to the fee schedule established in these rules.

(b) Only facilities and programs currently on the Public Health laboratory submitter list will be authorized to submit samples under this fee structure.

(c) Facilities and programs that are not currently on the Public Health Laboratory submitter list that are, or that may need to request laboratory testing services should contact the Public Health Laboratory for information and assistance to get on the submitter list.

Section 5. Fees.

(a) The Public Health Laboratory may increase individual fee assessments by up to twenty percent (20%) without a rule change, if it is determined that the costs of laboratory testing necessitates such increases. The Public Health Laboratory will notify all facilities and programs on the submitters list at least 90 days before any increase is effective. Increases in the fee assessments that are greater than twenty percent (20%) will require a rule change.

(b) The Public Health Laboratory reserves the option to enter into agreements with State Agency programs that would adjust or waive fees included in these rules and regulations.

(i) Immunology

(ii) Microbiology

(iii) Molecular biology

(iv) Drinking Water

(v) Blood Alcohol

(vi) Toxicology

Section 6. Fee Schedule for Services. The following fees shall apply for each test request submitted:

| | Chemistry | | --- | --- | | Fee | Test Description | | $14.00 | Oral fluid collection kit and 4 drug screen w/confirmation | | $9.00 | Urine analysis kit and 8 drug screen w/confirmation | | $9.50 | Blood alcohol collection kit w/confirmation and 10 drug screen | | $90.00 | 20 drug blood screening panel w/alcohol screen and confirmation | | $9.00 | Ethyl Glucuronide (ETG) | | $9.00 | Methadone | | $9.00 | Propoxyphene | | $8.00 | Cotinine | | $23.00 | Synthetic marijuana | | $23.00 | Inhalants | | $23.00 | Emerging drugs | | $9.00 | Toxicology screen | | $9.00 | Toxicology confirmation |

| | Microbiology | | | --- | --- | --- | | Fee | Test Description | CPT code | | $8.00 | Drinking water total coliform | N/A | | $8.00 | Drinking water E. coli screen | N/A | | $4.00 | Occult blood feces | 82270 | | $20.00 | Immunoassay for blood fecal | 82274 | | $15.00 | Chemiluminescent assay | 82397 | | $45.00 | Electrophoretic test | 82664 | | $10.00 | Assay IgA/IgD/IgG/IgM each | 82784 | | $6.00 | IgG 1 2 3 or 4 each | 82787 | | $15.00 | Immunoassay nonAntibody | 83516 | | $10.00 | Immunoassay dipstick | 83518 | | $15.00 | Immunoassay quant nos nonab | 83520 | | $20.00 | Western blot test | 84181 | | $20.00 | Protein western blot test | 84182 | | $4.00 | Bl smear w/o diff wbc count | 85008 | | $5.00 | Chromogenic substrate assay | 85130 | | $15.00 | Immunoglobulin assay | 86023 | | $5.00 | Complement fixation each | 86171 | | $15.00 | Fluorescent Antibody screen | 86255 | | $15.00 | Fluorescent Antibody titer | 86256 | | $5.00 | Heterophile Antibody screen | 86308 |

| $5.00 | Heterophile Antibody titer | 86309 | | --- | --- | --- | | $10.00 | Heterophile Antibody absrbj | 86310 | | $15.00 | Immunoassay infectious agent | 86318 | | $10.00 | Particle agglut antbdy scrn | 86403 | | $10.00 | Particle agglut antbdy titr | 86406 | | $40.00 | Quantiferon Gold (Tb immun measure) | 86480 | | $3.00 | Syphilis test non-trep qual | 86592 | | $5.00 | Syphilis test non-trep quant | 86593 | | $6.00 | Bacterium Antibody | 86609 | | $15.00 | Borrelia Antibody | 86619 | | $15.00 | CMV Antibody | 86644 | | $15.00 | CMV Antibody IgM | 86645 | | $20.00 | Diphtheria Antibody | 86648 | | $15.00 | Encephalitis californ antbdy | 86651 | | $15.00 | Encephaltis east eqne anbdy | 86652 | | $15.00 | Encephaltis st louis antbody | 86653 | | $15.00 | Encephaltis west eqne antbdy | 86654 | | $15.00 | Epstein-barr Antibody | 86663 | | $15.00 | Epstein-barr nuclear antigen | 86664 | | $15.00 | Epstein-barr capsid vca | 86665 | | $10.00 | Francisella tularensis | 86668 | | $6.00 | Fungus nes Antibody | 86671 | | $15.00 | Helicobacter pylori Antibody | 86677 | | $15.00 | Helminth Antibody | 86682 | | $15.00 | Herpes simplex nes antbdy | 86694 | | $15.00 | HIV-1/hIV-2 1 result screen | 86703 | | $15.00 | Hepatitis B Core Antibody total | 86704 | | $15.00 | Hepatitis B Core Antibody IgM | 86705 | | $15.00 | Hepatitis B Surface Antibody | 86706 | | $15.00 | Hepatitis A Antibody total | 86708 | | $15.00 | Hepatitis A Antibody IgM | 86709 | | $15.00 | Legionella Antibody | 86713 | | $15.00 | Leishmania Antibody | 86717 | | $15.00 | Leptospira Antibody | 86720 | | $6.00 | Mumps Antibody | 86735 | | $15.00 | Mycoplasma Antibody | 86738 | | $15.00 | Neisseria meningitidis | 86741 | | $15.00 | Parvovirus Antibody | 86747 | | $14.00 | Protozoa Antibody nos | 86753 | | $20.00 | Rickettsia Antibody | 86757 |

| $6.00 | Rubella Antibody | 86762 | | --- | --- | --- | | $6.00 | Rubeola Antibody | 86765 | | $15.00 | Toxoplasma Antibody | 86777 | | $15.00 | Toxoplasma Antibody IgM | 86778 | | $15.00 | Treponema pallidum | 86780 | | $5.00 | Trichinella Antibody | 86784 | | $6.00 | Varicella-zoster Antibody | 86787 | | $20.00 | West Nile virus ab IgM | 86788 | | $20.00 | West Nile virus Antibody | 86789 | | $15.00 | Virus Antibody nos | 86790 | | $20.00 | Hepatitis C Antibody | 86803 | | $5.00 | Specimen infect agnt concntj | 87015 | | $5.00 | Feces culture aerobic bact | 87045 | | $5.00 | Stool cultr aerobic bact ea | 87046 | | $5.00 | Culture othr specimn aerobic | 87070 | | $5.00 | Culture aerobic quant other | 87071 | | $5.00 | Culture bacteria anaerobic | 87073 | | $5.00 | Cultr bacteria except blood | 87075 | | $10.00 | Culture anaerobe ident each | 87076 | | $10.00 | Culture aerobic identify | 87077 | | $5.00 | Culture screen only | 87081 | | $10.00 | Culture of specimen by kit | 87084 | | $5.00 | Urine culture/colony count | 87086 | | $5.00 | Skin fungi culture | 87101 | | $5.00 | Fungus isolation culture | 87102 | | $5.00 | Fungi identification yeast | 87106 | | $5.00 | Fungi identification mold | 87107 | | $5.00 | Mycoplasma | 87109 | | $10.00 | Mycobacteria culture | 87116 | | $10.00 | Mycobacteric identification | 87118 | | $25.00 | DNA/RNA direct probe | 87149 | | $40.00 | DNA/RNA amplified probe | 87150 | | $50.00 | Culture type pulse field gel (PFGE) | 87152 | | $50.00 | DNA/RNA sequencing | 87153 | | $4.00 | Macroscopic exam arthropod | 87168 | | $4.00 | Macroscopic exam parasite | 87169 | | $4.00 | Pinworm exam | 87172 | | $5.00 | Tissue homogenization cultr | 87176 | | $8.00 | Ova and parasites smears | 87177 | | $5.00 | Microbe susceptible diffuse | 87181 |

| $5.00 | Microbe susceptible disk | 87184 | | --- | --- | --- | | $10.00 | Microbe susceptible mic | 87186 | | $10.00 | Microbe susceptible mlc | 87187 | | $3.00 | Smear fluorescent/acid stai | 87206 | | $5.00 | Smear special stain | 87207 | | $15.00 | Smear complex stain | 87209 | | $3.00 | Smear wet mount saline/ink | 87210 | | $25.00 | Assay toxin or antitoxin | 87230 | | $15.00 | Cryptosporidium ag if | 87272 | | $15.00 | Legionella micdadei ag if | 87277 | | $15.00 | Legion pneumophilia ag if | 87278 | | $15.00 | Pneumocystis carinii ag if | 87281 | | $16.32 | Antibody detection nos if | 87299 | | $15.00 | Adenovirus ag eia | 87301 | | $15.00 | Aspergillus ag eia | 87305 | | $15.00 | Chylmd trach ag eia | 87320 | | $15.00 | Cryptococcus neoform ag eia | 87327 | | $15.00 | Cryptosporidium ag eia | 87328 | | $15.00 | Giardia ag eia | 87329 | | $15.00 | Cytomegalovirus ag eia | 87332 | | $15.00 | E. coli 0157 ag eia | 87335 | | $15.00 | H. pylori stool eia | 87338 | | $15.00 | H. pylori ag eia | 87339 | | $15.00 | Hepatitis B Surface Antigen | 87340 | | $15.00 | Histoplasma capsul ag eia | 87385 | | $15.00 | Influenza A/B ag eia | 87400 | | $15.00 | Resp syncytial ag eia | 87420 | | $15.00 | Rotavirus ag eia | 87425 | | $15.00 | Shiga-like toxin ag eia | 87427 | | $15.00 | Ag detect nos eia mult | 87449 | | $13.00 | Ag detect nos eia single | 87450 | | $13.00 | Ag detect polyval eia mult | 87451 | | $40.00 | Bartonella DNA amp probe | 87471 | | $40.00 | Lyme dis DNA amp probe | 87476 | | $40.00 | Candida DNA amp probe | 87481 | | $40.00 | Chylmd pneum DNA amp probe | 87486 | | $12.00 | Chylmd trach DNA amp probe | 87491 | | $14.00 | Chylmd trach and N. gono DNA amp probe | 87491 | | $40.00 | C. diff amplified probe | 87493 | | $40.00 | Cytomeg DNA amp probe | 87496 |

| $40.00 | Enterovirus probe&revrs trns | 87498 | | --- | --- | --- | | $20.00 | Influenza DNA amp prob 1+ | 87501 | | $20.00 | Influenza DNA amp probe | 87502 | | $100.00 | Nfct agent detection gi | 87505 | | $150.00 | IaDNA-DNA/RNA probe tq 6-11 | 87506 | | $250.00 | IaDNA-DNA/RNA probe tq 12-25 | 87507 | | $40.00 | Hepatitis B DNA amp probe | 87516 | | $50.00 | Hepatitis B DNA quant | 87517 | | $25.00 | Hepatitis C RNA dir probe | 87520 | | $40.00 | Hepatitis C probe&rvrs trnsc | 87521 | | $55.00 | Hepatitis C revrs trnscrp | 87522 | | $45.00 | Hsv DNA amp probe | 87529 | | $45.00 | HIV-1 probe&reverse trnscrpj | 87535 | | $115.00 | HIV-1 quant&revrse trnscrpj | 87536 | | $25.00 | Legion pneumo DNA dir prob | 87540 | | $40.00 | Legion pneumo DNA amp prob | 87541 | | $56.82 | Legion pneumo DNA quant | 87542 | | $20.00 | Mycobacteria DNA dir probe | 87550 | | $40.00 | Mycobacteria DNA amp probe | 87551 | | $20.00 | M.tuberculo DNA dir probe | 87555 | | $40.00 | M.tuberculo DNA amp probe | 87556 | | $20.00 | M.avium-intra DNA dir prob | 87560 | | $40.00 | M.avium-intra DNA amp prob | 87561 | | $40.00 | M.pneumon DNA amp probe | 87581 | | $12.00 | N.gonorrhoeae DNA amp prob | 87591 | | $45.00 | HPV low-risk types | 87623 | | $45.00 | HPV high-risk types | 87624 | | $45.00 | HPV types 16 & 18 only | 87625 | | $100.00 | Resp virus 3-11 targets | 87631 | | $150.00 | Resp virus 6-11 targets | 87632 | | $200.00 | Resp virus 12-25 targets | 87633 | | $47.76 | Staph a DNA amp probe | 87640 | | $47.76 | Mr-Staph DNA amp probe | 87641 | | $27.29 | Strep A DNA dir probe | 87650 | | $47.76 | Strep A DNA amp probe | 87651 | | $47.76 | Strep B DNA amp probe | 87653 | | $45.00 | Trichomonas vaginalis amplif | 87661 | | $25.00 | Detect agent nos DNA dir | 87797 | | $35.00 | Pertussis (PCR) | 87798 | | $40.00 | Norovirus molecular | 87798 |

| $40.00 | Detect agent nos DNA amp | 87798 | | --- | --- | --- | | $55.00 | Detect agent nos DNA quant | 87799 | | $50.00 | Detect agnt mult DNA direc | 87800 | | $95.00 | Detect agnt mult DNA ampli | 87801 | | $16.32 | Strep B assay w/optic | 87802 | | $30.00 | HIV antigen w/HIV antibodies | 87806 | | $15.00 | RSV assay w/optic | 87807 | | $15.00 | Adenovirus assay w/optic | 87809 | | $6.00 | Group A Strep assay | 87880 | | $16.32 | Agent nos assay w/optic | 87899 | | $300.00 | Genotype DNA/RNA Hep C | 87902 | | $250.00 | Genotype DNA Hepatitis B | 87912 | | $26.88 | Protein analysis w/probe | 88372 | | $15.00 | HIV-1/HIV-2 confirm | 86703-92 |

History

Effective 2016-01-13

Effective 2016-12-20

174 Rural Health, Office of

Chapter 2 Wyoming Healthcare Professional Loan Repayment Program

Wyo. Code R. 048.0050.2.04142016 Wyoming Healthcare Professional Loan Repayment Program

CHAPTER 2

Rules for the Wyoming Healthcare Professional Loan Repayment Program

Section 1. Authority. These rules are promulgated by the Department of Health, Public Health Division, pursuant to W.S. §§ 9-2-118 and 119, and the Wyoming Administrative Procedures Act at W.S. § 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) These rules implement the Wyoming Healthcare Professional Loan Repayment Program which governs the award of grant funds to healthcare professionals to repay loans taken for educational expenses.

(b) The Department may issue manuals, bulletins, or both, to interpret the provisions of these Rules. Such manuals and bulletins shall be consistent with and reflect the policies contained in these Rules. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these Rules.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules.

(a) "Allied Healthcare Professional" means an individual who is licensed or certified to practice in the state as defined under Wyoming Statutes, Title 33, Chapter 9 (Podiatrists), Chapter 10 (Chiropractors), Chapter 15 (Dental Hygienists), Chapter 21 (Advanced Practice Registered Nurses, Registered Nurses, Licensed Practical Nurses, Certified Nurses Assistants), Chapter 23 (Optometrists), Chapter 24 (Pharmacists and Pharmacy Technicians), Chapter 25 (Physical Therapists), Chapter 26, Article 5 (Physician Assistants), Chapter 27 (Psychologists), Chapter 33 (Speech Pathologists and Audiologists), Chapter 34 (Laboratory Directors), Chapter 36 (Emergency Medical Technicians), Chapter 37 (Radiologic Technologists), Chapter 38 (Professional Counselors, Marriage and Family Therapists, Social Workers, and Chemical Dependency Specialists), Chapter 40 (Occupational Therapists), and Chapter 43 (Respiratory Care Practitioners).

(b) "Dentist" means an individual licensed under Wyoming Statutes, Title 33, Chapter 15, excluding Dental Hygienists.

(d) "Physician" means an individual who is licensed to practice in the state under Wyoming Statutes, Title 33, Chapter 26, of the Wyoming Medical Practice Act.

(e) "This Program" means the loan repayment programs authorized by W.S. § 9-2-118 and W.S. § 9-2-119.

Section 5. Healthcare Professional Loan Repayment Program Grants - Terms and Service.

(a) The Department may provide loan repayment grants to physicians, dentists, and allied healthcare professionals to repay loans taken for educational expenses in exchange for their agreement to provide full-time service at an approved practice location in the state for a period of three (3) years.

(b) Under either W.S. § 9-2-118 or W.S. § 9-2-119, loan repayment grants may be given only to repay bonafide loans that meet the following criteria:

(i) A commercial loan made by a bank, credit union, savings and loan association, insurance company, school, or credit institution; or

(ii) A governmental loan made by a federal, state, county, or city agency.

(iii) Educational loans may only include those costs related to the applicant's education in a healthcare profession, including the cost of books, education equipment, fees, materials, reasonable living expenses, supplies and tuition. Loans which include debt belonging to an individual other than the applicant or costs not associated with the applicant's healthcare professional education are not eligible for repayment under this Program.

(iv) Educational loans which are in default at the time of the healthcare professional's application for loan repayment are not eligible for repayment under this Program.

(c) Before receiving an award under this Program, the recipient shall enter into a contract with the Department agreeing to the conditions upon which the award is to be made.

The contract shall include necessary conditions to carry out the purposes of this Program including, but not limited to: service obligation and reporting requirements; payment schedule and terms; and penalties for breach of contract pursuant to Section 7 of these Rules.

(d) In exchange for financial assistance under this Program, the recipient shall serve full-time for a minimum of three (3) years at a practice location approved by the Department.

(i) The recipient's three (3) year service obligation begins on the date the contract between the Department and the recipient is finalized or the first day of full-time service at the approved practice location, whichever is later. Periods of internship, preceptorship, or other clinical training do not satisfy the service obligation under this Program.

(ii) The recipient must be licensed, including a temporary license, or be certified to practice in the recipient's healthcare specialty in Wyoming before the recipient's first day of service under the contract.

(iii) The recipient must obtain approval from the Department of the practice location where the recipient will complete the service obligation.

(iv) Full-time is defined as working at least forty (40) hours per week. The Department, at its discretion, may consider less than forty (40) hours per week as full-time when the industry standard for full-time for the healthcare professional's discipline is less than forty (40) hours per week.

(e) The Department may not disburse any grant monies under this Program until the recipient's contract has been finalized and the recipient has performed at least six (6) months of full-time service at the approved practice location. The date on which the recipient's initial six (6) months of service begins is the first day of the recipient's three (3) year service obligation pursuant to Section 5(d)(i) of these Rules.

(f) The loan repayment grant recipient must apply one hundred percent (100%) of the grant payments received under this Program to the educational loans identified in the application and approved by the Department.

Section 6. Loan Repayment Grant Eligibility and Selection.

(a) Applicant Eligibility.

(i) Applicants must indicate full time employment or an offer for full time employment on their application.

(ii) Applicants must agree to treat Medicaid, Medicare or Kid Care eligible patients.

(iii) Applicants must be licensed or certified in Wyoming, or within one (1) year of licensure in their profession.

(iv) Applicants must be United States citizens or permanent residents.

(v) Applicants must disclose any other obligations to practice at a specific location and any other loan repayment arrangements in their application.

(A) An applicant with an obligation to practice professionally at a specific location is not eligible to receive a loan repayment grant under this Program until the existing obligations are fulfilled.

(B) Applicants required to practice in Wyoming, but not required

to practice at a specific location, may be eligible to receive a loan repayment grant under this Program. The Department will determine applicant eligibility upon review of the application and circumstances of the obligation.

(C) WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) Medical Education Program participants required to practice in Wyoming are eligible for a loan repayment grant under this Program.

(D) Any portion of the applicant's educational loans to be forgiven or repaid as a result of paragraphs (B) and (C), is not eligible for repayment under this Program.

(b) Applicant Selection.

(i) The Department shall prioritize selections on geographic need for healthcare professionals due to demand exceeding capacity.

(ii) The Department shall prioritize selections on need for a given profession. Healthcare professions enhancing access to primary care will be prioritized over other healthcare professions.

(iii) The Department may consider other information in the application to further prioritize selections as needed to best meet the needs of Wyoming.

Section 7. Loan Repayment Grant Breach, Repayment, and Penalties.

(a) A loan repayment grant recipient under this Program who fails to complete the service obligation or fails to comply with the requirements of W.S. §§ 9-2-118 or 119, these Rules, or the terms and conditions set forth in the contract shall repay:

(i) The total amount of the loan repayment grant monies received under this Program according to a schedule established by the Department and set forth in the contract; and

(ii) Costs and expenses incurred in collection, including attorney fees.

(iii) The amount to be paid back shall be determined from the end of the month in which the recipient breached the contract as if the recipient had breached at the end of the month.

(iv) Amounts recovered and damages collected under this section shall be deposited as dedicated credits to be used to carry out the provisions of this Program.

(b) The Department may cancel or release, in full or in part, a recipient from the requirements of W.S. §§ 9-2-118 or 119, these Rules, and the terms and conditions of the

contract without penalty:

(i) If the recipient is unable to fulfill the service obligation due to permanent disability or a chronic or life threatening illness that prevents the recipient from performing any work for remuneration or profit;

(ii) If the recipient dies;

(iii) A family member for whom the recipient is the principle caregiver has a chronic or life threatening illness; or

(iv) For other good cause shown, as determined by the Department.

(c) The Department may allow a loan repayment grant recipient to transfer to another practice location to fulfill the service obligation if the recipient is unable to fulfill the service obligation at the current practice location.

History

Effective 2016-04-14

Chapter 3 Designation of Critical Access Hospitals

Wyo. Code R. 048.0050.3.11042004 Designation of Critical Access Hospitals

CHAPTER 3

DESIGNATION OF CRITICAL ACCESS HOSPITALS

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Office of Rural Health at W.S. 9-2-117 et seq. and the Wyoming Administrative Procedures Act at W.S. 16-3-101 et seq.

Section 2. Purpose and Applicability.

(a) These rules have been adopted to provide the application process and criteria for a facility to become designated as Critical Access Hospital.

(c) 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 these rules and regulations.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

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 these rules, the following shall apply:

(a) "Certification" means a health care provider or supplier of services meets the federal conditions to participate in the Medicare and/or Medicaid programs.

(b) "Critical Access Hospital" means a facility certified by the United States Secretary of Health and Human Services as a critical access hospital under the Social Security Act Section 1820. 42 U.S.C. 1395i-4

(c) "Designation" means an official finding and recognition by the Director, Department of Health, that a facility meets Wyoming State Rural Health Care Plan criteria to be a Critical Access Hospital.

(d) "Governing Body" means the individual(s), group, or corporation that is legally responsible for the Critical Access Hospital.

(e) "Rural Health Care Plan" means the document used by the Department of Health as basis for improving primary health care services in rural Wyoming communities.

Section 5. Application Process.

(a) Applications for Critical Access Hospital designation can be obtained by contacting: Wyoming Department of Health, Office of Rural Health, 2300 Capitol Avenue, 4th Floor, Cheyenne, WY 82002, (307) 777-8651 Phone, (307) 777-8776 Fax.

(b) The Office of Rural Health will, within ten (10) working days from receipt of the application request, mail the application form plus other pertinent material to the applicant.

(c) The applicant will have up to sixty (60) days to complete and submit an application form to the Office of Rural Health. The applicant can request permission to extend the time period for completion of the application.

(d) The Office of Rural Health must declare an application complete or incomplete within ten (10) working days after receipt of the application. Once the application has been declared complete, the Office of Rural Health will have twenty (20) days to draft preliminary findings and recommendations for consideration by the Director, Department of Health.

(e) The Director, Department of Health will have twenty (20) days to review the findings and recommendations offered by the Office of Rural Health and provide written notice of designation or denial of designation to the applicant. The Director must designate the applicant as Critical Access Hospital before the applicant can petition for Medicare certification.

(f) Hearings

(i) To review a decision of the Department, a provider may request a hearing by submitting a written request within thirty (30) days of the date of receipt of the notice of adverse action to the Director, Department of Health.

(ii) Hearings requested under the terms of these rules shall be held in accordance with the provisions of the Wyoming Administrative Procedure Act.

Note: The above process outlines only minimum requirements for designating facilities as Critical Access Hospitals. It is recommended that each facility develop a clearly defined strategy which includes additional factors such as: Governing board education and involvement, financial feasibility study, health care facility and medical staff education, community education and awareness, and a study of potential networking relationships.

Section 6. Criteria.

(a) Critical Access Hospital Requirements.

(i) Each Critical Access Hospital shall comply with criteria set forth in Social Security Act Section 1820. 42 U.S.C. 1395i-4. This document is available at the website http://www.ssa.gov/OP_Home/ssact/title18/1820.htm.

(ii) Key Criteria for designation include:

(A) A facility shall be currently participating Medicare hospital, a hospital that ceased operation on or after November 29, 1989, or a health care clinic or health center that ceased operation as a hospital before being downsized to a health clinic or health center.

(B) A facility located more than 35-mile drive from any other hospital (or, in the case of mountainous terrain or in areas with only secondary roads available, a 15-mile drive) or Critical Access Hospital unless designated by the Department of Health, prior to January 1, 2006 to be a necessary provider.

(C) The facility makes available 24-hour emergency medical services that the State determines are necessary for ensuring access to emergency care services in each area served by a Critical Access Hospital (consistent with the Wyoming Trauma Plan).

(D) The facility provides not more than twenty five (25) acute care inpatient beds or in the case of a Critical Access Hospital with a swing bed agreement, swing beds.

(E) The facility provides inpatient care for a period that does not exceed, as determined on an annual, average basis, ninety-six (96) hours per patient, unless a longer period is required because:

(I) Transfer to a hospital is precluded because of inclement weather or other emergency conditions, or;

(II) A peer review organization or equivalent entity, upon request, waives the 96-hour restriction on a case-by-case basis;

(F) The facility meets such staffing requirements as would apply to a hospital located in a rural area, except that:

(I) The facility need not meet hospital standards relating to the number of hours during a day, or days during a week, in which it must be open and fully staffed, except as required to make available emergency medical care services as described above and must have nursing services available on a 24-hour basis, but need not otherwise staff the facility except when an inpatient is present;

(G) The facility may provide the services of a dietitian, pharmacist, laboratory technician, medical technologist, and/or radiological technologist on a part-time, off site basis; and

(H) The inpatient care described may be provided by a Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist subject to the oversight of a physician who need not be present in the facility.

(I) Documentation of agreements for the following services with one or more hospitals for;

(I) Patient referral and transfer;

(II) Development and use of communications systems including telemetry systems and systems for electronic sharing of patient data;

(III) Provision of emergency and non-emergency transportation; and

(IV) Documentation of agreement with respect to credentialing and quality assurance with one or more hospitals or a peer review organization or equivalent entity.

(b) Necessary Provider Requirements.

The following criteria will be used to certify a facility as being a necessary provider of health care services to residents in an area. The facility will be designated as a necessary provider of health care services if it meets two (2) of the following criteria:

(i) The facility is located in an area that meets the criteria for designation as a Health Professional Shortage Area (HPSA)as defined by 42 Code of Federal Regulations, Chapter 1, Part 5, or Medically Underserved Area (MUA) as defined by Public Law 99-280, Federal Register, October 15,1976, Pages 45718-45723.

(ii) The facility has been designated a Sole Community Provider as defined by the Department of Health's Rural Health Care Plan.

(iii) The facility was licensed by the State as a hospital and has been closed for no more than ten (10) years.

(iv) The board has determined that the ongoing operation of the facility is in danger of financial insolvency and has passed a board resolution allowing the facility to apply for Critical Access Hospital designation. This does not apply to closed facilities.

(v) The Director, Department of Health, must designate the facility as a Critical Access Hospital before state licensure or federal (Medicare) certification can be pursued.

Section 7. State Licensure. Rules and Regulations for the Licensure of Critical Access Hospitals can be obtained for a nominal fee by contacting: Wyoming Department of Health, Office of Health Facilities, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, (307) 777-7123 Phone, (307) 777-7127 Fax.

Section 8. Federal Certification. Federal (Medicare) certification standards for Critical Access Hospitals can be obtained for a nominal fee by contacting: Wyoming Department of Health, Office of Health Facilities, 2020 Carey Avenue, 8th Floor, Cheyenne, WY 82002, (307) 777-7123 Phone, (307) 777-7127 Fax.

History

Effective 2004-11-04

Chapter 5 Wyoming Provider Recruitment Grant Program

Wyo. Code R. 048.0050.5.04122016 Wyoming Provider Recruitment Grant Program

CHAPTER 5

Rules and Regulations for the Wyoming Provider Recruitment Grant Program

Section 1. Authority. These rules are promulgated by the Department of Health, Public Health Division, pursuant to W.S. § 35-1-1101, and the Wyoming Administrative Procedures Act at W.S § 16-3-101, et seq.

Section 2. Purpose and Applicability.

(a) These rules implement the Wyoming Provider Recruitment Grant Program which governs the award of grant funds to recruiting entities to recruit healthcare providers.

(b) The Department may issue manuals, bulletins or both to interpret the provision of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

Section 3. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

Section 4. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules.

(a) "Department" means the Wyoming Department of Health, Public Health Division.

(b) "Provider" means an individual who is licensed or eligible to be licensed in a healthcare profession under Wyoming Statutes, Title 33.

Section 5. Provider Recruitment Grant Program Administration.

(a) The Department shall develop an application form and solicit eligible applicants seeking to recruit eligible healthcare providers between July 1st and September 30th of each year in which funding is available. The application form will be made available online at http://www.health.wyo.gov/rfhd/rural/index.html.

(i) In the event funding remains in the Program budget or additional funding is appropriated to the Program, the Department may accept additional applications at other times.

(ii) The Department will accept applications for the recruitment of healthcare provider types the Department has determined to be of highest need pursuant to Section 8 of these rules and regulations.

(iii) The Department may identify a maximum amount in grant funding each applicant may apply for during each application period which aligns with the average reimbursement paid under all prior awards. The Department will indicate the identified maximum amount on the application form.

(iv) The Department shall verify the eligibility of each recruiting entity prior to making award determinations.

(b) The Department shall make award determinations and issue written notifications of award to selected recruiting entities within sixty (60) days after the close of an application period.

(c) The Department shall determine the total amount of the grant authorized for each approved application and shall finalize a written Contract Agreement between the Department and the recruiting entity which sets forth the terms and conditions for receiving grant monies under this Act. The Department shall consider the following in determining the authorized grant amount:

(i) The amount the recruiting entity specified on the application to the Program;

(ii) The appropriateness of the amount applied for in relation to the recruiting entity type and the provider type to be recruited; and

(iii) The average amount reimbursed under all prior awards.

(d) The Department may reimburse the recruiting entity for appropriate costs identified in the Contract Agreement, not to exceed the amounts identified by category in this Act.

(e) The Department may reimburse the recruiting entity for recruitment costs described below, not to exceed the Ten Thousand Dollars ($10,000) allowed by this Act. This applies only to providers targeted to fill positions specifically identified in the Contract Agreement. Covered costs include:

(i) Costs associated with hiring a professional recruitment company.

(ii) Interview costs to include hotel, meals, transportation and entertainment for providers and their immediate family to visit the location and interview at the recruiting entity's offices (maximum of two (2) visits per candidate).

(iii) Advertising expenses, including marketing and mailings.

(iv) Salaries of recruiting entity staff are not eligible.

(v) Travel expenses to attend professional conferences and expenses for exhibits and displays used at professional conferences are not eligible.

(f) The above amounts will be reimbursed after the recruited provider has relocated and has begun full-time practice in the approved geographic area of Wyoming and after all documentation required by the Contract Agreement is received and approved by the Department.

(i) To verify payment amounts, the Department shall demand appropriate documentation, including but not limited to receipts, vouchers, and premium documentation.

(ii) Grant monies not used will be retained by the Department for future use under this Act.

(g) The Department may request information from the recruiting entity to verify progress in the recruitment process.

(h) The Department shall notify recruiting entities, and recruited providers in a timely fashion, when appropriate, of any changes in the Contract Agreement, the Act, and/or these rules and regulations.

Section 6. Recruiting Entity Responsibilities.

(a) An eligible applicant shall complete and submit an application to the Department between July 1st and September 30th each year. In the event additional applications are accepted pursuant to Section 5(a)(i), eligible applicants shall complete and submit an application to the Department by the deadline identified in the Program application.

(b) Once the application is approved by the Department, the applicant becomes a recruiting entity. The recruiting entity shall enter into a Contract Agreement with the Department. The Contract Agreement will outline the grant amount the recruiting entity is eligible for and how those amounts are required to be used.

The recruiting entity must have a separate contract with the recruited provider.

(i) The recruiting entity must enter into a written and legally binding Offer of Recruitment or employment contract with the recruited provider. The recruiting entity must include terms in the Offer of Recruitment or employment contract to recoup any benefits paid to the recruited provider, using grant monies under this Act, in the event the recruited provider fails to meet the requirements of this Act, these rules and regulations, and/or the Contract Agreement.

(d) The recruiting entity must annually submit to the Department verification that the recruited provider treats Medicare, Medicaid and Kid Care insurance eligible patients, and that the provider works full-time in Wyoming in the approved geographic area for a period of two (2) years.

(i) Full-time is defined as working at least forty (40) hours per week. The Department, at its discretion, may consider less than forty (40) hours per week as full-time when the industry standard for full-time for the provider's profession is less than forty (40) hours per week.

(e) The recruiting entity must ensure the recruited provider does not already practice in Wyoming, including part-time. The only exceptions are providers completing residency training in Wyoming and military providers (not practicing in Wyoming other than to fulfill a military obligation) which may still be recruited under this Act.

(i) Within ten (10) business days of signing an Offer of Recruitment, the recruiting entity must submit a notarized affidavit from the recruited provider to the Department stating he does not already practice in Wyoming, including part-time, and has not done so for a period of at least twenty-four (24) months.

(ii) Payment will not be made to the recruiting entity until the affidavit and all documentation required by the Contract Agreement is received by the Department, and the recruited provider has relocated and begun full-time practice in the approved geographic area of Wyoming.

(f) The recruiting entity shall not require that the recruited provider sign any type of "non-compete agreement" which continues after termination of the recruited provider's employment or practice arrangement with the recruiting entity. This includes early termination by the recruited provider or the recruiting entity prior to the end of the stated term of the employment contract and/or Offer of Recruitment.

(g) If the recruiting entity is a hospital, the recruiting entity must ensure that the agreement between the hospital and a recruited physician meets the conditions set forth in 42 C.F.R. 411.357(e), as amended. This law provides the exceptions to referral prohibitions related to compensation arrangements, also known as the "Stark Amendment."

(h) The recruiting entity has one (1) year from the effective date of the Contract Agreement to recruit an eligible provider and must keep the Department's program coordinator updated on its progress.

(i) The recruiting entity shall require that the recruited provider begin full-time practice in the approved geographic area of Wyoming within six (6) months of signing an Offer of Recruitment.

Section 7. Eligibility Criteria for Provider Recruitment Grant Program Applicants.

(a) For-profit and non-profit hospitals, physicians, and healthcare clinics in Wyoming, and other appropriate Wyoming organizations (including county and city government agencies, non-profit organizations, and in-state provider recruitment agencies) are eligible to apply for grants under this Act.

(b) Providers may not recruit themselves, nor may they be recruited by their immediate family members.

A separate application is required for each provider to be recruited.

(d) The recruited provider cannot already practice in Wyoming, including part-time.

The only exceptions are providers completing residency training in Wyoming and military providers (not practicing in Wyoming other than to fulfill a military obligation) which may still be recruited under this Act.

(e) Providers relocating to Wyoming to become employed by the state or by the United States are not eligible.

(f) An organization recruiting a provider to treat that organization's employees, family members, or former employees is not eligible. An organization is eligible if the recruited provider's practice is "open to the public" and patient access is not in any way limited to a relationship with the organization.

Section 8. Selection Process.

(a) The Department will make selections based on:

(i) The Department's determination of priority of the various geographic areas of Wyoming;

(ii) The Department's determination of priority of the medical specialty need of the various geographic areas of Wyoming; and

(iii) Other relevant information submitted on the application.

(b) The Department shall give priority to recruitment of private practice providers.

(d) Applicants demonstrating the greatest need for providers, at the discretion of the Department, shall be given highest priority. The Department will not award grants to applicants not recruiting for geographic areas demonstrating substantial need for providers.

Section 9. Provider Recruitment Grant Termination Breach, Repayment and Penalties.

(a) The Department is contracting with the recruiting entity. If the recruited provider fails to meet the requirements of this Act, the recruiting entity must repay the entire amount of grant funds received under this Act to the state. The recruiting entity is not precluded from recovering these repayments from the recruited provider.

(b) If the recruiting entity is unable to recruit an eligible provider within one (1) year of the effective date of the Contract Agreement, the contract terminates without penalty. If the recruiting entity incurred eligible costs under Section 5 (e), but was unsuccessful in recruiting a provider, the recruiting entity may submit a request for reimbursement to the Department.

Payment of grant monies under Section 5 (e) without a successful recruitment will be at the discretion of the Department.

(c) If the recruited provider fails to relocate and begin full-time practice in the approved geographic area of Wyoming within six (6) months as required by Section 6 (i), the Contract Agreement terminates and the Department will not make any grant payments to the recruiting entity for eligible costs under Section 5 (d).

(d) Repayments include:

(i) The total amount of grant funds paid to the recruiting entity;

(ii) Interest at the rate of ten percent (10%) per annum; and

(iii) The amount to be repaid shall be determined from the end of the month in which the recruiting entity breached the Contract Agreement as if the recruiting entity had breached at the end of the month.

(e) Amounts recovered and damages collected under this section shall be deposited into the General Fund.

(f) The Department may cancel or release, in full or in part, a recruiting entity from the requirements of this Act without penalty upon submission of appropriate documentation of the following:

(i) The recruited provider becomes permanently disabled;

(ii) The recruited provider dies;

(iii) The recruited provider or a family member for whom the recruited provider is the principal caregiver has a chronic life threatening illness or a severe chronic medical circumstance that requires relocation or a significant reduction in practice hours.

(iv) For other good cause shown, as determined by the Department.

History

Effective 2016-04-12

Chapter 8 Wyoming Primary Care Support Grant Program

Wyo. Code R. 048.0050.8.12132012 Wyoming Primary Care Support Grant Program

History

Effective 2012-12-13

184 Senior Services Board, Wyoming

Chapter 1 Wyoming Senior Services Board

Wyo. Code R. 048.0060.1.06152017 § 1 Authority

These rules are promulgated by the Wyoming Senior Services Board, in consultation with the Aging Division, pursuant to Wyo. Stat. Ann § 9-2-1212 (a)(iv) and the Wyoming Administrative Procedures Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 2 Definitions

(a) "Board" or "WSSB" means the Wyoming Senior Services Board created by Wyo. Stat. Ann. § 9-2-1211.

(b) "Division" means the Aging Division within the Wyoming Department of Health designated pursuant to Wyo. Stat. Ann. § 9-2-1302(a)(iv).

(c) "Eligible Senior Center" means an organization that receives funds under the federal administration on aging Title III-B supportive services program or Title III-C nutrition program, excluding organizations that only receive Title III-B supportive services funds used exclusively for transportation. The term "eligible senior center" may include a community facility or statewide service, which is the focal point for providing a broad spectrum of services, including health, mental health, social, nutritional, recreational, and educational services for senior citizens.

(d) "Emergency" means a serious situation that happens unexpectedly and demands immediate attention.

(e) "Grants" means the basic, formula and emergency grants and may include others as approved by the Governor and/or legislators in the future.

(f) "Senior citizen" means any person sixty (60) years of age or older.

(g) "This act" means W.S. § 9-2-1201 through 9-2-1215.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 3 Duties and Responsibilities of the Board

(a) Review emergency grant proposals.

(b) Adopt the basic grant amount, grant formula, and approve criteria for emergency grant applications through rules and regulations promulgated by the Board to meet the public purposes identified in W.S. § 9-2-1212(a)(ii) to serve the senior citizens of Wyoming.

(d) The Board shall select one (1) of its voting members to serve as chairman, one (1) of its voting members to serve as vice chairman, and one (1) of its voting members to serve as secretary. The selection shall be made by a majority of voting members at the first full Board meeting of each odd numbered fiscal year.

(e) The Board shall meet not less than two (2) times each year. Members shall serve without compensation, but shall be reimbursed for expenses incurred in the performance of their official duties in the manner and amounts provided by law for state employees. Members who are government employees or public officials shall be considered on official business of their agency when performing duties as members of the board.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 4 Disbursement of Funds

(a) Funding will be dispersed per W.S. § 9-2-1214.

(b) The Board, in consultation with the Division, shall develop funding criteria, based on the purposes in W.S. § 9-2-1212, and provide information on the anticipated funding levels for each grant period.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 5 Public Notice to Accept Grant Applications/Contracts

(a) The Division, in consultation with the Board, will provide written notice regarding the acceptance by the Board of applications for the basic grant and the formula grant. Notice of the process for grant applications, as determined by the Board, will be distributed no later than March 31 for a grant period covering July 1 through June 30 of the following year. Information will be sent directly to eligible senior centers by the Division.

(b) Applications for emergency funds will be accepted on an as needed basis.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 6 Grant Applications

(a) Grant applications shall include, at a minimum:

(i) A cover page, in a format approved by the Board in consultation with the Division, with the original signature of the applicant organization's Board Chairman, or authorized official, and the original signature of the organization's Director.

(ii) Supporting budget pages and budget justification.

(iii) Funding request narrative in the format approved by the Board.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 7 Approval or Denial of Grant Applications

(a) Grant applications must be received in the office of the Division by the date set by the Board, in consultation with the Division.

(i) Grant applications postmarked after the specified date may not be accepted.

(b) Each application will be reviewed by the Board, in consultation with the Division, to determine if it is complete and accurate and that it serves the purposes W.S. § 9-2-1212 (a) (ii)(A)-(F).

(c) If approved, by a formal vote of the WSSB at an advertised public board meeting, the grant will be processed, and a Notice of Grant Award will be issued by the Division, along with a contract for the disbursement of funds.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 8 Carryover of Funding

. The Board, in consultation with the Division, will review the final reports from grantees within thirty (30) days of the end of the grant period. If a grantee has not spent all of its awarded funds by the end of the grant year, the Board may approve an extension of time in which to use those unspent funds, contingent upon the following:

(a) The grantee must submit to the Board, within thirty (30) days prior to the end of the grant period, a letter of explanation outlining:

(i) Why the grantee will be unable to spend the funds by June 30.

(ii) The date by which the carryover funds will be spent, not to exceed three (3) months after the end of the previous grant period.

(b) Any unspent funds must be returned to the Board by July 15 each year, unless an extension for carryover has been approved by the Board.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 9 Payment

. The Division, at the direction of the Board, will make payments to grantees, contingent on the following:

(a) The Board, in consultation with the Division staff, will review and analyze required quarterly program performance reports and fiscal reports.

(b) The Board reserves the authority to suspend or delay funding if terms and requirements of the contract are not being met.

(c) First quarter grant expenditure reports shall be approved by the Board prior to the further release of any WSSB funding.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 10 Budget Revisions

. Any modification to an approved budget that exceeds twenty-five percent (25%) of the original budgeted amount in any expense category must be approved, in advance, by the Board. A written letter of request and explanation must be submitted to the Chair of the Board, who will seek timely approval by the Board, and will notify the requesting entity of the Board's decision.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 11 Monitoring and Assessment

. The Board, in consultation with the Division, will review and analyze required grantee quarterly grant expenditure forms and end of year program performance reports. The Board may request other documentation from the grantee to ensure compliance with the terms of WSSB funding.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 12 Reporting

. The Board, in consultation with the Division, will review and evaluate program and fiscal reports:

(a) Signed, original quarterly fiscal reports must be submitted to the grantee's WSSB Board representative by the fifteenth (15th) day of the month following the end of each quarter.

(b) Signed, original year-end performance reports must be submitted to the grantee's WSSB Board representative by the fifteenth (15th) day following the end of the fiscal year.

(c) Quarterly grant expenditure and year-end performance reports shall be approved by formal WSSB action at an advertised public WSSB meeting.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 13 Compliance

. If grantee contract violations are found, the Board, in consultation with the Division, may:

(a) Work with the grantee to determine the corrective steps and/or plan of action to be taken by the grantee.

(b) Develop a written plan of action and/or corrective steps to be completed by a mutually agreed upon date.

(c) Re-assess or re-evaluate the grantee at the end of each quarter until full compliance with all grant requirements is achieved.

History

Effective 2017-06-15

Wyo. Code R. 048.0060.1.06152017 § 14 Severability

. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2017-06-15

175 Sexually Transmitted Diseases

Chapter 1 General Provisions

Wyo. Code R. 048.0051.1.10222001 General Provisions

CHAPTER 1

General Provisions

Section 1. Statutory Authority. Pursuant to W.S. 35-4-107, W.S. 35-4-108, and W.S. 35-4-130 the Wyoming Department of Health is authorized to make rules and regulations pertaining to a list of reportable communicable diseases. The Wyoming Department of Health is generally authorized pursuant to W.S. 35-1-229 to adopt rules as necessary to enforce.

Section 2. Definitions. These rules and regulations shall use the following terms as defined within this section:

(a) "Acquired Immune Deficiency Syndrome" (AIDS) is the end result of Human Immunodefi- ciency Virus (HIV) infection supported by documented opportunistic infections, malignancies, or selected sys- temic diseases in association with HIV seropositivity.

(b) "Appropriate and Adequate Treatment" is the application and use of current minimum public health/medical standards regarding the treatment type and schedule for specific sexually transmitted diseases (STD).

(d) "Battery" is the intentional touching of another person without justification and/or without consent.

(e) "Body Fluid" includes any fluids that have been identified by the Center for Disease Control as potentially infectious and capable of facilitating the transmission of sexually transmitted disease including HIV/ AIDS.

(f) "Care and Treatment" is a schedule of care advised, offered and/or provided to a patient based on the current recommended minimum medical standard of care for sexually transmitted diseases.

(i) The definition for Care and Treatment is not intended to be construed as making the Wyoming Department of Health, Disease Prevention Program(s), responsible for providing medical services for STD patient care.

(g) "Communicable" is the known or suspected transmissibility of an infection.

(h) "Community Correctional Facilities" means a community based facility or program as autho- rized by the Adult Community Corrections Act W.S. 7-18-101 et seq.

(i) "Confidential" means the restriction of information and records relating to a known or sus- pected case of sexually transmitted disease which has been reported, acquired and maintained under W.S. 35-4- 130 through 35-4-134, unless otherwise required by law and except pursuant to W.S. 35-4-132(d)(i) through

(iv)

(j) "Contagious" is the transmission of a disease by direct or indirect contact.

(k) "Convicted" as used in these rules includes: pleas of guilty, nolo contendere and verdicts of guilty upon which a judgment of conviction may be rendered, and includes juvenile adjudications of delin- quency if the adjudication is based upon an act which would constitute a sex offense. "Convicted" shall also include dispositions pursuant to W.S. 7-13-301.

(l) "Dangerous" means hazardous, unsafe or perilous to private or public health.

(m) "Designee" is an individual appointed by the Health Officer and conducting official business for and on behalf of the Wyoming Department of Health, a county, city or district health office.

(n) "Dispensary" is any facility other than a hospital, that provides health care services, including the diagnosis and/or treatment of patients under the care of a licensed physician, with a capacity to conduct patient health care needs of relatively short duration.

(o) "Emergency Medical Services Provider" means an emergency medical technician, paramedic, physician, nurse or other health care worker providing direct patient care services, whose medical care of an infected individual resulted in a significant exposure.

(p) "Examined for Sexually Transmitted Disease" refers to the medical, clinical, laboratory or historical evaluation of a person's health status regarding suspected and/or known sexually transmitted disease.

(q) "Health Care Employee" is a general term used to identify a person (employee) of a health care facility involved in the supervision, care and treatment of patients commensurate with the employee's qualifica- tions and training.

(r) "Health Care Facility" is a public or private hospital, dispensary, or other facility or institution offering and/or providing medical services.

(s) "Health Care Professional" shall include licensed physicians, nurses, physician's assistants, nurse practitioners, dentists, dental hygienists, dental assistants.

(t) "Health Care Provider" is a general term used to identify a health care facility and/or medical professional (e.g., physician, nurse, physician's assistant) providing, directing, supervising or recommending a schedule of medical services to or on behalf of a person.

(u) "Health Care Worker" includes all personnel involved in the care of a patient including first responders, such as law enforcement, rescue personnel and those persons acting as good samaritans.

(v) "Health Officer" is the physician or qualified designee selected by the appointing authority for specific jurisdiction: state, county, and/or city.

(w) "HIV Infection/AIDS" is a sexually transmitted disease but may also be transmitted to another

person via an exchange of or contact with contaminated body fluids, e. g., sharing of contaminated needle as used for intravenous injection.

(x) "Hospital" is a facility with an organized medical staff with a capacity to conduct patient health care needs on a continuous and/or extended basis.

(y) "Infectious" is the capacity to rapidly spread infection to other persons.

(z) "Isolate" is the restriction of one's freedom necessary to ensure individual and/or public health and welfare.

(i) A person may be advised by the Health Officer and/or authorized Designee to voluntar- ily restrict his or her freedom of movement so as to limit contact with other persons.

(ii) Action may be taken by the Health Officer and/or authorized Designee for the protec- tion of public health and welfare to legally and formally restrict a person's freedom of movement or perfor- mance of an activity.

(aa) "Laboratory" is a facility involved in the collecting, processing, analyzing, storing or passing of patient specimens to reference laboratory facilities for the purpose of identifying infectious, microbiological, serological, chemical, hematological, biophysical, cytological or pathological specimens from the human body.

(bb) "Life Threatening" means the potential for loss of life due to the known or suspected presence of medical condition(s) that may result in or lead to imminent death.

(cc) "Penal Institution" is any public or private facility authorized by law to incarcerate individuals as ordered by the court.

(dd) "Positive Test Result" is a test that concludes a person is infected with a sexually transmitted disease.

(i) Positive STD test results may include but not be limited to the following test methods: [A] Culture [B] Serology [C] Direct Slide [D] EIA (Enzyme Immunoassay) [E] DNA Probe (Deoxyribonucleic Acid) [F] Other FDA technology

(ee) "Prisoner" is a person confined or imprisoned in any state penal institution, county or city jail or any community correctional facility.

(ff) "Public Safety Worker" means law enforcement personnel, correctional facility personnel or firefighter.

(gg) "Rescue Personnel" includes law enforcement officers, firemen, emergency medical techni- cians, paramedics, physicians, nurses, and those individuals acting as good samaritans.

(hh) "Sex Offense" means sexual assault under W.S. 6-2-302 through 6-2-305, attempted sexual assault, conspiracy to commit sexual assault, incest under W.S. 6-4-402 or indecent liberties under W.S. 14-3- 105.

(ii) "Sexually Transmitted Disease" includes AIDS, HIV infection, Syphilis, Gonorrhea, and Chlamy- dia.

(jj) "Significant Exposure" includes:

(i) Contact of a health care provider's broken skin or mucous membrane with known or suspected to be infected body fluids other than tears, perspiration or saliva.

(ii) A needle stick, scalpel or other instrument wound occurring during the process of car- ing for an infected individual.

(iii) Sexual contact - known as a fact or epidemiologically suspected.

(iv) Sharing of potentially contaminated needles as practiced by IV drug users.

(v) Exposure that occurs during the course of examination or treatment by dental care providers.

(vi) Any physical act that results in the exchange of bodily fluids, see Section 2 (e).

(kk) "Treatment" is the actual passing or prescribing of medications or a schedule of health care procedures established by current medical standards to effect a cure for a disease or in the case of incurable sexually transmitted disease, enhance and/or sustain the patient's life expectancy.

(ll) "Venereal Disease" is known as VD, a term used to refer to a sexually transmitted disease; pertains to a specific group of diseases that may be transmitted from one person to another during intimate sexual activity.

Section 3. Confidentiality of Information.

(a) All records pertaining to sexually transmitted diseases are confidential and except as otherwise required by law shall not be disclosed unless the disclosure:

(i) Is for statistical purposes and the information is released in a manner that does not reveal personal identifiers; or

(ii) Is necessary for the exclusive administration and enforcement of these rules and regu- lations and/or Wyoming State Statutes; or

(iii) Is preceded by the written consent of the infected individual specifying where the infor- mation shall be sent; or

(iv) Is for notification of health care employees as necessary to protect life and health.

(v) Is pursuant to a civil action for negligent or intentional infection of or exposure to a sexually transmitted disease.

(vi) Is pursuant to a criminal prosecution for the criminal infection of or exposure to a sexually transmitted disease.

(b) The Health Officer and/or qualified Designee shall have access to medical records and other information pertaining to individuals covered by W.S. 35-4-107.

Section 4. Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

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History

Effective 2001-10-22

Chapter 2 Reporting Procedures

Wyo. Code R. 048.0051.2.10222001 Reporting Procedures

CHAPTER 2

Reporting Procedures

Section 1. Disease List. W.S. 35-4-130 declares Sexually Transmitted Diseases to be contagious, infectious, communicable and dangerous to public health. A current listing of time based reportable diseases may be obtained from the office of the State Health Officer, State Epidemiologist, state Sexually Transmitted Diseases Program or State HIV/AIDS Prevention Program. Reportable Sexually Transmitted Diseases include the following (a through e):

(a) AIDS - Acquired Immune Deficiency Syndrome

(b) Chlamydia - Chlamydia trachomatis

(d) HIV Infection - Human Immune Deficiency Virus

(e) Syphilis - Treponema pallidum

Section 2. Reporting Required.

(a) The following is a list of individuals and facilities which have an independent duty to report the occurrence of sexually transmitted disease:

(i) A physician or other health care provider diagnosing or treating a case of sexually transmitted disease;

(ii) The administrator of a health care facility or penal institution in which there is a case of sexually transmitted disease;

(iii) The administrator or operator of a laboratory performing a positive test for sexually transmitted disease.

Section 3. Reporting Procedure

(a) The physician must report or cause a report to be made using an official State Disease Case Report, a report via telephone, or a report via secured fax.

(b) The administrator of a health care facility or penal institution must report or cause a report to be made of the diagnosis or treatment of a sexually transmitted disease..

(c) The administrator or operator of a laboratory must report or cause a report to be made of test findings for reportable sexually transmitted diseases.

(d) Any physician or other health care provider and any administrator or operator of a health care facility or laboratory or penal institution reporting a diagnosis or positive test result pursuant to W.S. 35-4-130 through 35-4-134 shall notify any health care employee and/or health care professional reasonably expected to be at risk of exposure to a dangerous or life-threatening sexually transmitted disease, e. g., HIV/AIDS, who is involved in the supervision, care, and treatment of an individual infected or reasonably suspected of being infected with a dangerous life-threatening sexually transmitted disease.

(i) Notification shall be verbal.

(ii) Notification shall take place within 24 hours or as soon as possible.

Section 4. Submission of Reports. All sexually transmitted diseases and HIV/AIDS reports made by the physician or other health care provider, administrator of a hospital, director or supervisor of a laboratory facility, dispensary or penal institution, or any other health care facility shall be forwarded to:

Wyoming Department of Health

Preventive Health and Safety Division

Epidemiology Section

Hathaway Building, 4th Floor

Cheyenne, Wyoming 82002

Fax: (307) 777-5573

Phone: (307) 777-3593

All written reports mailed utilizing a mail carrier shall be in an envelope marked "CONFIDENTIAL".

Section 5. Report Forms. Reporting forms may be obtained from the Wyoming Department of Health, Epidemiology Section.

History

Effective 2001-10-22

Chapter 3 Public Health Responsibilities

Wyo. Code R. 048.0051.3.10222001 Public Health Responsibilities

CHAPTER 3

Public Health Responsibilities

Section 1. Public Health Action. Upon receipt of a report or notice of a case of sexually transmitted disease within a respective jurisdiction, a Health Officer or Designee may take any or all of the following actions:

(a) If examination has not been performed, may provide for the examination of the infected individual(s) or the individual(s) reasonably suspected of suffering from a sexually transmitted disease and shall report the examination results to the individual(s);

(b) May require the infected individual(s) to seek adequate medical assistance for treatment of said infection either privately or if necessary at public expense;

(c) To the extent possible, provide for and/or arrange for the education and counseling of the in- fected individual(s) and/or their partner(s) as to the medical significance of the sexually transmitted disease;

(d) To the extent possible, identify, locate and refer the individual(s) with whom the infected individual(s) may have had contact for medical evaluation and treatment if necessary;

(e) Shall follow procedures (a) through (d) (Chapter III, Section 1) above with any identified partner(s);

(f) May isolate the individual(s) when that person(s) fails to comply with medical recommenda- tions pertaining to an infection with or exposure to a dangerous or life-threatening sexually transmitted disease.

Section 2. Public Health Notification.

(a) To the extent possible, the Health Officer or Designee shall make every reasonable effort to locate and notify any person identified as having been exposed to a sexually transmitted disease within the prescribed public health standard for critical dates of exposure.

(b) Notification may include:

(i) The name of the sexually transmitted disease to which the individual may have been exposed;

(ii) The approximate date of exposure;

(iii) The nature of the disease (method of transmission, effects of the disease, etc.);

(iv) The available sources for education and counseling as to the medical significance of the disease;

(v) A recommendation to the individual about seeking medical assistance to determine if he or she is infected and obtaining treatment for known or suspected infection necessary.

(c) The notice shall not provide any information that may be construed to identify the specific identity of the originally infected individual, unless the Health Officer or Designee has received written autho- rization for the release of information from the originally infected individual.

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History

Effective 2001-10-22

Wyo. Code R. 048.0051.4.10222001 Consent to Treatment

CHAPTER 4

Consent to Treatment

Section 1. Persons Under Eighteen. Persons under eighteen years of age may give legal con- sent for examination and treatment for any sexually transmitted disease.

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History

Effective 2001-10-22

Chapter 5 Confined Population

Wyo. Code R. 048.0051.5.10222001 Confined Population

CHAPTER 5

Confined Population

Section 1. Examination Period. Any person confined in a state penal institution or a county jail or a community correctional facility for fifteen (15) days or more should be examined by the appropriate Health Officer or qualified Designee.

Section 2. Health Officer or Designee Action. The Health Officer shall take any or all of the following steps:

(a) Determine from the prisoner's record and/or personal interview whether the individual is at risk for a sexually transmitted disease.

(b) May isolate prisoner(s) with treatable sexually transmitted diseases within the facility to pre- vent the spread of infection.

(c) Provide prisoner(s) infected with a curable sexually transmitted disease(s) with the minimum medical care and treatment to affect a cure.

(d) In the case of individuals(s) infected with an incurable sexually transmitted disease, provide for the minimum care and treatment of the individual(s).

Section 3. Care and Treatment. Minimum care and treatment for incurable sexually transmitted dis- eases requires that a prisoner shall be afforded equal provision of services available to any other member of the confined population.

(a) The facility shall furnish or arrange for the provision of minimum medical care and/or medica- tion pursuant to current medical practice in response to the specific disease.

Section 4. Interference with Judiciary Action. These Rules and Regulations shall not be construed to interfere with the service of any sentence or other judicial action.

History

Effective 2001-10-22

Chapter 6 Mandatory Testing

Wyo. Code R. 048.0051.6.10222001 Mandatory Testing

CHAPTER 6

Mandatory Testing

Section 1. Consent of Accused to Examination. Upon the consent of a person accused of any crime involving the alleged exchange of bodily fluids, the accused person shall be examined, as soon as practical, for sexually transmitted diseases included within the list of reportable diseases.

Section 2. Warrant for Examination. Persons accused of any crime wherein it is alleged that there has been an exchange of bodily fluids who are unwilling or unable to give consent or from whom it is impractical to seek consent for examination, the court may issue a warrant upon a sufficient showing of probable cause by affidavit, at any time of day or night, and thus order the medical examination of the accused person for sexually transmitted diseases included within the list of reportable diseases.

Section 3. Person Convicted. Any person convicted of a sex offense shall, at the request of the victim, be examined as soon as practicable after the conviction for reportable sexually transmitted diseases.

(a) The victim shall make the request to the District Attorney responsible for prosecuting the of- fense.

(b) If the offender is unwilling or unable to consent to the examination, the District Attorney shall petition the court for an order requiring the offender to submit to the examination.

Section 4. Conduct of Examination. Any examination performed under this Chapter shall be performed by a licensed physician or health care provider and shall include:

(a) Collection of an appropriate laboratory specimen for sexually transmitted diseases for submis- sion to:

(i) The State Public Health Laboratory or

(ii) An approved private laboratory if such tests are unavailable at the State Public Health Laboratory.

(b) Medical examination to evaluate the symptomatic presence of sexually transmitted disease(s).

(c) Social and medical historical information that may disclose suspected or known events or cir- cumstances that support the possibility of infection and/or exposure to infection.

Section 5. Results Laboratory-Medical Examination.

(a) Examination results shall be reported to the appropriate Health Officer and/or Designee.

(b) Upon receipt of the examination results, the Health Officer or Designee shall notify the victim, alleged victim, or if a minor, the parents or guardian of the victim or the alleged victim.

(c) Costs of any medical examination undertaken pursuant to this section shall be funded through the Wyoming Department of Health. Any claim for reimbursement for physician and/or laboratory costs for examination of patient and/or patient specimen for confirmation of sexually transmitted infection(s) must be adequately confirmed by the provision of a copy of the court order provided to the Wyoming Department of Health at the time the reimbursement is made in writing. The claim shall include patient identification, age, marital status, gender and risk factor for exposure to infection.

Claim for reimbursement shall include:

Nature of medical examination-clinical procedure(s).

Summary of clinical findings and clinical diagnosis.

Laboratory test procedure used to determine suspect or known infection.

Laboratory test findings and reference laboratory.

2. Claim(s) for reimbursement shall be submitted in writing, if by mail it shall be marked "CONFIDENTIAL" and mailed to:

Wyoming Department of Health

Chief, Acute Illness and Injury Section

Hathaway Building, Room 520

Cheyenne, WY 82002

(d) If the court finds that the offender is able to reimburse the Wyoming Department of Health, the offender shall reimburse the Wyoming Department of Health for costs of any medical examination under this section.

Reimbursement shall be forwarded to:

Wyoming Department of Health

Chief, Acute Illness and Injury Section

Hathaway Building, Room 520

Cheyenne, WY 82002

(e) All results which are or can be derived from the examination ordered pursuant to this section are confidential, not admissible as evidence and shall not be disclosed except:

(i) as provided by this section;

(ii) as provided by W.S. 35-4-132(d);

(iii) in a civil action for the negligent or intentional infliction of or exposure to a sexually transmitted disease;

(iv) in a criminal prosecution for the criminal infliction of or exposure to a sexually trans- mitted disease; or

(v) as otherwise provided by law.

Section 6. Medical Examination (W.S. 7-1-109).

(a) Whenever possible, the medical examination of the accused shall be performed at a public health facility by a public health physician or qualified Designee.

(b) Whenever possible, the laboratory specimen collected shall be submitted to the State Public Health Laboratory for analysis.

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History

Effective 2001-10-22

Chapter 7 Authority for Testing Following Exposure

Wyo. Code R. 048.0051.7.10222001 Authority for Testing Following Exposure

CHAPTER 7

Authority for Testing Following Exposure

Section 1. Significant Exposure to Blood or Body Fluids. Following a documented exposure of a health care worker to blood or bodily fluids of a patient that could lead to infection of a communi- cable disease which is capable of transmission by blood or other body fluids, a health care provider, worker or professional, acting within his scope of practice, may order an appropriate test to be per- formed on a specimen from the patient by a duly licensed and accredited laboratory.

Section 2. Unavailability of Specimen. If a patient specimen is not available for testing, a health care provider, worker or professional, acting within the scope of his practice, or the Health Officer may, with the patient's consent, order the necessary testing.

Section 3. Court Ordered Testing. If the patient does not consent to testing, the Health Officer or the authority responsible for the care of the patient may apply to the district court for an order to have the necessary testing performed.

Section 4. Confidentiality of Results. Test results will be kept confidential and shall be re- ported by the health care provider, worker or professional, in accordance with W.S. 35-4-130 through 35-4-134.

Section 5. Official Reports. Laboratory and physician disease reports to the Wyoming Depart- ment of Health shall be made on an official state disease report form or the report may be made by telephone or secured fax with confirmation by written form.

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History

Effective 2001-10-22

176 Small Water Supply

Chapter 0 Appendix A

Wyo. Code R. 048.0052.0.11221995 Appendix A

APPENDIX A

Minimum water quality standards

Used for the conveyance of private rural property connected to a private supply

| Analyte | MCL* MCL/SMCL** | Limit | Det. | Units | | | --- | --- | --- | --- | --- | --- | | Calcium | | | 1 | mg/L | | | Magnesium | | | 1 | mg/L | | | Sodium | | | 3 | mg/L | | | | | | | | | | Hardness as CaCO3 | | | | mg/L | | | Total Alkalinity as CaCO3 | | | | mg/L | | | Chloride | (250) | 250 | | | | | | | | | | | | Sulfates | 750 | deferred | 3 | mg/L | | | Nitrates + Nitrites as N | 10 | 10 | 0.05 | mg/L | | | Fluoride | (2) | 2 | | mg/L | | | | | | | | | | Conductivity | | | | | | | pH | (6.5-8.5) | | | | | | Total Dissolved Solids, Summation | 1500 | 6.5-8.5 | | pH Units | | | Iron | (0.3) | 500 | | mg/L | | | Manganese | (0.05) | | | | | | | | | | | | | Lead, First draw | (0.015) | TT/0.015 | 0.002 | mg/L | | | Copper, First draw | (1.3) | TT/1.3 | 0.1 | mg/L | | | Lead, Second draw | (0.015) | TT/0.015 | 0.002 | mg/L | | | Copper, Second draw | (1.3) | TT/1.3 | 0.l | mg/L | | | | | | | | | | Zinc | (5) | 5 | | mg/L | | | Corrosivity | (Non-Cor) | Non-Cor | | LI Units | | | Total Coliform | Negative | Negative | | /100ml | |

Total Coliform Negative Negative /100ml

1. Analytes in BOLD shaded ares represent the minimum requirement for private water supplies serving a single residence.

2. Analytes in parentheses are recommended, in addition to those in #1, for private water supplies connected to a single residence but required for private supplies serving multiple residences below those regulated under the Safe Drinking Water Act.

3. If first draw lead and/or copper data exceeds recommendations, the data should ONLY be used to warn buyers or renters and make suggestions to minimize exposure.

*MCL - Maximum Contaminant Level

**SMCL - Secondary Maximum Contaminant Level

History

Effective 1995-11-22

Chapter 1 Purpose and Background

Wyo. Code R. 048.0052.1.11221995 Purpose and Background

CHAPTER 1

PURPOSE AND BACKGROUND

Section 1. Purpose. The purpose of these standards is not to substitute for the Safe Drinking Water Act or its associated regulations, nor to guarantee absolute safety of a private water supply, but to establish minimum water quality criteria to be used in the conveyance of private property which derives domestic water from a non-public or "small" water supply. With these standards as guidance, conveyees of such property should have assurance that the water supply is potable at the time of conveyance or take measures to assure treatment of the water to make it potable prior to or concurrent with transfer of the property.

Section 2. Authority. The specific statutory authority is W.S. 35-1-229(b).

Section 3. Definition. A small water supply is defined as any water supply with not more than nine (9) service connections which are, or may be, used for human consumption.

History

Effective 1995-11-22

Chapter 2 Tests and Standards

Wyo. Code R. 048.0052.2.11221995 Tests and Standards

CHAPTER 2

TESTS AND STANDARDS

Section 1. Minimum Testing Requirements.

(a) For purposes of meeting the requirements of W.S. 35-1-229(b), the following tests shall be conducted. The listed analytic levels are the standards for the water source to be suitable for human consumption:

Test Standard Total coliform negative/100 milliliters Total dissolved solids: <=1500 mg/L Sulfates: <=750 mg/L Nitrate + Nitrite as N: <=10 mg/L

(b) Tests should be conducted within 90 days prior to conveyance of the property. Tap water samples should be collected by a public authority (sanitarian or other county or state health department official). In case arrangements cannot be made with a public official, then the conveyee may collect, or arrange for collection of the sample by a documented third party. When the sample is not collected by a public authority, appropriate containers and instructions for collection should be obtained from the laboratory performing the test. Under no circumstances may the conveyor or their representatives collect the water sample.

(c) Tests must be conducted by a laboratory certified by EPA for the analytes included in these rules and the cost of such tests is to be borne by the parties as stated in the legislation. The four tests listed above are the minimum requirement for transfer of property covered by the legislation.

Copies of the analysis report shall be mailed to the conveyee and his/her agent, the conveyor and his/her agent, the lender, if there is one involved in the conveyance, and the State Health Department Epidemi- ologist. Lists of EPA approved laboratories may be obtained from the Department of Environmental Quality, Agriculture Department Extension Offices, the State Public Health Laboratory, and County Public Health Offices. Imposition of the requirement for EPA certification will become effective 1 July 1997.

(d) In addition, consideration must be given for the following as either party in the transac- tion may deem appropriate:

(1) For new construction serving a single residence: Calcium Magnesium Sodium pH Specific conductance Hardness Total alkalinity Chloride Sodium absorption ratio

(2) After 6 months of occupancy in the new residence: Iron Zinc Lead* Fluoride Manganese Copper Corrosivity *First and second draw samples used to evaluate contributions from the plumbing, pump, and/or source water. Acceptable limits for these analytes may be found in Appendix A of this document.

(e) For private water supplies serving 2-9 residences, the entire list of major cations, anions and metals (underlined above) shall be tested from the source water. The total coliform shall be tested from the property being conveyed. Every connected property must receive a copy of the analysis from the testing laboratory. These standards will apply to new wells or other private water source(s). The complete list of tests would only be required once for a given water source, but the short list (four tests) is required each time a connected property changes ownership. The short list of tests does not need to be given to the other owners of property on the same system.

History

Effective 1995-11-22

177 State Hospital

Chapter 6 Designated Hospitals

Wyo. Code R. 048.0053.6.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to the Involuntary Commitment Act ("the Act"), at Wyo. Stat. Ann. §§ 25-10-101 through -305, and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish definitions applicable to Chapter 7, Standards for the Designation of Hospitals pursuant to Wyo. Stat. Ann. § 25-10-104 and Chapter 8, Standards for the Reimbursement of Designated Hospitals or Other Treatment Providers pursuant to Wyo. Stat. Ann. § 25-10-112.

(b) The Department may issue manuals or bulletins to interpret the provisions of these rules, which reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 3 General Provisions

(a) Terminology. Except as otherwise specified, the terminology used in these rules is the standard terminology used in the industry, and has the standard meaning used in accounting, healthcare, Medicaid and Medicare.

(b) 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 these rules and regulations.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 4 Definitions

The following definitions shall apply in the interpretation and enforcement of Chapters 6, 7, and 8 of these rules:

(a) "CARF Accreditation" means accreditation according to the Commission on Accreditation of Rehabilitation Facilities.

(b) "Centers for Medicare and Medicaid (CMS) Certification" means the state survey agency has determined that a healthcare entity has been determined to meet the Social Security Act's provider or supplier definitions, and is in compliance with standards required by Federal regulations.

(c) "Claims" means the process of billing the allowable cost of services under the Act to the Department or responsible county pursuant to Wyo. Stat. Ann. § 25-10-112.

(d) "CMS 1500" means the billing claim form for healthcare services approved by the Centers for Medicaid and Medicare Services, which is used by physicians (formerly the HCFA 1500).

(e) "Department" means the Wyoming Department of Health.

(f) "Designated Hospital" means a general hospital or psychiatric treatment hospital or unit that provides care to an individual detained under Wyo. Stat. Ann. §§ 25-10-109 through -110.1, which is under an agreement with the Department and bills the Department or the responsible county for the costs of care under the Act.

(g) "Directed Outpatient Commitment" means as defined at Wyo. Stat. Ann. § 25-10-110.1.

(h) "Emergency Detention" means the detention of a person pursuant to Wyo. Stat. Ann. § 25-10-109.

(i) "Inpatient psychiatric treatment" means the medical diagnosis, treatment and care of persons with mental illness requiring hospitalization which is provided under the direction of a licensed, board certified psychiatrist, directed at reducing the risk, symptoms and impact of the psychiatric disorder.

(j) "Involuntary hospitalization" means the hospitalization of a person against his will under Wyo. Stat. Ann. § 25-10-110, at the Wyoming State Hospital or at a designated hospital or treatment provider under agreement with the Department to provide inpatient psychiatric treatment.

(k) "JCAHO" means the Joint Commission for the Accreditation of Healthcare Organizations.

(l) "Medicaid" means medical assistance and services provided pursuant to Title XIX of the Social Security Act or the Wyoming Medical Assistance and Services Act, at Wyo. Stat. Ann. §§ 42-4-101, et seq.

(m) "Medically necessary" means items and services which may be justified as reasonable, necessary, or appropriate, based on evidence-based clinical standards of care, as measured by the Level of Care Utilization System (LOCUS) tool.

(n) "Medical Records" means all documents in the possession of or subject to the control of the designated hospital, which describe the patient's psychiatric assessments, diagnosis, condition or treatment.

(o) "Treatment Provider" or "treatment center" means a community mental health center under contract or agreement with the Department to provide outpatient or residential treatment to persons with mental illness or substance use disorders.

(p) "Universal billing claim form" means the national standardized form used by hospitals and other healthcare facilities or treatment providers which summarizes the allowable costs for services provided by the hospital or other treatment provider.

(q) "Utilization Review" means the process of comparing requests for medical services to guidelines deemed appropriate for such services.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 5 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 6 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.6.04042017 § 7 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 7 Standards for the Designation of Hospitals and Treatment Providers

Wyo. Code R. 048.0053.7.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to the Involuntary Commitment Act, ("the Act") at Wyo. Stat. Ann. §§ 25-10-101 through -305, and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish standards for the designation of hospitals and to define the conditions under which the Department may enter into a contract or agreement with a designated hospital or treatment provider for the inpatient psychiatric treatment or community-based treatment of persons with mental illness pursuant to Wyo. Stat. Ann. § 25-10-104.

(b) The Department may issue manuals or bulletins to interpret the provisions of these rules which reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 3 Designated Hospital Requirements and Treatment Provider Requirements

(a) Designated hospitals or treatment providers shall have a safe and secure location to hold an individual who is emergently detained under Wyo. Stat. Ann. § 25-10-109 in a suitable setting pursuant to the Act and based on the patient's condition.

(b) Designated hospitals or treatment providers shall provide treatment services with the patient's consent or allow access to the patient by treatment provider staff or the patient's private mental health provider for purposes of providing treatment with the patient's consent. Treatment services may be provided without patient consent or the consent of his parent or guardian when treatment is limited to diagnosis or evaluation or when treatment is necessary to prevent immediate and serious physical harm to the person or others pursuant to Wyo. Stat. Ann. § 25-10-109(f).

(c) Designated hospital staff or treatment provider staff shall have access to ongoing psychiatric consultation services provided by the Wyoming State Hospital for purposes of prescribing and monitoring psychotropic medications.

(d) Designated hospital staff or treatment provider staff may also consult with the Wyoming State Hospital staff in advance of the following anticipated extended hospital stays:

(i) An anticipated extension of an emergency detention beyond 72 hours;

(ii) An anticipated extended detention beyond 14 days;

(iii) An anticipation of an Involuntary Hospitalization order.

(e) If the patient's symptoms resolve so that emergency detention or involuntary hospitalization are no longer required prior to the patient's transfer to the Wyoming State Hospital, the designated hospital or treatment provider shall file the appropriate documentation evidencing the reason for the patient's release as required by Wyo. Stat. Ann. § 25-10-116(b). If a hearing is requested, the designated hospital or treatment provider must appear to explain and support its decision that the patient no longer meets the criteria for emergency detention or involuntary hospitalization.

(f) If conditions justifying hospitalization continue to exist, the designated hospital or treatment provider shall send the court notice of the determination for continued hospitalization, including a detailed statement of the factual basis for the determination. Notice of the determination shall also be sent to the patient and the person responsible for the patient's care and custody. As required by Wyo. Stat. Ann. § 25-10-116(c) the notice shall include:

(i) The patient's right to contest the determination;

(ii) The patient's right to a hearing; and

(iii) The patient's right to counsel.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 4 Contracts or Agreements with Designated Hospitals

(a) Pursuant to Wyo. Stat. Ann. § 25-10-104, the Department may enter into a contract or agreement with a designated hospital for the provision of inpatient psychiatric treatment if the designated hospital meets one of the following qualifications:

(i) A hospital which meets the "special provisions applying to psychiatric hospitals," pursuant to 42 C.F.R. § 482.60;

(ii) A general hospital with a specific inpatient psychiatric unit;

(iii) A hospital without a specific inpatient psychiatric unit with psychiatric services available, to include a psychiatrist as a member of the medical staff of the hospital;

(iv) Other licensed treatment facilities which have psychiatrists available for consultation such as residential crisis stabilization centers; or

(v) A Wyoming hospital that does not have specific psychiatric services, but admits a patient on an emergency basis when no other appropriate level of care is available.

(b) To enter into a contract or agreement with the Department, 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:

(i) A copy of the hospital's or facility's license issued by the state survey agency; and

(ii) A copy of the hospital or facility's most recent JCAHO or CARF accreditation certificate or Centers for Medicare and Medicaid (CMS) certification.

(c) Once verification of all documents has been completed by the Wyoming State Hospital, notification of acceptance or rejection will be provided to the hospital. If the hospital is accepted, a contract or agreement outlining the hospital's or facility's responsibilities with regard to accepting patients and providing treatment for persons with mental illnesses, as defined in Wyo. Stat. Ann. § 25-10-110, will be initiated by the Division.

(d) Contract or agreement extensions or the development of new contracts or agreements will be completed biennially pending receipt by the Wyoming State Hospital of the documents listed in Section 4(b)(i) and (ii).

(e) The contract or agreement shall require compliance with these rules.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 5 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 6 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.7.04042017 § 7 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 8 Standards for the Reimbursement of Designated Hospitals and Treatment Providers

Wyo. Code R. 048.0053.8.04042017 Standards for the Reimbursement of Designated Hospitals and Treatment Providers

CHAPTER 8

Standards for Reimbursement of Designated Hospitals and Treatment Providers

Section 1. Authority.

This Chapter is promulgated by the Department of Health ("the Department") pursuant to the Involuntary Commitment Act ("the Act"), codified at Wyo. Stat. Ann. §§ 25-10-101 through -305, and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

Section 2. Purpose and Applicability.

(a) These rules have been adopted to establish standards for the reimbursement of designated hospitals or other treatment providers and to establish standards to manage costs billed to the Department pursuant to Wyo. Stat. Ann. § 25-10-112.

Section 3. Filing of Claims.

(a) Designated hospitals or treatment providers filing claims with the Department or responsible county under Wyo. Stat. Ann. § 25-10-112 for services provided pursuant to Wyo. Stat. Ann. § 25-10-109, Wyo. Stat. Ann. § 25-10-110 or Wyo. Stat. Ann. § 25-10-110.1 shall provide documentation to the Department or responsible county detailing the services rendered and the payment requested. This documentation shall include, but is not limited to:

(i) All relevant and requested medical records directly related to the services for which payment is being requested;

(ii) An itemized billing statement (for services provided by designated hospitals) for services, including:

(1) A universal billing form;

(2) A CMS 1500.

(iii) The emergency detention notice, Form 3-81, and the continued emergency detention court order, if applicable;

(iv) The involuntary hospitalization court order, if applicable, and any papers showing the patient's release from involuntary hospitalization, Form 14-81.

(v) A certification signed by the designated hospital representative or treatment provider, indicating that the patient has no public or private health insurance and that there are no other governmental benefit programs from which it can recover the costs of treatment;

(vi) Documentation of all efforts made to recover costs of treatment from public and private health insurance, and from government benefit programs prior to seeking payment from the Department.

(b) The Department may not pay claims submitted more than one (1) year after the service date.

(c) The Department may not pay claims for medical treatment for conditions that are not directly related to the emergency detention or involuntary hospitalization.

Section 4. Payment of Claims.

(a) Payment made by the Department pursuant to Wyo. Stat. Ann. § 25-10-112, for services provided by a designated hospital or other treatment provider under Wyo. Stat. Ann. § 25-10-109 and Wyo. Stat. Ann. § 25-10-110, shall not exceed:

(i) The current rate for similar services as determined by Medicaid;

(ii) A fixed, all-inclusive per diem rate as determined by the Department; or

(iii) Payments arranged through mental health or substance abuse contracts with the Behavioral Health Division, if applicable.

(b) In considering a claim for payment, the Department shall determine if the costs submitted by the designated hospital or treatment provider are reasonably related to the care furnished to the patient and if the care furnished to the patient was medically necessary for the specific treatment of the patient's mental illness.

(c) After a designated hospital has submitted all documentation as required in Section 4(b) of Chapter 7, the Department shall pay each claim within 45 days of receipt of the claim pursuant to Wyo. Stat. Ann. § 16-6-602.

Section 5. Implementation of Chapter.

(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.

Section 6. Superseding Effect.

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

Section 7. Severability.

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 9 Convalescent Leave from Involuntary Hospitalization

Wyo. Code R. 048.0053.9.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to Hospitalization of Mentally Ill Persons ("the Act") codified at Wyo. Stat. Ann. §§ 25-10-101 through -127, and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish definitions applicable to Chapter 10, Standards for Convalescent Leave, pursuant to Wyo. Stat. Ann. § 25-10-127.

(b) The Department may issue manuals or bulletins to interpret the provisions of these rules, which 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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 3 General Provisions

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 4 Definitions

The following definitions shall apply in the interpretation and enforcement of Chapters 9 and 10 of these rules:

(a) "Appropriate Parties" means the patient's guardian, if applicable, the patient's care giver, if applicable, the patient's family, if applicable, the community treatment provider, and the county attorney involved in the involuntary hospitalization procedures for the patient.

(b) "Community Treatment Provider" means a community mental health center or other mental health treatment service provider chosen by the patient.

(c) "Convalescent Leave" means the placement of a patient who was involuntarily hospitalized under Wyo. Stat. Ann. § 25-10-110 and treated at the Wyoming State Hospital or designated hospital, into a community on a conditional status, for purposes of continued recovery.

(d) "Designated Hospital" means a psychiatric treatment hospital that provides care to an individual detained under Wyo. Stat. Ann. § 25-10-109, Wyo. Stat. Ann. § 25-10-110, or Wyo. Stat. Ann. § 25-10-110.1, which is under an agreement with the Department and bills the Department or the responsible county for the costs of care under the Act.

(e) "Involuntary hospitalization" means the hospitalization of a person against their will under Wyo. Stat. Ann. § 25-10-110, at the Wyoming State Hospital or at a designated hospital under contract or agreement with the Department to provide inpatient psychiatric treatment.

(f) "Treating Medical Provider" means a physician, psychiatrist, advanced practice registered nurse, physician assistants, or other medical staff licensed in the State of Wyoming and employed by the Wyoming State Hospital or designated hospital.

(g) "Treatment Team" means staff of the Wyoming State Hospital or designated hospital representing the various disciplines needed to treat and promote the recovery of the patient. Treatment teams include, but are not limited to, the treating physician and a case manager.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 5 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 6 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.9.04042017 § 7 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 10 Standards for Convalescent Leave

Wyo. Code R. 048.0053.10.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to Hospitalization of Mentally Ill Persons ("the Act") codified at Wyo. Stat. Ann. §§ 25-10-101 through -127 and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish and implement the procedures and corresponding responsibilities for releasing a patient on convalescent status pursuant to Wyo. Stat. Ann. § 25-10-127.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 3 Conditions Necessary for Convalescent Leave

(a) Convalescent Leave may be utilized by the State Hospital or designated hospitals when:

(i) The patient:

(A) Was previously involuntarily hospitalized and demonstrated an inability to follow past discharge plans, or has demonstrated a history of noncompliance with outpatient treatment;

(B) Will need additional assistance and support to adequately comply with the required plan of treatment on an outpatient or nonhospital basis; or

(C) Will likely need and will benefit from community-based services and support to avoid decompensation and additional involuntary hospitalizations, and those services and support are available in the community the patient wishes to return to, or in the community best suited to provide such aftercare of the patient.

(ii) When the treating medical provider, after consultation with the treatment team and appropriate parties, believes it is in the best medical interest of the patient.

(b) Wyoming State Hospital patients who have active or pending criminal charges may not be placed on convalescent leave.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 4 Process to Initiate Convalescent Leave

(a) Request for Convalescent Leave.

(i) Treatment team. Members of the patient's treatment team and any designated gatekeeper must meet to discuss the potential benefits of Convalescent Leave. Although all members of the treatment team do not need to agree to the leave, all members of the team must be a part of the decision-making process. If the members of the treatment team do not arrive at a consensus for the use of Convalescent Leave, the patient's treating medical provider leading the treatment team will make the final decision. If a decision is made to pursue Convalescent Leave, the request must be documented and include the applicable conditions contained in Section 3(a) as justification for the request. If the patient's treatment team is located at a designated hospital, the treatment team shall consult with the Wyoming State Hospital on all convalescent leave orders and treatment plans.

(ii) Patient and Appropriate Parties. After a request for Convalescent Leave is made by the treatment team, one or more members of the treatment team shall provide written, email, or fax notice to and consult with the patient and appropriate relevant parties, including, when applicable, the guardian, parent, gatekeeper, and community treatment provider. A member of the treatment team shall document this process.

(iii) Wyoming State Hospital or designated hospital staff shall assist patients being released on convalescent leave in applying for Medicaid and securing Social Security benefits, if applicable.

(b) Convalescent Leave Plan.

(i) Using input from the patient and all appropriate parties, the treatment team shall develop a written Convalescent Leave Plan.

(ii) The Convalescent Leave Plan shall include:

(A) The roles and responsibilities of the patient and other appropriate parties and any areas for which the treating facility, Wyoming State Hospital, or designated hospital will retain responsibility while the patient is on Convalescent Leave;

(B) The community treatment services, medication, and supports to be provided, the entity responsible for providing them, and how they will be paid;

(C) Provisions for quarterly reports from the community treatment provider, or any designated gatekeeper, to the Department on the status and progress made by the patient. If more than one community treatment provider is selected by the patient to provide outpatient services and supports, the plan shall specify the community treatment provider or gatekeeper responsible for providing quarterly reports;

(D) The conditions under which Convalescent Leave will be revoked;

(E) The preferred location for detention and the method of detention of the patient if Convalescent Leave is revoked.

(iii) The Convalescent Leave Plan will be provided to the patient, the patient's treatment team, any designated gatekeeper, and other appropriate parties for signature. Signature shall constitute acknowledgment of the plan, and the role of each entity in achieving the goals of the Convalescent Leave.

(iv) The Convalescent Leave Plan, signed by the patient, the patient's treatment team and other appropriate parties, may act as the initial report to the court, or a separate report to the court outlining additional information may be drafted and submitted by the treating medical provider.

(v) The treatment team shall provide copies of the signed Convalescent Leave plan to the patient and the appropriate parties in a manner to ensure receipt of the copy prior to the beginning of convalescent leave.

(i) The Wyoming State Hospital or designated hospital will file all notices for Convalescent Leave with the Court, and provide notice to the county attorney office that initiated involuntary hospitalization proceedings, any designated gatekeeper, and other interested parties. Notice shall consist of a copy of the notice for convalescent leave along with copies of the initial commitment documents, the signed Convalescent Leave Plan, and any other relevant information or documents, including any separate reports or documents in support of the Convalescent Leave.

(ii) The Wyoming State Hospital shall develop and utilize uniform forms for Convalescent Leave Plans.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 5 Return to Involuntary Hospitalization from Convalescent Leave

(a) If the hospital reasonably believes that it is in the best interest of the patient, the patient shall be returned to the hospital from which the patient was given convalescent leave. The hospital from which the patient was given convalescent leave may return the patient to its care, subject to notice and hearing as provided by Wyo. Stat. Ann. §§ 25-10-116 and 127.

(b) Any member of the patient's treatment team, the patient, any designated gatekeeper, or other appropriate parties may request that the hospital from which the patient was given convalescent leave return the patient to its care to comply with the Convalescent Leave Plan. The hospital shall review requests under subsection (b) to determine whether return from Convalescent Leave pursuant to subsection (a) is in the best interests of the patient.

(c) If the patient is not able or is unwilling to return to the hospital, or if the hospital from which the patient was given convalescent leave refuses to return the patient to its care for a violation of the Convalescent Leave Plan, the party seeking the patient's return may request a hearing before the court that ordered the patient's involuntary hospitalization.

(d) The Wyoming State Hospital shall arrange transportation for a patient returning to the Wyoming State Hospital.

(e) The Wyoming State Hospital shall pay for the detention and transportation expenses to detain and return the patient to the hospital, pursuant to Wyo. Stat. Ann. § 25-10-127.

(f) The hospital from which the patient was given convalescent leave shall file a Notice of Return from Convalescent Leave with the court, and will provide copies to the appropriate parties, notifying the parties that the patient is being or will be returned to the hospital.

(g) Upon the patient's return to the hospital from which the patient was given convalescent leave, the patient shall be notified of his/her rights, including the right to contest his return to the hospital, the right to a hearing, and the right to counsel.

(h) If the patient is returned to the Wyoming State Hospital or designated hospital, the Convalescent Leave is revoked.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 6 One Year Follow Up

(a) Prior to the end of one (1) year on convalescent leave, and not less than annually thereafter, the patient's treatment team shall consult with the patient, any designated gatekeeper, and other appropriate parties to reconsider and reexamine the facts relating to the original involuntary hospitalization of the patient.

(b) If the patient's treatment team and the community treatment provider determine that involuntary hospitalization is no longer anticipated for the patient, the community treatment provider and any designated gatekeeper, in collaboration with the Wyoming State Hospital or designated hospital, shall submit a 14-81 form to the Court for the discharge of the patient, following the procedures set forth in Wyo. Stat. Ann. § 25-10-116(b). With the participation of the patient, the patient's guardian, the patient's caregiver, the patient's family, if applicable, and the community treatment provider, the Wyoming State Hospital or designated hospital shall prepare a discharge plan.

(c) If a patient on Convalescent Leave is returned to the Wyoming State Hospital, designated hospital, or treatment provider and later re-placed on Convalescent Leave status, the one year follow up shall be based on the date of the most recent Convalescent Leave.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 7 Two Year Discharge Process

(a) After two (2) years on Convalescent Leave, the community treatment provider, in collaboration with the Wyoming State Hospital or designated hospital, and any designated gatekeeper, shall submit a 14-81 form to the court, seeking the discharge of the patient, pursuant to Wyo. Stat. Ann. § 25-10-116(b). The 14-81 form should note the client's success during the two year Convalescent Leave period, and include a discharge plan prepared by the Wyoming State Hospital or designated hospital in conjunction with the patient, the patient's guardian, if applicable, the patient's caregiver, if applicable, the patient's family, if applicable, and the community treatment provider and any designated gatekeeper.

(b) If the patient is returned from Convalescent Leave to the Wyoming State Hospital, designated hospital, or treatment provider and re-placed on Convalescent Leave status, the required discharge after two (2) years of Convalescent Leave shall be based on the date of the most recent Convalescent Leave.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 8 Responsibilities of the Wyoming State Hospital or Designated Hospital While Patient is on Convalescent Leave

(a) While the patient is on Convalescent Leave, the Wyoming State Hospital or designated hospital shall periodically review, with the community provider and any designated gatekeeper, the treatment progress of the patient as documented in the quarterly report submitted by the community treatment provider.

(b) Neither the physicians nor the caseworkers at the Wyoming State Hospital or designated hospital shall provide direct care or treatment of the patient while the patient is on Convalescent Leave unless otherwise documented in the treatment plan, although they shall be available for consultation with community treatment providers. This provision recognizes the patient's best interests in being placed in his or her local community, which may be a great distance from the Wyoming State Hospital or designated hospital. bin

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 9 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 10 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter 8-3.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.10.04042017 § 11 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 11 Directed Outpatient Commitment (Wyo. Stat. Ann. 25-10-110.1)

Wyo. Code R. 048.0053.11.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to Hospitalization of Mentally Ill Persons ("the Act") codified at Wyo. Stat. Ann. §§ 25-10-101 through -127 and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. § 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish and implement the procedures and corresponding responsibilities of Wyoming Department of Health treatment providers for the treatment of patients court-ordered to Directed Outpatient Commitment as provided in Wyo. Stat. Ann. § 25-10-110.1.

(b) The Department may issue manuals or bulletins to interpret the provisions of this rule, which 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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 3 Directed Outpatient Commitment Treatment Provider Requirements

(a) If an individual is determined mentally ill under the Act (Wyo. Stat. Ann. §§ 25-10-109 through -110.1) and is ordered by a court for directed outpatient commitment to a treatment provider as defined in Chapter 6 of these rules, the treatment provider shall comply with the court order and admit the patient unless it demonstrates to the court that it cannot comply with the court order for directed outpatient commitment.

(b) The treatment provider shall prepare a treatment plan, as required by the court order, in consultation with any gatekeeper designated by the Department. In preparing the treatment plan, the treatment provider shall consult with the county attorney, any relevant healthcare providers, and the patient or the person responsible for the care and custody of the patient. The treatment plan may not exceed two (2) years.

(c) The treatment provider shall issue a report to the court, the county attorney, and any gatekeeper designated by the Department every six (6) months. The report shall contain the patient's status in the directed outpatient commitment treatment plan, any past non-compliance with the treatment plan by the patient, and any barriers to the patient's continued maintenance in the community setting.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 4 Payment of Treatment Providers for Directed Outpatient Commitment

Services provided by a treatment provider, pursuant to Wyo. Stat. Ann. § 25-10-110.1, shall be reported under mental health and substance abuse treatment contracts and agreements between treatment providers and the Department.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 5 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 6 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.11.04042017 § 7 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

Chapter 12 Exchange of Information Under Title 25

Wyo. Code R. 048.0053.12.04042017 § 1 Authority

This Chapter is promulgated by the Department of Health ("the Department") pursuant to Hospitalization of Mentally Ill Persons ("the Act") codified at Wyo. Stat. Ann. §§ 25-10-101 through -127 and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101 through -115.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.12.04042017 § 2 Purpose and Applicability

(a) These rules have been adopted to establish and implement the procedures and corresponding responsibilities for the treatment of patients court-ordered to emergency detention, involuntary hospitalization, or Directed Outpatient Commitment as provided in Wyo. Stat. Ann. §§ 25-10-101 through -127.

Section 3. Exchange of Patient Information under Title 25

(a) When an individual is determined mentally ill under Wyo. Stat. Ann. §§ 25-10-109 through -110.1, protected health information regarding the individual's condition, diagnoses, history, and detention or hospitalization may be exchanged between relevant healthcare providers, treatment providers, the county attorney, the examiner, any gatekeeper designated by the Department, and the court as necessary to carry out the purposes of this Act. Any exchange of protected health information under the Act shall comply with requirements under all applicable state and federal law.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.12.04042017 § 4 Implementation of Chapter

(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.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.12.04042017 § 5 Superseding Effect

When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter.

History

Effective 2017-04-04

Wyo. Code R. 048.0053.12.04042017 § 6 Severability

If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

History

Effective 2017-04-04

179 Tax Refund to Elderly & Disabled

Chapter 1 Rules for Tax Refund For Eldery & Disabled

Wyo. Code R. 048.0055.1.10172014 Rules for Tax Refund For Eldery & Disabled

DEPARTMENT OF HEALTH

RULES AND REGULATIONS FOR THE TAX REFUND

TO THE ELDERLY AND DISABLED PROGRAM

CHAPTER 1

Section 1. Authority. This rule is being promulgated by the Department of Health in accordance with W.S. 39-11-109 and the Wyoming Administrative Procedures Act at W.S. 16-3-101, et seq.

Section 2. Purpose and Applicability. These rules are being adopted to implement legislation involving tax refunds to the elderly and disabled.

Section 3. General Provision.

(a) The Wyoming Department of Health may issue materials to providers and/or other affected parties to interpret the provisions of this Chapter. Such materials shall be consistent with and reflect the rules and regulations contained within this Chapter. The provisions contained in the materials shall be subordinate to the provisions of this Chapter.

(b) 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.

(c) If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

Section 4. Definitions. For the purpose of these rules, the following shall apply:

(a) "Abandoned." To leave with no intent to return.

(b) "Actual income" includes, but is not limited to, pre-tax wages, earnings from self-employment, interest, dividends, annuities, trusts, pensions, alimony, support payments (Child Support or AFDC/POWER/TANF), benefits received by any member of the household, including children (SSI, SSDI, SSA, State SSI), public assistance payments, unemployment compensation, federal Social Security payments, Veteran's benefits and disability payments, Native American Per Capita payments, rental income or net income from other qualified income, as determined by the Department;

(d) "Earned Income" is money received (wages, salary, self-employment earnings, etc.) for which a person has performed a service.

(e) "Equity Value" means the current market value less any legal debts against the property, such as mortgages and encumbrances.

(f) "Foster Grandparents Program." The Program's purpose is to provide opportunities for low income persons aged sixty (60) or over to provide supportive, person-to-person services in health, education, welfare, or related settings to help alleviate the physical, mental, or emotional problems of children having special needs.

(g) "Household assets" means real property, which is land and the buildings and structures placed on that land; and personal property, including, but not limited to: money and cash on hand, including currency, gold, silver, and other coins, including money on deposit in savings, checking accounts, and IRAs; bonds, promissory notes and debentures; shares of stock, pensions, mutual funds and other investments; and annuities and annuity contracts.

(h) "Income year" is the full calendar year proceeding January 1 of the year during which the application is made. For example, if it is now 2008, the income year is 2007.

(i) "IRAs." Individual Retirement Accounts.

(j) "Joint Applicant." An individual who was legally married on December 31 of the income year to a living person.

(k) "LIEAP." Low Income Energy Assistance Program.

(l) "Qualification Criteria." Age, Disability, Residency, Income (see Section 3).

(m) "SEPs." Simplified Employee Pensions.

(n) "SCP." Senior Companion Program.

(o) "SSAN." Social Security Account Number.

(p) "State/County/City/Federal funded institutions." Wyoming Penitentiary, Wyoming Pioneer Home, Wyoming Retirement Center, Wyoming Veteran's Home, Wyoming State Hospital, Wyoming State Training School, County/City/State/Federal Detention Centers.

(q) "Substantial gainful employment." A person who has earned income (wages, salary, and self-employment) of under five thousand dollars ($5,000.00) a year is not "substantially" employed for this purpose.

(r) "Suspended application." An application missing information, incorrect, or without required documentation which has been stopped temporarily by the Department.

(s) "Title 19." Medicaid.

(t) "Third-party payments." Payments made on an individual's bills by sources other than the individual's income.

Section 5. Qualifications.

(a) Qualifications based on age or disability:

(i) An applicant must have attained the age of sixty-five (65) by the last day of December of the income year;

(ii) An applicant who is totally disabled must have attained the age of eighteen (18) by the last day of December of the income year;

(iii) A married couple, at least one of whom is at least sixty-five (65) years of age or totally disabled; or

(iv) A person who is at least age sixty (60) on December 31 of the income year and who was once married to someone who was qualified for and received this refund the prior year, may continue to apply and receive the refund provided the non-age qualifications are met as set forth in Section 3(b)(c)(d)(e) of these rules. A person qualified under this paragraph (a)(iii) does not have to be disabled.

(b) Qualifications based on income:

(i) A single applicant must have less than the amount established in W.S.39-11-109(c)(ii) during the income year.

(ii) A joint applicant must have had a combined income less than the amount established in W.S. 39-11-109(c)(ii) during the income year. A joint applicant's income includes the income of his/her spouse or anyone else in the household, including children.

(i) An applicant must be a Wyoming resident and United States Citizen at the time of application, and must have been a resident of Wyoming and a United States citizen for the twelve (12) continuous months prior to date of application

(ii) A person who resides in a State/County/City/Federal funded institution is not eligible for the refund.

(d) The application shall indicate whether the applicant has received any refund for a property tax exemption under W.S. 39-13-105, a property tax refund under W.S.39-13-109(c)(iii), and/or a property tax credit under W.S. 39-13-109(d) for the same calendar year.

Section 6. Amount of Refund.

(a) A qualified single person shall receive the amount listed in W.S. 39-11- 109(c)(ii) reduced by the percentage that his actual income exceeds the amount referenced in W.S. 39-11-109(c)(ii) per year.

(b) Qualified married persons shall receive the referenced amount listed in W.S.39-11-109(c)(ii) reduced by the percentage that their actual income exceeds the amount provided in W.S. 39-11-109(c)(ii) per year.

(c) Until remarriage, a person sixty (60) years or older once qualified through marriage remains eligible individually for single person benefits, subject to income limitations, after the death of his/her spouse. Applications can be made by a living applicant only. Relatives, attorneys, or estates can not apply on behalf of a deceased individual, except in the case of a surviving spouse as noted in this section.

(d) No person having total household assets exceeding the amount provided in W.S. 39-11-109(c)(ii) per adult member of the household as adjusted annually by the state average Wyoming cost-of-living index published by the economic analysis division of the Department of Administration and Information is eligible for a refund.

(e) Any refund provided by this subsection shall be reduced by the dollar amount received by the applicant for the preceding calendar year from any property tax exemption received under W.S. 39-13-105, for any property tax refund received under W.S. 39-13-109(c)(iii), or for any property tax credit received under W.S. 39-13-109(d) for the same calendar year.

Section 7. Application Basis: Single or Joint.

(a) An individual who is not legally married to a living person is single. An unmarried person may not apply jointly (see exceptions for joint applicants).

(b) An individual must apply jointly with a spouse who died during the application year. The total yearly income of both must be reported on the application. The applicant will enter the word "deceased" in the spouse's signature block and attach a copy of the death certificate. The same procedure will be used if the spouse died after the end of the application year, but before completing an application for the refund.

(c) An individual who was legally married on December 31 of the application year to a living person is required to apply jointly, except as noted below. Only one (1) person of a joint application is required to meet the qualifications except for income.

Exceptions under which a married applicant may apply as a single person and exclude his/her spouse's income from the application are as follows:

(i) If a person is legally married, but has been abandoned by his/her spouse, and is not receiving any economic benefit from any income or property of the spouse, and has not lived with the spouse for at least one (1) year, such person may apply as a single person. The spouse's SSAN must be entered on the application form with the words "abandoned" entered in the space for the spouse's name. (If the spouse is in a detention center, the cost to the State/City/County/Federal government will be counted as income.) In no case will applications be processed for two (2) people married to each other and both claiming abandonment.

(ii) An individual can apply as a single person if his/her spouse is in a nursing home and payment for care is provided by Title 19 (Medicaid). There is no time limit on this status. For example, if the spouse went into the nursing home yesterday, they may apply as single the next day. The remaining spouse must show proof that his/her spouse is receiving Title 19 assistance and is in a nursing home.

(iii) An individual who is legally separated is single for purposes of the refund. A person in the legal process of obtaining a divorce is considered legally separated, but documentation must be provided.

(iv) The spouse of a joint applicant cannot apply as a single person.

Section 8. Income Inclusions and Exclusions.

(a) All income, as defined above, is included for purposes of determining eligibility for this refund, except for the specific exclusions noted in Section 5(b). Income for this purpose is not defined or amplified by any considerations of income taxability or non-taxability under the U.S. Internal Revenue Service Code.

(b) Items listed below are excluded from income for the purpose of this program:

(i) Payments made for the Foster Grandparents and the Senior Companion Programs, as well as any other stipend payment programs;

(ii) LIEAP payments;

(iii) Tax Refund to Elderly and Disabled payments;

(iv) Housing subsidies;

(v) Group home rent subsidies; and

(vi) The value of food stamps received.

(c) Items listed below are to be included as income. This list does not override the definition of income or the inclusion to income listed elsewhere in the rules. This list only serves to clarify items which may be misunderstood.

(i) Payments by Social Security and/or State of Wyoming for Medicare/Medicaid premiums;

(ii) Third party payments for medical care, including private insurers, Medicare and Medicaid, support by City, County, State, or Federal government;

(iii) Title 19 payments for a person who is in a nursing home or similar institution;

(iv) The following are considered assets: recreational vehicles, snowmobiles, property other than the house where you are currently residing, motorcycles, cabins, jewelry, or other items so determined by the Department.

Section 9. Application Procedures.

(a) An application must be completed and postmarked by the last working day of the month of August of each year. Applications received by the Department or its representative that are postmarked after the closing date will be denied without action to the applicant.

(b) The program is non-continuing. An application must be submitted each year. No individual notice, reminder, blank form, or other personal contact will be made by the Department to invite a prior participant to apply again. Public Notice will be made through local radio, newspaper, television, and senior center.

(c) Applications must be fully documented each year. Copies of documents attached to the application are part of the application and will not be returned to the applicant.

(d) A timely submitted application may be suspended by the Department for cause. An application which appears to qualify may be suspended, for example, if proper documentation is not attached. Suspended applications will be marked "suspended" by the Department and a copy returned to the applicant with a cover letter outlining the problem. A suspended application received by the Department after November 15 with no corroborating documentation will be rejected.

(e) Applications will not be suspended a second time without good cause. A suspended application that is resubmitted with information still missing, incorrect, or without required documentation will be rejected.

(f) Applicants are required to sign the application form. Except in the case of a surviving spouse, both members of a joint application must sign. The signature of a legal guardian will be accepted as an original signature if the guardianship papers are attached. A person who has been given power of attorney may sign the application form if a copy of the power of attorney is attached to the application. Social Security representative payees may also sign as necessary. An application form received without proper signature(s) and documents will be suspended.

(g) Applications must be made on the current application form as prescribed by the Department. Only an original application form will be accepted.

(h) All changes to the application must be initialed by the individual signing the form, such as, when the total income is "lined through" and a new amount entered. If discrepancy exists between the documents submitted and information entered on the form, the application will be delayed until verification can be made.

(i) Changes of address to applications "in process" must be made in writing to the Department. The request must be dated, signed by the applicant, and include the applicant's Social Security Number. Address changes must be received by November 25.

(j) An application will be rejected if it fails to meet the qualification criteria. A rejected application will be marked as unqualified and a letter of denial remitted. A rejected application cannot be resubmitted. Rejected applications will not be returned to the applicant.

(k) As per the Wyoming Administrative Procedures Act, an appeal process exists whereby an applicant can appeal the decision made by the Department of Health to reject an application.

(l) In the event an applicant dies between the times his/her application is submitted and the time the payment is made, the refund automatically passes to the legal heir(s). If there is no legal heir, the money will revert to the State General Fund.

Section 10. Documentation.

(a) Applications must be accompanied by a copy of the applicant's tax return (form 1040 or form 1040A, or form 1040EZ) for the income year. If the applicant did not file a tax return, the statement on the application must be initialed attesting that he/she did not file a U.S. Income Tax Return for the income year.

(b) Certain types of income are not reportable on the U.S. Federal Income Tax Return. Documents for these items of income must be included with the application regardless of whether the applicant attached a copy of his/her tax return. These items of countable income include, but are not limited to, Social Security payments, Veteran's Administration (VA) disability payments, Railroad Retirement & Railroad Social Security (RRTA 1099 & 1099R) payments, and Native American Per Capita payments, etc.

(c) Applicants who did not file a tax return are required to attach copies of forms W-2, W-2p, 1099INT, 1099DIV, 1099G, 1099M, etc., for income for the year. A business owner, including owners of rental property of all types, is required to attach a copy of his/her year end income statement to the application.

(d) Non-documented income is required to be reported. A bank or other institution is not required to provide a 1099INT in the case of interest income under ten dollars ($10.00) per year, for example. Such income must be included in the total reported on the application, and noted that no document was available.

(e) Applicants between the ages of eighteen (18) and sixty-five (65) must attach proof of total disability. A report from the Veterans Administration (VA) or a benefit verification statement from the Social Security Administration attesting to a total disability is adequate.

(f) The application must be submitted with a document attesting date of birth or age. A copy of a Wyoming Driver's License or identification card is adequate for this purpose. If these are not available, then a copy of a birth certificate, baptismal certificate, or other similar attest will be acceptable.

(g) If the applicant is claiming single based on a legal separation, as much of the legal separation document as necessary to clearly show the names of the parties, the legal firm, the date of the agreement, and that it is a legal separation must be attached.

(h) A person claiming single as an abandoned spouse must provide a signed, notarized statement which clearly states how long they have been separated, and stating that they receive no economic benefit from their spouse. A spouse (inmate) being detained in a facility is not abandonment.

History

Effective 2014-10-17

180 Trauma Program, Wyoming

Chapter 1 General Provisions

Wyo. Code R. 048.0056.1.11202008 General Provisions

Chapter 1

GENERAL PROVISIONS

Section 1. Authority. These rules shall also apply to and govern the reimbursement of uncompensated trauma care to hospitals and ambulance services as outlined in House Enrolled Act 52 passed by the 2008 Budget Session. and W.S. 35-1-801, et. seq.

Section 2. Purpose and Applicability.

(a) These rules are designed to create an organized, statewide system for trauma patient care through the establishment of trauma service areas served by designated trauma center hospitals for which standards are set. The standards are formulated to be consistent with national criteria established by the American College of Surgeons and the American College of Emergency Physicians and have extended those criteria to meet the needs of Wyoming. These rules are applicable to facilities and emergency medical service providers which participate in the Wyoming Trauma Plan.They are designed to be consistent with and should be read in conjunction with the Wyoming Emergency Medical Services Act of 1977, W.S. 33-36-101, as amended, and the Standards, Rules, and Regulations for Hospitals and Related Facilities. The Department may issue manuals, bulletins, or both, to interpret the provisions of these rules and regulations. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules and regulations. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules and regulations.

Section 3. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules. Where the context in which words are used in these rules indicates that such is the intent, words in the singular number shall include the plural and vice versa. Throughout these rules, gender pronouns are used interchangeably. 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.

(a) "Advanced Trauma Life Support Course" or "ATLS" means the Advanced Trauma Life Support Course approved by the American College of Surgeons. When required by these rules, a physician shall maintain ATLS certification.

(b) "Acute Care Hospital" means a "hospital licensed in Wyoming pursuant to W.S. 35-2-901 through 35-2-912 and which provides acute patient care to patients with

injuries or illnesses."

(c) "Area Trauma Hospital" or "ATH" means a designated facility that has the facilities and surgical capabilities to provide care for the majority of injured patients. Area Trauma Hospitals may serve as referral centers for Community Trauma Hospitals and Trauma Receiving Facilities. An ATH need not include a neurosurgeon on staff.

(d) "Basic Life Support" or "BLS" means treatment rendered by personnel trained to at least the Basic EMT level, including but not limited to procedures such as bandaging, splinting, basic first aid, and performing cardiopulmonary resuscitation (CPR), as defined in the Wyoming Emergency Medical Services Act of 1977, W.S. 33-36-101, or as amended.

(e) "Board" means the Wyoming State Board of Medicine established by W.S. 33-26-102 (iii).

(f) "Board Certified" means a physician who has been awarded a board diploma in a specialty recognized by the American Board of Medical Specialties, the Canadian Board, the American Osteopathic Association, or the American Board of Oral and Maxillofacial Surgery.

(g) "Board Eligible" or "Board Admissible" refers to a physician who has applied to the Board and has received a ruling that he has fulfilled the requirements to take the necessary examinations to become board certified in a specialty.

(h) "By-pass" or "Bypass" means direction given to a prehospital emergency medical services unit, by direct/on-line medical control or predetermined triage criteria, to divert past the nearest hospital and transport the patient to a facility better equipped and staffed to care for that particular patient's needs.

(i) "Certified Critical Registered Nurse" or "CCRN" means a registered nurse who has completed the American Association of Critical-Care Nurses course of study and examination in the care of critically injured and ill patients.

(j) "Certified Registered Nurse Anesthetist" or "CRNA" means a registered nurse who has graduated from a school of nurse anesthesia accredited by the Council on Accreditation of Educational Programs of Nurse Anesthesia or its predecessor, and who has been certified as a nurse anesthetist by the Council on Certification of Nurse Anesthetists.

(k) "Community Trauma Hospital" or "CTH" refers to a designated facility that typically does not have twenty-four (24) hours per day coverage of its emergency department and shall, at a minimum, have only one (1) surgeon on staff. With these exceptions, these facilities are similar to Area Trauma Hospitals and may serve as referral centers for Trauma Receiving Facilities.

(l) "Consolidated Omnibus Budget Reconciliation Act" or "COBRA" refers to the consolidated Omnibus Budget Reconciliation Act of 1986 (Pub.L. 99-272,100 Stat.82). Adherence to COBRA is mandatory.

(m) "Continuing Education" refers to the minimum educational requirements necessary to remain certified in a medical discipline. "Continuing Nursing Education" refers to education approved or recognized by a national nurse's organization. "Continuing Medical Education" or "CME" refers to continuing education approved by the Board, Department of Health, State of Wyoming, or affiliated agencies.

(n) "Department" means the Wyoming Department of Health.

(o) "Designated Facility" refers to a health care facility that satisfies the requirements of one (1) of the four (4) categories of trauma facilities described in these rules.

(p) "Designation" refers to the process by which the Wyoming Office of Emergency Medical Services (OEMS) accepts plans submitted by Wyoming Health Care Facilities for inclusion within the Wyoming Trauma Plan, validates the plan, and assigns to the facilities the appropriate level as described in these rules.

(q) "Desirable" applies to a suggested criterion or standard which is not mandated or required for a trauma center. Compliance with this criterion or standard may be considered in the designation process.

(r) "Emergency Department" or "ED" or "Emergency Room" or "ER" means the area of a licensed health facility that customarily receives patients in need of emergency evaluation and/or care.

(s) "Emergency Medical Services" or "EMS" means the many agencies, personnel, and institutions involved in the planning, providing, and monitoring of emergency care for those suffering sudden illness or injury.

(t) "Emergency Medical Services for Children" or "EMS-C" means that portion of the emergency medical services system relating to the training of personnel and the provision of patient care to children suffering sudden illness or injury.

(u) "Emergency Medical System" means the entire system that provides care to a trauma patient through the entire spectrum of care.

(v) "Emergency Medical Technician" or "EMT" means a person who has graduated from a Division approved training program for Emergency Medical Technicians.

(w) "Emergency Medical Treatment and Active Labor Act" or "EMTALA" refers to that portion of COBRA codified at Section 1867 of the Social Security Act, and the accompanying regulations in 42 CFR § 489.20(1), (m), (p), and (r).

(x) "Emergency physician" means a physician who provides medical coverage in an emergency room.

(y) "Emergency nurse" means a registered nurse who provides patient care or administrative services in an emergency room.

(z) "Essential" applies to a criterion or standard, compliance with which is mandated or required for designation.

(aa) "First Responder" means an individual who has completed an approved training program sponsored or approved by the OEMS in locating, providing initial basic emergency treatment, and removing individuals from imminent danger, and who is presently certified.

(bb) "Health Care Facility" means a facility as defined in W.S. 35-2-901 (a)(x).

(cc) "Health Care Provider" means a person who is licensed, certified, or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profession, but does not include a person who provides services solely through the sale or dispensing of drugs or medical devices.

(dd) "Hospital" means a facility as defined in W.S. 35-2-901 (a)(xiii).

(ee) "Immediately Available" means unencumbered by conflicting duties or responsibilities, responding without delay when notified, and being within the specified area of the trauma facility when the patient arrives.

(ff) "Incident" means an admission to a hospital, both inpatient and outpatient, involving traumatic care for an individual patient within a one (1) year period to a single hospital. Admissions of the same patient for causes not directly related to an earlier admission shall be considered a separate incident.

(gg) "In House" means present at all times and immediately available to the trauma center or hospital. On call personnel are not considered in house.

(hh) "JCAHO" means the Joint Commission for Accreditation of Health Care Organizations, which is the organization responsible for accrediting Hospitals.

(ii) "Medical Control" means direction, advice, and supervision provided by medical personnel at a medical facility to prehospital personnel by radio, telephonic communications, written protocol, or direct verbal order. Medical control is also referred to as on-line medical supervision.

(jj) "Medical Director" means a licensed physician who is responsible for supervising medical decisions. OEMS will employ a statewide medical director to provide medical oversight to the state trauma plan. Each designated facility will be required to have its own medical director.

(kk) "Mid-level practitioner" refers to a physician assistant or advanced practitioner of nursing as defined in Title 33 of the statutes.

(ll) "Monitored Bed Unit" or "MBU" refers to each area of a facility that focuses on patients who are acutely ill but with a reversible disease. These patients require skilled nursing care, close observation, monitoring and management. All patients, who in the opinion of the attending physician are critically ill, unstable or require intensive monitoring, can be admitted to a MBU.

(mm) "Multi Disciplinary Trauma Committee" means a committee within each of the designated facilities that provides oversight and leadership to the trauma program of that specific facility.

(nn) "Off-line administration" refers to establishment and monitoring of medical components of a medical system including protocols, standing orders, educational programs, and the quality and delivery of on-line medical supervision.

(oo) "On Call" means agreeing to be available to respond to the trauma center in order to provide a defined service. On call personnel shall be at the trauma center or hospital when their presence is required, in accordance with an on call roster, and either promptly available or readily available.

(pp) "On Site Survey Team" refers to a multi disciplinary group of individuals who are knowledgeable in trauma care and trauma care systems. A team will be charged with the duty to inspect and interview each hospital or facility for purposes of designation verification.

(qq) "Patient" means a sick, injured, incapacitated, or helpless individual who requires medical supervision, treatment, or monitoring.

(rr) "Pediatric Advanced Life Support" or "PALS" means a course of training available through the American Heart Association. When required by these rules, medical personnel shall maintain PALS certification.

(ss) "Peer Review Process" means the review of professional practices within a health care facility for the purpose of reducing morbidity and mortality and for the improvement of care of patients in the facility.

(tt) "Physician" means a doctor of medicine or osteopathy licensed by the Board of Medicine to practice medicine and/or surgery under state law by the board.

(uu) "Poor" means any patient at or below 300% of the federal poverty level.

(vv) "Prehospital Provider" means personnel who are certified or who are licensed and function at any level in actually delivering prehospital care.

(ww) "Promptly Available" refers to those personnel who can be attending patients at the hospital or health care facility within a maximum of thirty (30) minutes from the time they are called.

(xx) "Protocol" means a written instrument that guides the collection of data regarding the patient, provides for actions to be taken based on the collected data, and provides for a minimum level of safe practice in specific situations.

(yy) "Quality Assurance" or "QA" means the evaluation of the performance of a hospital's or system's response to a given standard.

(zz) "Quality Improvement" or "QI" means a quality evaluation program that is on-going, team led, and research driven. QI focuses on care and performance improvement. QI emphasizes seeking ways to improve service, deliver care, manage resources, and develop professional competence.

(aaa) "Readily Available" refers to personnel who can be attending patients at the trauma center or hospital, within a maximum of one (1) hour from the time they are called.

(bbb) "Regional Advisory Council" or "RAC" means a council consisting of representatives of the Trauma Service Area (TSA), that provides consultation, education, and quality review for the member hospitals and health care facilities.

(ccc) "Regional Trauma Center" or "RTC" means a designated facility that has the medical staff and facilities to provide advanced care to trauma patients and serves as a referral hospital for the ATH, CTH, and Trauma Receiving Facility (TRF).

(ddd) "Registered Nurse" means a person who is licensed as a registered professional nurse in the state of Wyoming.

(eee) "Site Survey" means an on site review of a facility to determine if it meets the criteria for a particular level of designation or re-designation.

(fff) "State Trauma Plan" or "Trauma Care System" means a comprehensive plan, as required by W.S. 35-1-801, designed to organize Wyoming's health care facilities to more efficiently care for trauma patients.

(ggg) "Trauma" means a physical wound or injury, including a blunt injury, penetrating injury, or burn injury caused by external force or violence.

(hhh) "Trauma Care System" or "Trauma System" means an organized approach

to providing care to trauma patients that provides personnel, facilities, and equipment for effective and coordinated trauma care.

(iii) "Trauma Care Services" or "Traumatic Care" means services to patients with at least one (1) injury diagnosis code, using the International Classification of Diseases, 9th Edition, from 800.0 through 904, 925 through 929, 940 through 959.9, and 994.7, plus at least one (1) of the following:

(i) Hospitalization for one (1) calendar day;

(ii) Admission to the intensive care unit or monitored bed unit;

(iii) Cardiac or respiratory arrest on route to the hospital or emergency room;

(iv) Dead on arrival at the facility;

(v) Transfer from or to another acute care hospital;

(vi) Admission directly from the emergency room to the operating room;

(vii) Trauma team activation;

(viii) Meets prehospital triage criteria;

(ix) Ambulance services providing transportation to a hospital or emergency room.

(jjj) "Trauma Program Coordinator" means a registered nurse with significant experience managing trauma systems and data. This individual is employed by the OEMS to assist with the management of the Wyoming Trauma System.

(kkk) "Trauma Nurse Coordinator" means a registered nurse with specific experience in coordination of nursing of trauma patients and assumes the responsibility for or monitors the care of trauma patients throughout a hospital or facility.

(lll) "Trauma Patient" means a person who has sustained an acute injury.

(mmm)"Trauma Receiving Facility" or "TRF" means a designated facility that may include a hospital with no surgical coverage, to a small rural clinic. These facilities will provide initial resuscitation and stabilization and, as needed, will transfer critically injured patients to a higher level trauma facility.

(nnn) "Trauma Registry" means a comprehensive system established to facilitate data collection and processing from all Wyoming's designated trauma facilities. A registry is a statewide database which integrates medical and system information related to trauma patient diagnosis and the provision of trauma care by prehospital, hospital, rehabilitation centers, providers, and medical examiners. The data base is used to monitor trauma patient outcomes.

(ooo) "Trauma Service Area" or "TSA" means a geographic area designated by the OEMS for the purpose of developing a trauma system that is consistent with patient care and transport needs of the local hospitals and health care facilities.

(ppp) "Trauma Service Costs" means costs related to a facility's provision of trauma care to patients. These may include but are not limited to trauma team activation and the provision of staff for trauma call.

(qqq) "Trauma Transport Protocols" or "TTPs" refers to a document or group of documents which describes the policies, processes, and procedures governing the dispatch of vehicles, and the triage and transport of trauma patients or pediatric trauma patients.

(rrr) "Triage" means a process used to sort patients and determine priority of need and proper place of treatment.

(sss) "Verification" means a professional process based on a facility's performance and compliance with established guidelines. Verification involves a site survey and attempts to measure the facility's commitment to trauma care.

(ttt) "Waiver from Designation" means a hospital or medical facility that does not hold itself out to receive trauma patients and does not maintain an emergency department.

(uuu) "Wyoming Office of Emergency Medical Services" or "OEMS" means the Wyoming Department of Health's lead agency for emergency medical services and trauma services in the state.

(vvv) "Wyoming Trauma Coalition" or "WTC" is a group of interested health professionals and citizens established by the OEMS for the purpose of making recommendations to develop and direct the trauma system as needed.

Section 4. General Organization of Trauma Plan.

(a) OEMS shall:

(i) Collect and compile information concerning:

(A) Clinical components of the Trauma System:

(I) Public information, education, and prevention;

(II) Prehospital care;

(III) Medical direction;

(IV) Triage; and

(V) Transportation.

(B) Evaluation components of the Trauma System:

(I) Data collection; and

(II) Trauma center quality improvement.

(III) Standards of care and facility standards which include the designation of hospitals or health care facilities.

(ii) Establish a system for:

(A) Verification and designation of trauma facilities; and

(B) A mechanism for statewide trauma system evaluation.

(b) Wyoming Trauma Coalition.

(i) The WTC shall consist of:

(A) The Trauma Program Coordinator;

(B) The medical director of the trauma program;

(D) A representative from the American College of Surgeons Committee on Trauma;

(E) A representative from the Wyoming Nurses Association and/or the Wyoming Emergency Nurses Association;

(F) A certified EMT-Basic, EMT-Intermediate, and an EMT- Paramedic;

(G) A representative from the Wyoming Chapter of American College of Emergency Physicians;

(H) A representative from the Wyoming Chapter of American Academy of Family Physicians;

(I) At least one (1) medical director and one (1) trauma nurse coordinator from each of the Regional Trauma Centers and at least one (1) medical director or physician from an Area Trauma Hospital, Community Trauma Hospital, or Trauma Receiving Facility selected so as to include as many different regions of the state as possible;

(J) A representative from the Wyoming Hospital Association; and

(K) A representative from the Wyoming State Medical Society.

(ii) The WTC shall provide a consultation, education, and quality review role. The Committee shall review regional trauma care delivery, patient care outcomes, and compliance with the requirements of these Chapters. The Committee will provide the following:

(A) Communication with:

(I) Regional Advisory Councils (RACs) of each TSA;

(II) Participating facilities;

(III) Wyoming Department of Health;

(IV) Prehospital providers;

(V) Professional organizations; and

(VI) The general public.

(B) Education of all constituents and organizations in the delivery of trauma and emergency medical care;

(D) Recommendations to RACs and participating facilities for regional trauma planning;

(E) Recommendations to RACs and participating facilities for policy development; and

(F) Injury prevention recommendations.

(iii) The WTC shall provide for quality improvement (QI) in the statewide trauma system.

(iv) The WTC shall have a written plan for implementation that will describe:

(A) Scope of trauma and emergency services offered in the regions;

(B) Ongoing assessment of performance of the regional EMS and trauma care system, based on data supplied by the trauma registry and other sources including, but not necessarily limited to:

(I) Trauma care delivery;

(II) Patient care outcomes, including pediatric and adult patient outcomes;

(III) Unexpected deaths; and

(IV) Compliance with the requirements of W.S. 35-1- 801, et. seq., and this Chapter.

(D) Periodic assessment of data concerning aspects of patient care;

(E) Policies regarding confidentiality of data elements related to identification of provider's and facility's care outcomes, in accordance with applicable state and federal laws and regulations;

(F) Policies regarding confidentiality and release of patient care quality assurance committee minutes, records, and reports in accordance with applicable state and federal laws and regulations, including a requirement that each attendee of a RAC meeting is informed in writing of the confidentiality requirement. Information identifying individual patients shall not be publicly disclosed without the patient's consent or by court order;

(G) Policies regarding confidentiality of documentation of the results of inquires involving patient care issues; and

(H) Provision for feedback to the OEMS and the RAC on identified EMS and trauma system issues and concerns.

(v) It is desirable that the Committee meet on a quarterly basis, with meetings held in rotating locations or utilizing compressed video to assure easy access for Committee members.

(c) Advertising / Marketing. Only a facility which has been designated and continues to maintain designation by the Wyoming Office of Emergency Medical Services may use the terms "designated trauma center, service, unit, facility, program, hospital," or any similar terms in advertising or marketing materials, or in any other way hold itself out to the public as providing trauma treatment or services of the type offered by the designated facilities listed above and described in these rules.

Section 5: Severability. If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in full force and effect.

Section 6: Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department including manuals, bulletins, and policy statements, which are inconsistent with this Chapter.

Section 7: Effective Date. These rules are effective when duly approved and filed by the Secretary of State.

1-12

History

Effective 2008-11-20

Chapter 2 Designation Process

Wyo. Code R. 048.0056.2.11202008 Designation Process

Chapter 2

DESIGNATION PROCESS

Section 1. General Procedure.

(a) Trauma Care Facilities - Designation Process.

(i) The facility designation categories are as follows:

(A) Regional Trauma Centers (RTCs);

(B) Area Trauma Hospitals (ATHs);

(D) Trauma Receiving Facilities (TRFs).

(ii) The designation process shall consist of:

(A) Each facility providing information to the OEMS regarding that facility's capabilities as a trauma facility;

(B) A site survey as specified in Chapter 2, Section 1, (c);

(C) Identification of facility requirements that are not met by the facility. The OEMS shall provide advice and education to assist the facility in meeting these identified requirements; and

(D) Upon meeting the facility requirements, the OEMS shall assign a specific designation for a period of three (3) years.

(iii) The OEMS may provide consultation, advice, and/or technical assistance to facilities who request assistance in any aspect of this process. Telephone the OEMS Trauma Program Coordinator at (307) 777-7955.

(iv) The OEMS shall develop a designation criteria form for facilities seeking designation or renewal of designation as trauma care facilities. The form shall include:

(A) System standards for facility level and category of designation sought;

(B) Designation criteria form requirements;

(D) Goals and objectives of the facility;

(E) Capability to provide trauma care;

(F) Commitment to serve the trauma care needs of the state- wide system;

(G) Compliance with goals of the state trauma plan; and

(H) Geographic area for which the facility proposes to provide trauma care coverage.

(v) The OEMS's analysis of the submitted designation criteria form shall include a review of:

(A) The evidence of participation in system planning;

(B) The completeness of the form materials submitted; and

(vi) The facility shall:

(A) Submit designation criteria form to OEMS within ninety

(90) working days of receiving the these materials from the OEMS;

(B) Within thirty (30) working days of receipt of a form from the facility, the OEMS shall review the designation criteria form for completeness and notify the facility of the result of that review;

(I) If the form is complete, the facility shall be notified in writing;

(II) If the form is incomplete, the facility shall be notified in writing of omissions or errors. The facility may refile the form when complete; and

(vii) The OEMS may grant provisional designation, for a period not exceeding one (1) year, to facilities that are currently unable to meet the standards of this Chapter of these rules, in order to ensure adequate trauma care.

(viii) The OEMS shall;

(A) Conduct a site survey of each facility in accordance with this Chapter, Section 1 (b) (ii) (B) and Section 1 (c); and

(B) Consider applications for designation, if and when applications are received, from facilities located and licensed in adjacent states in the same manner as applications received from facilities located and licensed in Wyoming.

(ix) After an evaluation to determine the current capability of each facility to meet or exceed the requirements of this Chapter for the applicable level of designation applied for, the OEMS shall designate the health care facility, based on the following guidelines:

(A) Evaluation of the designation criteria form submitted;

(B) Recommendations from the on site survey team;

(C) For facilities that have been previously designated, outcomes of trauma patients during the previous designation period;

(D) Quality of care provided to patients residing in that area;

(E) Ability of each facility to comply with goals of the state and regional plan; and

(F) Compliance with these rules during the previous designation period.

(x) The OEMS shall:

(A) Notify the facility in writing of designation or denial of designation. This notification shall include a written report of the site survey; and

(B) Notify the OEMS and RACs of the name, location, level, and category of service of facilities that have been designated.

(xi) The OEMS shall issue a renewal designation criteria form as described in this section, for all interested health care facilities, including those currently designated, no later than one hundred twenty (120) working days prior to the expiration of each facility's current designation.

(b) Site survey for designation. The OEMS shall perform a site survey of all facilities prior to designation.

(i) The OEMS shall establish multi disciplinary on site survey teams composed of individuals knowledgeable in trauma care appropriate to the level of designation requested. On site survey team members may include:

(A) Trauma surgeons;

(B) Emergency physicians;

(D) Physicians knowledgeable in pediatric trauma;

(E) Family physicians;

(F) Hospital or medical administrators;

(G) OEMS personnel; and/or

(H) Other specialties as needed for the level and category applied for.

(ii) On site survey teams for Regional Trauma Centers and Area Trauma Hospitals will, consist of a general surgeon who is an out-of-state surveyor, an emergency physician, and a trauma nurse coordinator with experience in similar trauma systems.

(iii) On site survey teams for Community Trauma Hospitals and Trauma Receiving Facilities may be composed of in state surveyors, including a general surgeon, an emergency physician, and a trauma nurse coordinator.

(iv) The on site survey team shall evaluate the appropriateness and capabilities of the facility to provide high quality trauma care services, and validate the facility's ability to meet the responsibilities, equipment, and performance standards for the level of designation sought. The evaluation shall include, but not necessarily be limited to:

(A) Reviewing medical records, staff rosters, and schedules, quality assurance committee meeting minutes, and other documents relevant to trauma care;

(B) Reviewing equipment and the physical plant; and

(v) The on site survey team shall:

(A) Make a verbal report of findings to the facility prior to leaving the facility; and

(B) Make written recommendations to the OEMS in the format prescribed by the OEMS.

(vi) The OEMS shall review the report and recommendations to determine if the facility is substantially in compliance with the criteria. If the facility does not meet the criteria for the level of designation for which it applied, the OEMS, at its sole discretion, shall discuss designation at a lower level with the facility.

(vii) In the event there is an area in which the facility does not comply with the criteria, the OEMS shall within thirty (30) working days notify the facility, in writing, of deficiencies and recommend corrective action. The facility may submit to the OEMS a report which outlines the educational and corrective action taken. Before approving the designation, the OEMS may, at its sole discretion, elect to perform an on site inspection to confirm that the action taken brings the facility into compliance with all relevant criteria. If the OEMS elects not to perform an on site inspection and if the report substantiates action which brings the facility into compliance with all relevant criteria, the OEMS may approve the designation. If the facility disagrees that there is a need for corrective action, the facility may file a grievance according to Section 4 of these rules.

(viii) The OEMS shall require and maintain confidentiality of information, records, and reports developed pursuant to site surveys to the extent allowed by law. Members of the on site survey team shall not divulge any information obtained or included in reports submitted to the OEMS relating to the site survey, unless ordered to do so by a court of competent jurisdiction.

(ix) The facility may submit to the OEMS written objections to the report or recommendations or concerns regarding conflicts of interest pertaining to any member of the on site survey team.

(x) Applications from facilities located and licensed in adjacent states shall be treated in same manner as applications received from Wyoming facilities.

(i) Notify those facilities necessary for appropriate transfer of trauma patients as soon as possible before the applicable situation, if it anticipates being unable to comply with designation standards for twenty-four (24) hours or more1;

(ii) Immediately notify the OEMS, the WTC, and the RAC if it chooses to cease providing trauma services commensurate with its designation level. If the facility chooses to apply for a lower level of designation, it may do so at any time. This may be accomplished by initiating a new designation process as described in Section 1 of Chapter 2 of these rules. There shall be a paper review by the OEMS to determine if a full survey shall be required. This does not apply to temporary re-designation as described in Section 1 (d) (i) above. 1 Each facility shall develop written notification protocols.

(iii) Comply with the provisions within these sections, all current state and system standards as described in this Chapter, and all policies, protocols, and procedures set forth in the system plan;

(iv) Continue its commitment to provide the resources, personnel, equipment, and response as required by its designation level;

(v) Participate in the state trauma registry as described in Section 1 of Chapter 3 of these rules; and

(vi) Have a written transfer agreement with a receiving trauma facility (as appropriate) for the transfer of severely injured trauma patients. This transfer agreement shall include written guidelines for determining the basis for seeking consultation and arranging the transport of trauma patients. Trauma transport protocols must comply with current EMTALA and COBRA/OBRA regulations and shall include the following:

(A) The physician in the initial receiving facility shall be responsible for a decision to transfer a patient to another facility. Unless circumstances make such contact impossible, a physician or a physician-supervised mid-level practitioner in the initial receiving facility shall have direct contact with the physician at the accepting hospital before the transfer occurs;

(B) Once the decision to transfer has been made, it should be accomplished as soon as it is feasible. Resuscitation and stabilization should begin at the referring hospital, realizing that the patient's problems may be such that true stabilization may only be possible at another facility3. Transport decisions must comply with current EMTALA and COBRA/OBRA regulations;

(C) The mode of transportation used for transfer shall be determined based on time, medical interventions necessary for ongoing life support during transfer, and availability of resources. The referring and accepting physicians shall agree, prior to initiating transfer, who will assume responsibility for on-line medical control during transfer;

(D) All designated trauma services shall have written transfer agreements for the identification and transfer of patients with special care needs who meet interhospital transfer criteria; and

(E) Transfer agreements shall include the responsibility of the transferring hospital and of the receiving hospital and determine the method of assigning medical control during interhospital transfer. 2 The receiving facility may be an in state facility or an out of state facility. 3 All medical advanced directives shall be adhered to.

(d) The OEMS may at any time review, inspect, evaluate, and audit all trauma patient records, trauma quality assurance committee minutes, and other documents relevant to trauma care in any designated facility at any time to verify compliance with criteria. The OEMS shall maintain confidentiality of such records as required by federal and state statutes and rules. Such inspection shall be scheduled by the OEMS when appropriate.

(e) When a health care facility is designated or loses its designation as a trauma care facility, such information is not confidential and is considered public information.

(f) Whereby the OEMS may grant a waiver from designation to hospitals and medical facilities that do not maintain an emergency department or advertize to care for trauma patients.

Section 2. Plan Development.

(a) Facilities shall have a trauma plan that is consistent with the Wyoming Trauma Plan and these rules and shall include the following:

(i) Summary of the plan;

(ii) Organizational structure;

(iii) System design;

(iv) Objectives;

(v) Implementation schedule; and

(vi) Fiscal impact of the system.

(b) Regional Advisory Councils:

(i) The RAC shall develop a system plan based on standard guidelines for comprehensive system development. The system plan is subject to approval by the OEMS. The OEMS shall review the plan to assure that:

(A) All counties within the region have been included unless a specific county, or portion thereof, has been included within an adjacent system;

(B) All health care entities and interested speciality centers have been given an opportunity to participate in the planning process; and

(I) Access to the system;

(II) Communications;

(III) Medical oversight;

(IV) Prehospital triage criteria;

(V) Diversion protocols;

(VI) Bypass protocols;

(VII) Regional medical control;

(VIII) Facility triage criteria;

(IX) Inter-hospital transfers; and

(X) A quality improvement program that evaluates the outcome from a system perspective.

(ii) The RACs shall:

(A) Advise the OEMS concerning the statewide trauma system; and

(B) Establish trauma education and injury prevention programs.

(iii) The RAC is an entity which functions without the expectation of state or federal funding.

(iv) The RACs may request technical assistance from the OEMS.

(v) The RACs shall not require changes to referral or transport patterns for individual facilities.

(vi) The RAC shall provide a report by December 31 each year to the OEMS. This report shall describe the progress toward system development and include evidence that members of the RAC are currently involved in trauma care.

(i) Data and reports concerning peer review, quality improvement, or the quality of the trauma care provided by a health care facility or a health care provider that are produced by a RAC or the WTC or provided by a health care facility to a RAC or the WTC as well as the proceedings of those committees concerning peer review and quality improvement shall be confidential, as required by applicable federal and state laws and regulations.

(ii) A statistical report on trauma and trauma care developed by the OEMS that does not identify specific health care facilities, health care providers, or patients is not confidential and is considered public information.

Section 3. Policy Development. Health care facilities planning to implement a trauma system shall develop policies which, at a minimum, address the following:

(a) The multi disciplinary nature of systemized trauma care;

(b) Public information and education about the trauma system;

(d) Establishment of service areas for trauma hospitals;

(e) EMS dispatching;

(f) Communication system usage;

(g) Transportation, including inter-trauma center transfer and transfer from a receiving hospital to a trauma center;

(h) The integration of burn and pediatric hospitals, when applicable, into the overall Trauma Care System to ensure all trauma patients receive appropriate trauma care in the most expeditious manner possible;

(i) Training of prehospital EMS personnel;

(j) EMS and trauma care coordination and mutual aid between neighboring jurisdictions;

(k) Coordination and integration of trauma care with non-medical emergency services;

(l) Medical control and accountability, including triage and treatment protocols;

(m) System organization and management;

(n) Data collection and management;

(o) Quality control and system evaluation; and

(p) Assuring the availability of trauma team personnel.

Section 4. Denial, Revocation or Suspension of Designation and Appeals Process.

(a) OEMS shall deny an application for designation if it finds in the course of the designation process, that the applying facility:

(i) Is unable to meet the requirements of Chapter 4 of these rules for the level of designation sought;

(ii) Made a false statement of a material fact in its application for designation;

(iii) Refuses to allow representatives of the OEMS to inspect any part of the facility, records, documentation, or files;

(iv) Is unable to meet or comply with the requirements of the approved trauma plan;

(v) Refuses to submit data to the state trauma registry as described in Chapter 3, Section 1 of these rules; or

(vi) Has engaged in unauthorized disclosure of medical or other confidential information.

(b) OEMS shall revoke or suspend designation if any owner, officer, director, or managing employee of a designated facility:

(i) Fails to comply with Section 5 (e) of the State of Wyoming Department of Health Standards, Rules, and Regulations for Hospitals and Related Facilities;

(ii) Fails or refuses to comply with the provisions of this Chapter or Chapter 4 of these rules;

(iii) Fails to provide data to the trauma registry;

(iv) Makes a false statement of a material fact in the application for designation or in any record required by this Chapter or in a matter under investigation;

(v) Prevents, interferes with, or attempts to impede in any way, the work of a representative of the OEMS in the lawful enforcement of this Chapter;

(vi) Misrepresents or is fraudulent in any aspect of conducting 2-10 business, or has been unable or refuses to comply with OEMS requirements; or

(vii) Is substantially out of compliance with the requirements of this Chapter and Chapter 4 of these rules, and has been unable to or refused to comply with OEMS requirements.

(c) The OEMS shall notify a facility in writing of denial, revocation, or suspension of designation. Such notice shall include:

(i) The reasons for the action; and

(ii) Rights of the facility, which include a right to hearing, and may also include the opportunity to submit a plan of correction.

(A) The designated facility found out of compliance with Chapter 4 and this Chapter of these rules shall within thirty (30) working days, submit a plan of correction to the OEMS. The plan shall include steps the facility is to take to correct deficiencies. The OEMS shall provide assistance to the facilities that are out of compliance in order to bring the facility into compliance with these rules.

(B) When the facility submits a plan of correction, the OEMS shall approve or disapprove the plan within thirty (30) working days, unless the OEMS, at its sole discretion, elects to perform a site survey of the facility, in which case the OEMS shall approve or disapprove the plan within sixty (60) working days.

(C) Upon notification that the plan of correction is approved by OEMS, the facility shall implement that plan immediately.

(D) Upon the receipt of satisfactory evidence of correction, which may include a site survey, the OEMS may, at its sole discretion, reinstate designation status.

(E) The facility may appeal decisions of denial, suspension, or revocation of designation. Appeals will be addressed to the OEMS, Department of Health, Hathaway Building, Cheyenne, WY, 82002. Any appeal of the OEMS' decision shall be conducted in accordance with the Wyoming Administrative Procedure Act (W.S.16-3-101 through W.S. 16-3-115).

(d) Designation shall, unless earlier evoked or suspended, expire three (3) years after the date of award unless the designee has made a timely and sufficient request for renewal of the designation.

(e) OEMS shall conduct a site survey to inspect the facilities of all applicants, during the initial designation of the trauma facility and the renewing verification of such designation, for compliance of this part and Chapter 4 of these rules. A report of inspection shall be provided to the OEMS within thirty (30) working days after the site survey. Within thirty (30) working days of receipt of the inspection report, the OEMS may accept or reject the plan for designation based upon the findings and recommendations of such reports.

History

Effective 2008-11-20

Chapter 3 Designation Facilities' Requirements For Participation

Wyo. Code R. 048.0056.3.11202008 Designation Facilities' Requirements For Participation

Chapter 3

DESIGNATED FACILITIES' REQUIREMENTS FOR PARTICIPATION

Section 1. Data Collection. For the purpose of improving quality of trauma care, all designated facilities within the state are required to participate in use of the state trauma registry and report a portion of that data to OEMS for systems evaluation.

(a) The OEMS shall:

(i) Establish a statewide data registry to collect and analyze data on the incidence, severity, and causes of trauma for the purposes of:

(A) Improving trauma patient care;

(B) Monitoring and providing information necessary to evaluate major trauma patient care and outcome;

(C) Assessing compliance with the standards of state trauma system operation and designation of prehospital providers, health care facilities, hospitals, and rehabilitation services;

(D) Providing information necessary for resource planning and management;

(E) Providing data for injury surveillance, analysis, and prevention programs; and

(F) Providing a resource for research and education.

(ii) Establish criteria to identify injury types to be included in the state trauma registry. These criteria shall be used by designated health care facilities.

(iii) Suggested sources of data for the trauma registry include but are not limited to:

(A) All prehospital providers;

(B) Medical examiners reports;

(D) Wyoming Fire Incident Report System;

(E) Hospital discharge data;

(F) Law enforcement agency records; and

(G) Other sources, as available.

(iv) Establish, publish, and periodically review the required data elements to be submitted to provide information regarding injury, trauma care, and system operation, in the following categories:

(A) Demographic;

(B) Anatomic;

(D) Severity;

(E) Epidemiologic;

(F) Resource utilization;

(G) Quality assurance;

(H) Outcome; and

(I) Financial.

(v) Require a case specific patient identifier which complies with the patient confidentiality requirements of these rules common to all data sources used in the trauma registry.

(vi) Provide procedures for electronic submission of data including specifications for necessary software, or provide paper forms for manual submission of data, if needed.

(vii) Provide for data quality assurance by:

(A) Developing detailed protocols for quality control, consistent with the OEMS's most current data quality guidelines;

(B) Performing validity studies to assess the completeness and accuracy of case identification and data collection; and

(C) For each provider submitting data to the registry, providing a report on completeness and accuracy of data submitted.

(viii) Evaluate requests from the WTC and RACs for collection of voluntarily submitted additional data elements from agencies and facilities in that region.

(b) The prehospital data shall include at least the following, when applicable:

(i) Total number of ambulance runs per year;

(ii) Number of trauma runs per year;

(iii) Transportation times; and

(iv) Patient outcomes.

(i) Data from a trauma center or hospital:

(A) Time of arrival and description of patient treatment in:

(I) Emergency department or trauma receiving area; and

(II) Operating room.

(B) Dates for:

(I) Initial admission;

(II) Intensive care; and

(III) Discharge.

(I) Patient destination; and

(II) Patient outcome after rehabilitation.

(ii) Data from an intermediary hospital. In the event that a patient is first transported to a receiving hospital and subsequently transferred to another facility, the applicable information from the sections above shall be available from patient care. All related records will be supplied by the hospital the patient is transferred to and sent to the transferring hospital for entry into the trauma registry.

(d) Trauma Registry- Reports. Within three (3) months after receiving trauma registry data from the individual hospitals and facilities, the OEMS shall report to the submitting facilities:

(i) Semiannually and annually on all patient data entered into the trauma registry during the six (6) month reporting period;

(ii) Semiannually, on trends, patient care outcomes, and other data, for each region and for the state, for the purpose of regional evaluation; and

(iii) Periodically on reported financial data.

(iv) Aggregate regional data semiannually to the WTC and the Regional Advisory Council excluding any confidential or identifying data.

(e) Confidentiality. Patient identifiers shall be kept in such a way to assure that patient confidentiality is maintained. The OEMS shall comply fully with all federal and state laws and regulations concerning confidentiality.

(i) Data elements related to the identification of individual patient's, provider's, and facility's care outcomes shall be confidential and the OEMS shall comply with all federal and state laws and regulations concerning confidentiality.

(ii) Persons and organizations to whom the OEMS grants access to information collected under this Chapter shall use the information for only those purposes explicitly stated in the OEMS authorization for access.

(iii) All raw data collected and maintained by the OEMS is the property of OEMS.

(f) Provider Responsibilities.

(i) All facilities shall:

(A) Use the criteria set forth by the OEMS for inclusion of patient data in the trauma registry; and

(B) Submit required registry data to the OEMS.

(ii) Data collected shall be recorded upon the registry software provided by the OEMS, using the data elements provided.

(iii) Data shall be submitted to the OEMS on a semi-annual basis:

(A) Data for patients discharged between July 1 and December 31 shall be submitted by June 30 of the following year; and

(B) Data for patient discharged between January 1 and June 30, shall be submitted by December 31 of the same year.

(iv) If the patient is further transported from one acute care hospital to another acute care hospital, a follow-up report of the care the transferred patient received and the final disposition of the patient shall be provided by the receiving hospital to the transferring hospital. The transferring hospital shall complete the trauma registry data for that patient, based upon the information it receives.

Section 2. Trauma System Evaluation. All designated facilities will be required to participate in quality initiatives within these rules.

(a) The following key components shall be addressed by the quality improvement plan designed by each facility:

(i) Clearly stated goals and objectives;

(ii) An organizational structure which facilitates the process of quality improvement;

(iii) The development of standards of care;

(iv) Established quality indicators (audit filter);

(v) A plan to define adverse outcomes by using a code that describes the complications;

(vi) A systematic peer review process utilizing a multi disciplinary method and involving prehospital care providers;

(vii) A plan to incorporate autopsy information, where available, regarding all trauma patients; and

(viii) A facility plan that includes a method for computing survival probability and comparing patient outcome.

(b) All designated trauma care services shall:

(i) Document the trauma care quality assurance program's proceedings, findings, conclusions, recommendations, the actions taken, and the result of these actions, demonstrating that relevant findings are used to study and improve processes that affect trauma patient care;

(ii) Evaluate the results of the trauma quality assurance program and include them with the hospital's general quality assurance program; and

(iii) Participate in the state trauma registry as required by Section 1 of Chapter 2.

(c) A standard or protocol adopted or studied by the individual facilities may not be used by the OEMS to demonstrate negligence by a health care provider or health care facility to whom the standard or protocol applies.

Section 3: Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department including manuals, bulletins, and policy statements, which are inconsistent with this Chapter.

History

Effective 2008-11-20

Chapter 4 Facility Standards

Wyo. Code R. 048.0056.4.11202008 Facility Standards

Chapter 4

FACILITY STANDARDS

Section 1. Regional Trauma Centers. To be designated a Regional Trauma Center (RTC), a licensed general acute care hospital shall have at least the following:

(a) Hospital Organization.

(i) Trauma Service. The trauma service shall be established and recognized by the medical staff and its bylaws and be responsible for the overall coordination and management of the system of care rendered to the injured patient. The trauma service must come under the organization and direction of a general surgeon or emergency physician who is trained, experienced, and committed to the care of the injured patient. All patients with multiple system trauma or major injury must be evaluated by the trauma service. The surgeon or emergency physician responsible for the overall care of each patient must be specifically identified.

(ii) Trauma Program Director. The director must be a board certified surgeon or a board certified emergency physician with demonstrated competency in trauma care. The director shall develop a quality improvement process and, through this process, shall be responsible for all trauma patients and administrative authority for the hospital's trauma program. The director shall be given administrative support to implement the requirements specified by the Wyoming Trauma Plan. The director shall work with the credentialing process of the hospital and participate with the credentialing committee to recommend participation on the trauma team4. The trauma director or his designee shall be actively involved with trauma care development at the community, state, and national level.

(iii) Trauma Team. The hospital shall have a policy describing the respective roles of all personnel on the trauma team. The composition of the trauma team in any hospital will depend on the characteristics of that hospital and its staff. The team leader shall be a qualified surgeon or emergency physician who is clinically capable in all aspects of trauma care. Suggested composition of the trauma team may include:

(A) Surgeons;

(B) Anesthesiologists;

4 It is strongly recommended that the director be an instructor in the American College of Surgeons Advanced Trauma Life Support (ATLS) course and maintain current ATLS certification or maintain certification of attendance to an American College of Emergency Physicians (ACEP) accredited trauma conference every two (2) years, maintain personal involvement in care of the injured, be educated in trauma care, and involved in professional organizations.

(D) Laboratory technicians;

(E) Registered nurses;

(F) Physician specialists as dictated by clinical needs;

(G) Prehospital care providers;

(H) Radiology technicians;

(I) Respiratory therapists; and

(J) Social services/pastoral care.

(iv) Qualifications for Surgeons on the Trauma Team. As a general rule, all surgeons on the trauma team shall be board certified in a surgical specialty recognized by the American Board of Medical Specialties, the Canadian Board or the American Osteopathic Association. An exception to this rule is Oral and Maxillofacial Surgery. These physicians shall be board certified by the American Board of Oral and Maxillofacial Surgery5. The surgeons shall participate in the multi disciplinary trauma committee and the quality improvement process. All general surgeons participating on the trauma team shall be current in ATLS and be involved in continuing education specific to trauma sufficient to maintain quality patient care. This includes all residents.

(v) Trauma Nurse Coordinator. A RTC shall have a registered nurse working in the role of trauma nurse coordinator. Working in conjunction with the trauma director, the trauma nurse coordinator shall organize the program and all systems necessary for the multi disciplinary approach throughout the continuum of trauma care.

The trauma nurse coordinator shall coordinate optimal patient care for all injured patients6.

(vi) Multi Disciplinary Trauma Committee. The purpose of the committee is to provide oversight and leadership to the entire trauma program. The major focus shall be quality improvement activities, policy development, communication among all team members, development of standards of care, education, and outreach programs and working with appropriate groups for injury prevention. The clinical managers (or designees) of the organizational areas involved with trauma care shall play

5 It is understood that many boards require a practice period, and that complete certification may take three (3) to five (5) years after residency. If an individual has not been certified five (5) years after successful completion of residency, that individual is unacceptable for inclusion on the trauma team.

6 Recommended credentials for this position include: Certified Emergency Nurse (CEN), Trauma Nurse Core Course (TNCC) (or equivalent education), demonstrated expertise in trauma care, five (5) or more years clinical nursing experience, experience with hospital quality assurance programs including a trauma registry, experience in education program development and membership in professional organizations.

an active role with the committee. The committee shall include representatives from each of the following areas, unless the hospital has no such organizational area defined:

(A) Administration;

(B) Anesthesia;

(D) Family Practice Residency Program;

(E) Intensive Care;

(F) General Surgery;

(G) Laboratory;

(H) Medical Records;

(I) Neurosurgery;

(J) Nursing;

(K) Operating Room;

(L) Orthopedics;

(M) Pediatrics;

(N) Prehospital care providers;

(O) Radiology;

(P) Rehabilitation;

(Q) Respiratory Therapy; and

(R) Trauma Nurse Coordinator.

(b) Clinical Components.

(i) A RTC shall have the following medical specialists available to the injured patient:

(A) Emergency Medicine in house twenty-four (24) hours per day;

(B) Trauma/General Surgery; and

(ii) The following specialists shall be on call and promptly available from inside or outside the hospital:

(A) Cardiology;

(B) Internal Medicine;

(D) Obstetrics/Gynecological Surgery;

(E) Ophthalmic Surgery;

(F) Oral/Maxillofacial;

(G) Plastic Surgery/ENT;

(H) Orthopedic Surgery;

(I) Pediatrics;

(J) Physical Medicine and Rehabilitation;

(K) Pulmonary/Intensive Care Medicine;

(L) Radiology;

(M) Thoracic Surgery;

(N) Urologic Surgery; and

(O) Vascular Surgery.

(iii) It is desirable to have the following specialists available to a RTC:

(A) Cardiac Surgery;

(B) Hand Surgery;

(D) Microvascular Surgery.

(iv) The staff specialist on call shall be notified at the discretion of the trauma surgeon or emergency physician and will be promptly available. This availability will be monitored continuously by the quality improvement program. The specialist involved for consultation to the trauma patient shall be appropriately board certified and have an awareness of the unique problems of trauma patients.

(v) A general/trauma surgeon shall be qualified and have privileges to provide thoracic surgical care to patients with thoracic injuries. In instances where this is not feasible, the hospital shall apply for a waiver from the OEMS which at its sole discretion can grant such a waiver.

(vi) Policies and procedures shall be in place to notify the patient's primary physician of the patient's condition.

(i) Emergency department.

(A) The hospital shall have an emergency department, division, service, or section staffed so that trauma patients are assured immediate and appropriate initial care. The emergency physician shall be in house twenty-four (24) hours per day and immediately available at all times, capable of evaluating trauma patients, providing initial resuscitation, and performing necessary surgical procedures not requiring general anesthesia.

(B) The emergency department medical director shall be board certified in emergency medicine7.

(C) The emergency medicine physician shall activate the trauma team based on predetermined criteria8. He will provide team leadership and care for the trauma patient until the arrival of the trauma surgeon in the resuscitation area. The emergency department shall have established standards and procedures to ensure immediate and appropriate care for the adult and pediatric trauma patient. The emergency department medical director or his designee shall participate with the multi It is highly recommended that the emergency medical physician be currently certified in ATLS or maintain certification of attendance to an ACEP accredited trauma conference every two (2) years. It is recommended that the emergency medicine physician participating with the trauma team should be board certified in a specialty recognized by the American Board of Medical Specialties, the Canadian Board, or the American Osteopathic Association. It is understood that many boards require a practice period, and the complete certification may take three (3) to five (5) years after residency. If an individual has not been certified five (5) years after completion of a residency, that individual is unacceptable as the medical director of the emergency department. Each facility may develop local written protocol for the activation of the trauma team. disciplinary trauma committee and the trauma quality improvement process.

(D) General/Trauma Surgeon.

(I) A general/trauma surgeon shall be available on call twenty-four (24) hours per day to respond to the emergency department as requested. The trauma surgeon on call shall be promptly available to respond to the trauma patient. Local criteria shall be established to define conditions requiring the trauma surgeon's immediate hospital presence. The trauma surgeon's participation in major therapeutic decisions and presence in the emergency department for major resuscitation is highly recommended. The trauma surgeon's presence at operative procedures is mandatory. A system shall be developed to assure early notification of the on call surgeon and compliance with this criteria and their appropriateness must be monitored by the hospital's trauma quality improvement process. The surgeon shall maintain current certification in ATLS.

(II) The surgeon shall, in conjunction with the emergency physician, make key decisions about management of the trauma patient's care and determine if the patient needs transport to a higher level of care. If transfer is required, either the surgeon or emergency physician shall be accountable to coordinate the process with the receiving physician at the receiving facility. Generally, if an injured patient requiring surgery is to be admitted to the RTC, the surgeon shall be the admitting physician and will coordinate the patient care while hospitalized. Guidelines shall be written at the local level to determine which types of patients should be admitted to the RTC and which patients should be considered for transfer to a higher level of care.

(E) Nursing Personnel.

(I) Emergency nurses shall have special expertise in trauma care9.

(II) There shall be a minimum of two (2) registered nurses available in house twenty-four (24) hours per day to staff the emergency department to meet the needs of the trauma patient.

(ii) Surgical Suites. The surgical team is not required to be in house twenty-four (24) hours per day. This requirement may be met by a technician or nurse who is capable of responding to the trauma resuscitation area, anticipating the operative needs of the patient, initiating the call process for on call staff, and preparing the operating room for the patient. A team shall be on call with a well-defined mechanism/criteria for notification.

(A) Nursing Personnel. Surgical nurses shall participate in the It is highly recommended that emergency nurses demonstrate successful completion of TNCC (or equivalent education), evidence of continuing education in trauma nursing, and participation in the ongoing quality improvement process of the trauma program. care of the trauma patient and be competent in the surgical stabilization of the major trauma patient. Surgical nurses shall be trained in principles of resuscitation, mechanism of injury theory, multiple systems trauma, and knowledge of surgical instrumentation. The surgical nurses are integral members of the trauma team and shall participate in the ongoing quality improvement process of the trauma program and shall be represented on the multi disciplinary trauma committee.

(B) Policies and Procedures. Policies and procedures shall be in place for the following:

(I) Prioritized room availability for the emergency trauma patient during a busy operating schedule;

(II) Notification of on call surgical teams for both single and multiple patient admission;

(III) Managing death in the operating room and facilitating the organ procurement process;

(IV) Preservation of evidence;

(V) Patient monitoring by a registered nurse while the patient is in transport to the radiology suite or intensive care unit (ICU) from the operating room; and

(VI) In hospital access of blood and blood products to the operating room.

(C) Anesthesia. Anesthesia shall be promptly available with a mechanism established to ensure early notification of the on call anesthesiologist. Local criteria shall be established to determine when the anesthesiologist shall be immediately available for airway emergencies and operative management. The anesthesiologist participating on the trauma team shall be appropriately board certified or board eligible, have the necessary educational background in the care of the trauma patient, and participate in the multi disciplinary trauma committee and the quality improvement process.

(iii) Intensive Care Unit. The RTC shall have an ICU which meets the requirements of licensure in the state of Wyoming. Additionally the ICU shall have:

(A) Medical Director. The medical director for the ICU is responsible for the quality care and administration of the ICU. The trauma program director or his designee will work collaboratively with the ICU medical director to set policy and establish standards of care to meet the unique needs of the trauma patient.

(B) Physician Coverage. Trauma patients admitted to the ICU

shall be admitted under the care of a general surgeon or a qualified board certified physician who is knowledgeable about the care of ICU patients. Guidelines may be written for the rare exception to this rule (e.g., isolated head injury that the neurosurgeon agrees to manage). In addition to overall responsibility for patient care by the primary surgeon or ICU physician, there shall be in house physician coverage for intensive care at all times. This coverage may be provided by a physician who is approved by the director of the ICU. This coverage is for emergencies only (e.g., an unexpected extubation of an ICU patient) and is to ensure the patient's immediate needs are met while the identified surgeon or physician is contacted.

(C) Nursing Personnel. RTCs shall provide staffing in sufficient numbers to meet the critical needs of the trauma patient. Critical care nurses shall show evidence of completion of a structured in-service program which includes didactic and clinical content related to the care of the trauma patient10. ICU nurses are an integral part of the trauma team and as such, shall be represented on the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(iv) Post Anesthesia Recovery Room (PAR room). A RTC shall have a PAR room with staff on call twenty-four (24) hours per day and available to the postoperative trauma patient. PAR room staffing shall be as required for the critical needs of the trauma patient. Frequently it is advantageous to bypass the PAR room and directly admit to the ICU. In this instance, these requirements may be met by the ICU.

PAR room nurses shall provide evidence of completion of a structured in-service program which includes didactic and clinical content related to the care of the trauma patient. PAR room nurses are an integral part of the trauma team and as such, shall be represented in the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(d) Clinical Support Services.

(i) A RTC shall have the following service capabilities:

(A) Radiological Service. A radiological service shall have a licensed radiological technician in house and immediately available at all times for general radiological procedures, angiography, imaging services, sonography, and computerized tomography (CT), for both head and body. If a technician is not in house twenty-four (24) hours per day for CT, angiography or sonography, the quality improvement process must document and monitor that the procedure is promptly available. A board certified radiologist shall administer the department and participate actively in the trauma quality improvement process. Written policy shall delineate the prioritization/availability of the CT scanner for trauma patients;

(B) Clinical Laboratory Service. Sufficient numbers of clinical It is highly recommended that nurses in the ICU demonstrate special expertise in critical care by acquisition and maintenance of a CCRN certification. laboratory technologists shall be promptly available at all times. A clinical laboratory service shall have the following services available twenty-four (24) hours per day:

(I) Comprehensive blood bank or access to a community central blood bank and adequate storage facilities;

(II) Standard analysis of blood, urine, and other body fluids;

(III) Blood gas and pH determinations. (This function may be performed by providers other than the clinical laboratory service, when applicable); and

(IV) Massive transfusion policy.

(D) Social Service/Pastoral Care Support. The nature of traumatic injury requires that the psychological needs of the patient and family are considered and addressed in the acute stages of injury and throughout the continuum of recovery. Adequate numbers of trained personnel shall be readily available to trauma patients and their families. Programs shall be available to meet the unique needs of the trauma patients and their families.

(E) Rehabilitation. At the earliest stage possible after admission to the trauma center, each RTC shall address a plan for integration of rehabilitation into the acute and primary care of the trauma patient,. Designated hospitals shall identify a mechanism to initiate rehabilitation services and/or consultation upon admission as well as policies regarding coordination of the multi disciplinary rehabilitation team. Policies shall be in place to address the coordination of transfers between acute care facilities and rehabilitation facilities. Transfer agreements shall include a feedback mechanism for the acute care facilities to update the health care team on the patient's progress and outcome for inclusion in the trauma registry.

(F) Outreach. As a RTC, the trauma program shall develop programs for consultation with physicians in the region. Additionally, the trauma center shall provide leadership in professional education programs for prehospital care providers, nurses, and physicians in the hospitals and clinics in their region.

(G) Prevention/Public Outreach. The RTC shall take a leadership role in coordination of appropriate agencies, professional groups and hospitals in their region to develop a strategic plan for public awareness. This plan shall take into consideration public awareness of the trauma system, access to the system, public support of the system, as well as specific prevention strategies. Substance abuse is consistently linked with traumatic injury and should be a key focus for prevention. Prevention

programs shall be specific to the needs of the region. Trauma registry data shall be utilized to identify injury trends and focus prevention needs.

(H) Transfer Protocol. RTCs shall work collaboratively with the referral trauma facilities in their region and develop interfacility transfer protocols.

These guidelines shall address criteria to identify high risk trauma patients that could benefit from a higher level of trauma care. All trauma facilities shall provide services to the trauma patient regardless of their ability to pay. All transfer protocols shall be written in accordance with COBRA/OBRA and EMTALA regulations. Transfer protocols shall be written for specialty referral centers such as burn or spinal cord injury centers if the services are not available at the trauma center. The transfer agreement shall include a feedback loop so the primary provider has a good understanding of the patient outcome.

(I) Quality Improvement/Evaluation.

(I) All designated facilities shall participate in the trauma registry and submit data to OEMS as requested. The RTCs shall assist other facilities in their referral area in establishing the data collection process and, if necessary, provide data entry into the registry from abstracted patient records.

(II) Each RTC shall develop an internal quality improvement plan that, at a minimum, addresses the following key components11:

(1) An organizational structure which facilitates the process of quality improvement (multi disciplinary trauma committee);

(2) Clearly stated goals and objectives of the quality improvement plan;

(3) The development of standards of care;

(4) A process to delineate privileges for all physicians participating in trauma care;

(5) Participation in the trauma statewide registry;

(6) Established quality indicators (audit filters). The plan must include, at a minimum, the recommended audit filters by the ACS and the JCAHO. The plan shall define adverse outcomes by using an explicit list of well-defined complications;

(7) A systematic informed peer review process utilizing a multi disciplinary method including prehospital care providers; and It is highly recommended that the plan incorporate autopsy information on all trauma patients. Complete anatomical diagnosis of injury is essential to the quality of trauma care.

(8) A method for computing survival probability and comparing patient outcomes.

(III) The RTCs shall be required to take a lead role in the statewide WTC and the RAC of their TSA.

Section 2. Area Trauma Hospitals. An Area Trauma Hospital (ATH) is an acute care facility with the commitment, medical staff, personnel, and specialty training necessary to provide primary care to the trauma patient. An ATH shall provide initial resuscitation of the trauma patient and immediate operative intervention to control hemorrhage and to assure maximal stabilization prior to referral to a higher level of care. In many instances, patients will be maintained in the ATH unless the medical needs of the patient require a higher level of care. The decisions to transfer a patient rests with the physician attending the trauma patient. All ATHs shall work collaboratively with the Regional Trauma Centers, Community Trauma Hospitals and Trauma Receiving Facilities to develop transfer protocols and a well-defined transfer sequence.

(a) Hospital Organization.

(i) Trauma Program. The trauma program shall be established and recognized by the medical staff and hospital administration. The trauma program shall come under the overall organization and direction of a general surgeon or emergency physician who is trained, experienced, and committed to the care of the injured patient.

(ii) Trauma Program Director. The director must be a board certified surgeon or a board certified emergency physician with demonstrated competency in trauma care. The director shall develop a quality improvement process and through this process, shall be responsible for all trauma patients and administrative authority for the hospital's trauma program. The director must be given administrative support to implement the requirements specified by the Wyoming Trauma Plan. The director shall work with the credentialing process of the hospital and participate with the credentialing committee to recommend participation on the trauma team.12

(iii) Trauma Team. The hospital shall have a policy describing the respective roles of all personnel on the trauma team. The composition of the trauma team in any hospital will depend on the characteristics of that hospital and its staff. The team leader shall be a qualified physician who is clinically capable in all aspects of trauma resuscitation. Suggested composition of the trauma team may include:

(A) Surgeons, General, and Orthopedic; It is strongly recommended that the director be an instructor in the American College of Surgeons Advanced Trauma Life Support (ATLS) course, maintain current ATLS certification or maintain certification of attendance to an ACEP accredited trauma conference every two (2) years, and maintain personal involvement in care of the injured, education in trauma care, and involvement in professional organizations.

(B) Anesthesiologists;

(D) Family physicians;

(E) Laboratory technicians;

(F) Registered nurses;

(G) Physician specialists as dictated by clinical needs;

(H) Prehospital care providers;

(I) Radiology technicians;

(J) Respiratory therapists; and

(K) Social services/pastoral care.

(iv) Qualifications for Surgeons on the Trauma Team. As a general rule, all surgeons on the trauma team should be board certified in a surgical specialty recognized by the American Board of Medical Specialties, the Canadian Board or the American Osteopathic Association. An exception to this rule is Oral and Maxillofacial Surgery. These physicians should be board certified by the American Board of Oral and Maxillofacial Surgery.13 The surgeons shall participate in the multi disciplinary trauma committee and the quality improvement process. All general surgeons participating on the trauma team should be current in ATLS and be involved in continuing education specific to trauma sufficient to maintain quality patient care. This includes all residents.

(v) Trauma Nurse Coordinator. An ATH shall have a registered nurse working in the role of a trauma nurse coordinator. Working in conjunction with the trauma program director, the trauma nurse coordinator shall organize the program and all systems necessary for the multi disciplinary approach throughout the continuum of trauma care. The trauma nurse coordinator is responsible for coordinating optimal patient care for all injured patients. It is understood that many boards require a practice period, and that complete certification may take three (3) to five (5) years after residency. If an individual has not been certified five (5) years after successful completion of residency, that individual is ordinarily unacceptable for inclusion on the trauma team. Recommended credentials for this person include: Trauma Nurse Core Course (TNCC) (or equivalent education), Certified Emergency Nurse (CEN), demonstrated expertise in trauma care, five (5) or more years clinical nursing experience, experience with hospital quality assurance programs including a trauma registry, experience in education program development, and membership in professional organizations.

(vi) Multi Disciplinary Trauma Committee. The purpose of the committee is to provide oversight and leadership to the entire trauma program. The major focus shall be quality improvement activities, policy development, communication among all team members, development of standards of care, education and outreach programs and work with appropriate groups for injury prevention. The clinical managers (or designees) of the organizational areas involved with trauma care shall play an active role with the committee. The committee shall include representatives from each of the following areas, unless the hospital has no such organizational area defined:

(A) Administration;

(B) Anesthesia;

(D) General Surgery;

(E) Intensive Care;

(F) Laboratory;

(G) Medical Records;

(H) Nursing;

(I) Operating Room;

(J) Orthopedics;

(K) Pediatrics;

(L) Prehospital care providers;

(M) Radiology;

(N) Rehabilitation;

(O) Respiratory Therapy; and

(P) Trauma Nurse Coordinator.

(b) Clinical Components.

(i) An ATH shall have the following medical specialists available to the injured patient:

(A) Emergency Medicine in house twenty-four (24) hours per day;

(B) Trauma/General Surgery.

(D) Orthopedic Surgery;

(ii) The following specialists shall be on call and promptly available:

(A) Internal Medicine; and

(B) Radiology.

(iii) It is desirable to have the following specialists available to an ATH:

(A) Obstetrics/Gynecological Surgery;

(B) Pediatrics; and

(iv) The staff specialist on call shall be notified at the discretion of the trauma surgeon or the emergency physician and shall be promptly available. This availability shall be monitored continuously by the quality improvement program. The specialist involved for consultation to the trauma patient shall be appropriately board certified and have an awareness of the unique problems of trauma patients.

(v) A general/trauma surgeon shall be qualified and have privileges to provide thoracic surgical care to patients with thoracic injuries. In instances where this is not feasible, the hospital shall apply for a waiver from the OEMS, who at its sole discretion can grant such a waiver.

(vi) Policies and procedures shall be in place to notify the patient's primary physician of the patient's condition.

(i) Emergency Department.

(A) The hospital shall have an emergency department, division, service or section staffed so that trauma patients are assured immediate and appropriate initial care. ATHs shall have a physician in the emergency department twenty-four (24) hours per day capable of evaluating trauma patients and providing initial resuscitation and performing necessary surgical procedures not requiring general anesthesia.

(B) The emergency department shall have a designated medical director who is board certified in a specialty recognized by the American Board of Medical Specialties, the Canadian Board or the American Osteopathic Association.15

(C) All physicians covering the emergency department shall show commitment to trauma care by maintaining competency in resuscitation, airway management, central venous access, cervical immobilization and long bone fracture stabilization of the adult and pediatric trauma patient. This includes all residents.16

(D) The emergency medicine physician shall activate the trauma team based on predetermined criteria.17 The emergency department shall have established policies and procedures to ensure immediate and appropriate care for the adult and pediatric trauma patient. The physicians participating on the trauma team shall participate in CME activities related to trauma care, the multi disciplinary trauma committee and the trauma quality improvement process.

(E) General/Trauma Surgeon.

(II) The surgeon shall, in conjunction with the It is understood that many boards require a practice period, and the complete certification may take three (3) to five (5) years after residency. If an individual has not been certified five (5) years after residency, that individual is ordinarily unacceptable as the medical director of the emergency department. Current certification in ATLS is highly recommended or maintenance of certification of attendance to an ACEP accredited trauma conference every two (2) years. Each facility may develop local written protocol for the activation of the trauma team. Emergency physician, make key decisions about management of the trauma patient's care and determine if the patient needs transport to a higher level of care. If transfer is required, either the surgeon or emergency physician shall be accountable to coordinate the process with the receiving physician at the receiving facility. Generally, if an injured patient requiring surgery is to be admitted to the ATH, the surgeon shall be the admitting physician and will coordinate the patient care while hospitalized. Guidelines shall be written at the local level to determine which types of patients should be admitted to the ATH and which patients should be considered for transfer to a higher level of care.

(F) Nursing Personnel.

(I) Emergency nurses shall have special expertise in trauma care.18

(II) Adequate numbers of registered nurses shall be available in house twenty-four (24) hours per day to staff the emergency department to meet the needs of the trauma patient.

(ii) Surgical Suites. The surgical team is not required to be in house twenty-four (24) hours per day. A team shall be on call with a well-defined mechanism for notification to expedite admission to the operating room if the patient's condition warrants. The process shall be monitored continuously by the trauma quality improvement program. Surgical nurses shall be trained in principles of resuscitation, mechanism of injury theory, multi systems trauma, and knowledge of surgical instrumentation. The surgical nurses are integral members of the trauma team and shall participate in the ongoing quality improvement process of the trauma program and shall be represented on the multi disciplinary trauma committee.

(A) Policies and Procedures. Policies and procedures shall be in place for the following:

(I) Prioritized operating room availability for the emergency trauma patient during a busy operative schedule;

(II) Notification of on call surgical teams;

(III) Managing death in the operating room and facilitating the organ procurement process;

(IV) Preservation of evidence;

(V) Patient monitoring by a registered nurse while the patient is in transport to the radiology suite or ICU from the operating room; and

18 It is highly recommended that emergency nurses demonstrate successful completion of TNCC (or equivalent education), evidence of continuing education in trauma nursing, and participation in the ongoing quality improvement process of the trauma program.

(VI) Immediate access of blood and blood products to the operating room.

(B) Anesthesia. Anesthesia shall be promptly available with a mechanism established to ensure early notification of the on call anesthesiologist. Local criteria shall be established to determine when the anesthesiologist shall be immediately available for airway emergencies and operative management of the trauma patient. Anesthesia coverage may be provided by a CRNA who is supervised by an anesthesiologist as required for the CRNA's licensure. Local conditions shall be established to determine when the CRNA must be immediately available for airway emergencies and operative management. The availability of the anesthesiologist or the CRNA and the absence of delays in airway control or operative anesthesia shall be documented and monitored by the quality improvement process. The anesthesiologist/CRNA shall have the necessary education background in the care of the trauma patient, and participate in the multi disciplinary trauma committee and the trauma quality improvement process.

(iii) Intensive Care Unit. The ATH shall have an ICU which meets the requirements for licensure in the state of Wyoming. Additionally, the ICU shall have:

(A) Medical Director. The medical director for the ICU is responsible for the quality of care and administration of the ICU. The trauma program director or his designee shall work collaboratively with the ICU medical director to set policy and establish standards of care to meet the unique needs of the trauma patient.

(B) Physician Coverage. Trauma patients admitted to the ICU shall be admitted under the care of a general surgeon or a qualified board certified physician who is knowledgeable about the care of ICU patients. Guidelines may be written for the rare exception to this rule. In addition to overall responsibility for patient care by the primary surgeon or ICU physician, there shall be in house physician coverage for the ICU at all times. This coverage may be provided by a physician who is approved by the director of the ICU. This coverage is for emergencies only (e.g., an unexpected extubation of an ICU patient) and is to ensure the patient's immediate needs are met while the identified surgeon or physician is contacted.

(C) Nursing Personnel. ATHs shall provide staffing in sufficient numbers to meet the needs of the trauma patient. Critical care nurses should show evidence of completion of a structured ICU in-service program which includes didactic and clinical content related to the care of the trauma patient. ICU nurses are an integral part of the trauma team and shall be represented on the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(iv) Post Anesthesia Recovery Room (PAR room). An ATH shall have a PAR room with staff on call twenty-four (24) hours per day and available to the postoperative trauma patient. PAR room staffing shall be in sufficient numbers to meet the critical needs of the trauma patient. Frequently, it is advantageous to bypass the PAR room and directly admit to the ICU. In this instance, these requirements may be met by the ICU. PAR room nurses shall show evidence of completion of a structured in-service program which includes didactic and clinical content related to the care of the trauma patient. PAR room nurses are an integral part of the trauma team and, as such, shall be represented on the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(d) Clinical Support Services.

(i) An ATH shall have the following service capabilities:

(A) Radiological Service. A board certified radiologist or his designated mid-level practitioner shall be available to the facility for emergency procedures and on a routine basis to assure quality of services rendered. The radiologist is a key member of the trauma team and shall be represented on the multi disciplinary trauma committee. A licensed radiological technician shall be on call twenty-four (24) hours per day and readily available to meet the immediate needs of the trauma patient. The CT (specialty) technician may be on call from home with a mechanism in place to assure the technician is available. The quality improvement process shall verify all procedures are promptly available to the patient; and

(B) Clinical Laboratory Services. Sufficient numbers of clinical laboratory technologists shall be on call twenty-four (24) hours per day and promptly available at all times. The clinical laboratory service shall have the following services available twenty-four (24) hours per day:

(I) Comprehensive blood bank or access to a community central blood bank and adequate storage facilities;

(II) Standard analysis of blood, urine and other body fluids. Toxicology studies may be performed off site if necessary; and

(III) Blood gas and pH determinations. (This function may be performed by providers other than the clinical laboratory service, when applicable.)

(D) Social Service/Pastoral Care Support. The nature of traumatic injury requires that the psychological needs of the patient and family are considered and addressed in the acute stages of injury and throughout recovery. An ATH may utilize community resources as appropriate to meet the needs of the trauma patient and their families.

(E) Rehabilitation. At the earliest stage possible after admission to the trauma center, each ATH shall address a plan for integration of rehabilitation into the acute and primary care of the trauma patient. Designated facilities shall identify a mechanism to initiate rehabilitation services and/or consultation upon admission as well as policies regarding coordination of a multi disciplinary rehabilitation team. Policies shall be in place to address the coordination of transfer between acute care facilities and rehabilitation facilities. Transfer agreements shall include a feedback mechanism for the acute care facilities to update the health care team on the patient's progress and outcome for inclusion in the trauma registry.

(F) Outreach. The ATH shall work collaboratively to plan, facilitate and teach professional education programs for the prehospital care providers, nurses and physicians in their own facility and in the Community Trauma Hospital (CTH) and Trauma Receiving Facilities (TRF) in their region.

(G) Prevention/Public Education. The ATH is responsible for collaborating with RTCs, CTHs, and TRFs to develop education and prevention programs for their professional staff and the public. The education and prevention programs shall include implementation strategies to assure information dissemination to all residents in the region.

(H) Transfer Protocols. The facilities shall have transfer protocols in place with receiving trauma facilities, as well as all specialty referral centers (e.g., burn, pediatrics and rehabilitation) . All facilities shall work together to develop transfer guidelines indicating which patients should be considered for transfer and procedures to assure the most expedient, safe transfer of the patient. All trauma facilities shall agree to provide services to the trauma patients regardless of their ability to pay. The transfer guidelines need to assure feedback as provided to the facilities and assure this information eventually becomes part of the trauma registry. All transfer protocols shall be written in accordance with COBRA/OBRA and EMTALA regulations.

(I) Quality Improvement/Evaluation.

(I) All designated facilities will be required to participate in the trauma registry and submit data to OEMS as requested. The ATHs shall assist the CTHs and the TRFs in establishing the data collection process and, if necessary, provide data entry into the registry from abstracted patient records.

(II) Each ATH shall develop an internal quality improvement plan that, at a minimum, addresses the following key components:19

(1) An organizational structure which facilitates the process of quality improvement (multi disciplinary trauma committee); It is highly recommended that the plan incorporate autopsy information on all trauma patients. Complete anatomical diagnosis of injury is essential to the quality of trauma care.

(2) Clearly stated goals and objectives of the quality improvement plan;

(3) The development of standards of care;

(4) A process to delineate privileges for all physicians participating in trauma care;

(5) Participation in the statewide trauma registry;

(6) Established quality indicators (audit filters). The plan must include, at a minimum, the recommended audit filters by the American College of Surgeons and the JCAHO. The plan should define adverse outcomes by using an explicit list of well-defined complications;

(7) A systematic, informed peer review process utilizing a multi disciplinary method including prehospital care providers; and

(8) A method for computing survival probability and comparing patient outcomes.

(III) The ATH shall participate in the statewide WTC and the RAC of their TSA.

Section 3. Community Trauma Hospitals. Community Trauma Hospitals (CTH) are generally small, rural facilities with a commitment to the resuscitation of the trauma patient and with written transfer protocols in place to assure those patients who require a higher level of care are appropriately transferred for definitive care. The hospital is predominantly staffed with family physicians experienced and/or trained across a broad composite field of medicine including appropriate areas of acute trauma management. Frequently, these physicians are the obstetric and intensive care providers of the TSA. They commonly work in consultation with a board certified general surgeon who is committed to trauma management. A system for early notification of the physician on call shall be developed so that he can consistently be present at the time of arrival of the major trauma patient in the emergency department. This level of designation requires a general/trauma surgeon on call and promptly available to respond to the trauma patient. However, this level contemplates that there may be only one surgeon in the community and he may not be available at all times. During periods when the surgeon is not available, the hospital must notify other facilities that routinely transfer/refer patients to the CTH for emergency surgical services.20 Since this level contemplates a surgeon in the community who is committed to trauma care, it is anticipated that the CTH shall provide initial resuscitation and immediate operative intervention to control hemorrhage to assure maximum stabilization prior to transfer to each facility shall develop written notification protocols. higher level of care. In many instances, patients will be maintained in the CTH unless the medical needs of the patient require secondary transfer. The decision to transfer a patient rests with the physician attending the trauma patient. An institution intending to provide prolonged ventilatory care must assure that a physician qualified to provide ventilatory care is available at all times. If physician support is not available twenty-four (24) hours per day, transfer to a higher level of care is recommended.

(a) Hospital Organization.

(ii) Trauma Program Director. The director must be a board certified general surgeon, a board certified emergency physician, or a board certified physician with demonstrated competency in trauma care. The director shall develop a quality improvement process and, through this process, shall be responsible for all trauma patients and administrative authority for the hospital's trauma program. The director must be given administrative support to implement the requirements specified by the Wyoming Trauma Plan.21

(iii) Trauma Team. The hospital shall have a policy describing the respective roles of all personnel on the trauma team. The composition of the trauma team in any hospital will depend on the characteristics of development, communication among all team members, development of standards of care, education and outreach programs, and interaction with appropriate groups for injury prevention. Suggested membership for the committee include representatives (if available in the community) from:

(A) Surgeons;

(B) Emergency physicians;

(D) Laboratory technician;

(E) Physician with emergency department privileges;

(F) Prehospital care providers;

It is strongly recommended that the director be an instructor in the American College of Surgeons Advanced Trauma Life Support (ATLS) course, and maintain current ATLS certification or maintain certification of attendance to an ACEP accredited trauma conference every two (2) years, and maintain personal involvement in care of the injured, education in trauma care, and involvement in professional organizations.

(G) Respiratory therapist;

(H) Family physician(s) skilled in trauma care;

(I) Registered nurses;

(J) Physician specialists as dictated by clinical needs;

(K) Radiology technician; and

(L) Social services/pastoral care.

(iv) Trauma Nurse Coordinator. A CTH shall have at least a part-time registered nurse working in the role of a trauma nurse coordinator. Working in conjunction with the trauma program director, the trauma nurse coordinator shall organize the program and all systems necessary for the multi disciplinary approach throughout the continuum of trauma care. The trauma nurse coordinator shall coordinate optimal patient care for all injured patients.22

(v) Multi Disciplinary Trauma Committee. The purpose of the committee is to provide oversight and leadership to the entire trauma program. The committee shall focus on quality improvement activities, policy development, communication among all team members, development of standards of care, education and outreach programs, and interaction with appropriate groups for injury prevention. The clinical managers (or designees) of the organizational areas involved in trauma care shall play an active role with the committee. The committee shall include representatives from each of the following areas, unless the hospital has no such organizational area defined:

(A) Administration;

(B) Anesthesia;

(D) Family physicians;

(E) General surgery;

(F) Intensive Care;

(G) Medical Records;

Recommended credentials for this position include: Trauma Nurse Core Curriculum (TNCC) (or equivalent education), demonstrated expertise in trauma care and five (5) or more years clinical nursing experience.

(H) Pediatrics;

(I) Nursing;

(J) Prehospital care providers;

(K) Radiology;

(L) Rehabilitation;

(M) Respiratory therapy; and

(N) Trauma Nurse Coordinator.

(b) Facility Standards.

(i) Emergency Department.

(A) The hospital shall have an emergency department staffed so that trauma patients are assured immediate and appropriate initial care. CTHs may not have a physician in the emergency department twenty-four (24) hours per day.

Therefore, adequately trained registered nurses shall be available to initiate basic trauma life support care. Local policy shall be written to assure early notification of the on call physician and/or surgeon to meet the trauma patient in the emergency department.

This requirement may be satisfied by a physician not currently board certified but meeting the requirements of the hospital for appointment as an emergency department medical director. This exception is only valid for those non-qualifying medical directors at the time these requirements become effective.24 The physicians participating on the trauma team shall participate in continuing education activities related to trauma care, the multi disciplinary trauma committee and the trauma quality improvement process.

23 It is understood that many boards require a practice period, and the complete certification may take three (3) to five (5) years after residency. If an individual has not been certified five years after residency, that individual is ordinarily unacceptable as the medical director of the emergency department.

24 All physicians covering the emergency department shall be currently certified in ATLS, or maintain certification of attendance to an ACEP accredited trauma conference every two years, and shall show commitment to trauma care by maintaining competency in resuscitation, airway management, central venous access, cervical immobilization and long bone fracture stabilization of the adult and pediatric trauma patient. This includes all residents assigned to the emergency department and responsible for the resuscitation of the trauma patient.

(I) Emergency nurses shall have special expertise in trauma care.25

(II) Adequate numbers of registered nurses must be available in house twenty-four (24) hours per day to staff the emergency department to meet the needs of the trauma patient.

(D) General/Trauma Surgeon.

(I) A general/trauma surgeon shall be available on call twenty-four (24) hours per day to respond to the emergency department as requested. This level contemplates a community where only one surgeon may reside. During those periods when the surgeon is not available, the hospital shall notify other facilities who routinely transfer/refer patients to the CTH for emergency surgical care. The trauma surgeon on call shall be promptly available to respond to the trauma patient. The surgeons should have current certification in ATLS.

(II) Local criteria shall be established to define conditions requiring the trauma surgeon's immediate hospital presence. The trauma surgeon's participation in major therapeutic decisions and consultations and presence in the emergency department for major resuscitation is highly recommended. The trauma surgeon's presence at major operative procedures is mandatory. A system shall be developed to assure early notification of the on call surgeon and compliance with this criteria and their appropriateness shall be monitored by the hospital's trauma quality improvement process.

(III) The emergency physician is expected to make key decisions about management for the trauma patient's care and determine if the patient needs transport to a higher level of care in association with the surgeon. The emergency department physician or surgeon shall coordinate the process with the receiving surgeon at the receiving facility when transfer is necessary. If the patient is admitted to the CTH, the admitting physician shall provide care and utilize surgical consultation according to the CTH guidelines for trauma patient care. Guidelines shall be written at the local level to determine which types of patients should be admitted to the CTH and which patients should be considered for transfer to a higher level of care. Telephone, teleradiology and telemedicine consultation capabilities are highly desirable for internal medicine, orthopedic surgery, obstetric/gynecological surgery and radiology. If practical, local coverage of these services is desirable. The CTH's protocol and the skill levels of the surgeon and physician staff of the CTH will determine the transfer protocols to facilitate the movement of the patient to a higher level of care.

(ii) Surgical Suites. The surgical team is not required to be in house

It is highly recommended that emergency nurses successfully complete TNCC (or equivalent education), show evidence of continuing education in trauma nursing, and participate in the ongoing quality improvement process of the trauma program. Twenty-four (24) hours per day. A team shall be on call with a well-defined mechanism for notification to expedite admission to the operating room if the patient's condition warrants. This process shall be monitored continuously by the trauma quality improvement program. Surgical nurses shall be trained in principles of resuscitation, mechanism of injury theory, multi system trauma, and knowledge of surgical instrumentation. The surgical nurses are integral members of the trauma team and shall participate in the ongoing quality improvement process of the trauma program and shall be represented on the multi disciplinary trauma committee.

(A) Policies and Procedures. Policies and procedures shall be in place for the following:

(I) Prioritized hospital room availability for the emergency trauma patient;

(II) Notification of on call surgical teams;

(III) Managing death in the OR and facilitating the organ procurement process;

(IV) Preservation of evidence;

(V) Patient monitoring by a registered nurse while the patient is in transport to the radiology suite or ICU from the operating room; and

(VI) Immediate access of blood and blood products to the operating room.

(B) Anesthesia. Anesthesia shall be promptly available with a mechanism established to ensure early notification of the on call anesthesiologist/CRNA. Anesthesia coverage may be provided by a CRNA who is supervised by an anesthesiologist as required for the CRNA's licensure. The CTH shall document conditions when the anesthesiologist/ CRNA must be immediately available for airway emergencies and operative management of the trauma patient. The availability of the anesthesiologist and the absence of delays in airway control or operative anesthesia shall be documented and monitored by the quality improvement process.

(iii) Intensive Care Unit/Monitored Bed Unit (MBU).

(A) An institution intending to provide prolonged ventilatory care shall assure that a physician qualified to provide ventilatory care is available at all times. If physician support is not available twenty-four (24) hours per day, transfer to a higher level of care is recommended.

(B) The CTH shall have an ICU or MBU which meets the requirements of licensure in the state of Wyoming or the JCAHO. Additionally, the ICU/MBU shall have:

(I) Medical Director. The medical director for the ICU/MBU is responsible for the quality of care and administration of the ICU/MBU. The trauma program director or his designee shall work collaboratively with the ICU/MBU medical director to set policy and establish standards of care to meet the unique needs of the trauma patient.

(II) Physician Coverage. Trauma patients admitted to the ICU/MBU shall be admitted under the care of the patient's physician or an attending physician with ICU/MBU admission privileges. Consultation with the general surgeon is expected. In addition to the primary physician and general surgeon, there shall be physician coverage for the ICU/MBU as specified by local criteria. The coverage shall be provided by a physician experienced and trained to recognize and manage conditions of the trauma patient as determined by the multi disciplinary trauma committee; and

(III) Nursing Personnel. CTHs shall provide staffing in sufficient numbers to meet the needs of the trauma patient. Critical care nurses shall show evidence of completion of a structured ICU in-service program which includes didactic and clinical content related to the care of the trauma patient. ICU nurses are an integral part of the trauma team and shall be represented on the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(iv) Post Anesthesia Recovery Room (PAR room).

(A) A CTH shall have a PAR room staff on call twenty- four (24) hours per day and available to the postoperative trauma patient. PAR room staffing shall be in sufficient numbers to meet the critical needs of the trauma patient. Frequently, it is advantageous to bypass the PAR room and directly admit to the ICU/MBU. In this instance, these requirements may be met by the ICU/MBU.

(B) PAR room nurses shall show evidence of completion of a structured in-service program which includes didactic and clinical content related to the care of the trauma patient. PAR room nurses are an integral part of the trauma team and shall be represented on the multi disciplinary trauma committee and participate in the quality improvement process of the trauma program.

(c) Clinical Support Services. In addition to licensure requirements, a CTH shall have the following service capabilities:

(i) Radiology Services. It is highly desirable for a CTH to have a board certified radiologist or his designated mid-level practitioner available to the facility for emergency procedures, and on a routine basis, to assure quality of services rendered. The radiologist is a key member of the trauma team and shall be represented on the multi disciplinary trauma committee. A licensed radiological technician shall be on call twenty-four (24) hours per day and readily available to meet the immediate needs of the trauma patient. Twenty-four (24) hour teleradiology service is necessary if a radiologist is not available. A formal plan for emergency reading of films is necessary as backup, e.g., administrative commitment to twenty-four (24) hour available on call road transport of films to a radiologist. The CT technician may be on call from home with a mechanism in place to assure the technician is available. The quality improvement process shall verify the procedure is promptly available to the patient.

(ii) Clinical Laboratory Services.

(A) The standards for clinical laboratory services in CTHs differ very little from other designated facilities. Blood banking capability or access to community facilities shall be available. Toxicology studies may be performed off site if necessary.

(B) The clinical laboratory service shall have the following services available twenty-four (24) hours per day:

(I) Access to a community central blood bank and adequate storage facilities;

(II) Standard analysis of blood, urine and other body fluids; and

(III) Blood gas and pH determinations (this function may be performed by providers other than the clinical laboratory service, when applicable).

(D) Sufficient numbers of clinical laboratory technologists shall be promptly available twenty-four (24) hours per day. If this requirement is fulfilled by technicians not in house, quality improvement must document and monitor the availability of testing, blood access, and the prompt recording of accurate results.

(iii) Social Service/Pastoral Care. A CTH may utilize community resources as appropriate to meet the needs of trauma patients and their families.

(iv) Rehabilitation. Each CTH shall address a plan for integration of rehabilitation into the acute and primary care of the trauma patient, at the earliest stage possible, after admission to the trauma center. Designated facilities shall identify a mechanism to initiate rehabilitation services and/or consultation upon admission as well as policies regarding coordination of a multi disciplinary rehabilitation team. Policies shall be in place to address the coordination of transfers between acute care facilities and rehabilitation facilities. Transfer agreements shall include a feedback mechanism for the acute care facilities to update the health care team on the patient's progress and outcome for inclusion in the trauma registry.

(v) Outreach. The CTH shall work collaboratively to plan, facilitate and teach professional education programs for the prehospital care providers, nurses, and physicians in the CTHs and TRFs in their region.

(vi) Prevention/Public Education. The CTH shall collaborate with all other designated facilities to develop education and prevention programs for their professional staff and the public. The plan shall include implementation strategies to assure information dissemination to all residents in the region.

(vii) Transfer Protocols. CTHs shall have transfer protocols in place with receiving trauma facilities as well as all specialty referral centers (i.e., burn, pediatrics and rehabilitation). All facilities shall work together to develop transfer guidelines indicating which patients should be considered for transfer and procedures to assure the most expedient, safe transfer of the patient. All designated facilities shall agree to provide services to the trauma patient regardless of their ability to pay. The transfer guidelines need to assure feedback is provided to the facilities and assure this information eventually becomes part of the trauma registry. All transfer protocols shall be written in accordance with COBRA/OBRA and EMTALA regulations.

(viii) Quality Improvement/Evaluation.

(A) All designated facilities shall participate in the trauma registry and submit data to the OEMS as requested. The CTHs shall assist the TRFs in establishing the data collection process and, if necessary, provide data entry into the registry from abstracted patient records.

(B) Each trauma center shall develop an internal quality improvement plan that, at a minimum, addresses the following key components:26

(I) An organizational structure which facilitates the process of quality improvement (multi disciplinary trauma committee);

(II) Clearly stated goals and objectives of the quality improvement plan;

(III) The development of standards of care;

(IV) A process to delineate privileges for all physicians participating in trauma care;

(V) Participation in the statewide trauma registry;

(VI) Established quality indicators (audit filters). The Autopsy information on all trauma patients is highly recommended. Complete anatomical diagnosis of injury is essential to the quality improvement process plan must include, at a minimum, the recommended audit filters by the ACS and the JCAHO. The plan should define adverse outcomes by using an explicit list of well- defined complications;

(VII) A systematic, informed peer review process utilizing a multi disciplinary method including prehospital care providers; and

(VIII) A method for computing survival probability and comparing patient outcomes.

Section 4. Trauma Receiving Facilities. Trauma Receiving Facilities (TRF) are generally licensed rural facilities, clinics, or medical assistance facilities with a commitment to the resuscitation and stabilization of the trauma patient and written transfer protocols in place to assure those patients who require a higher level of care are appropriately transferred for definitive care. These facilities may not be staffed by a physician, but may be staffed by a licensed mid-level practitioner (e.g., nurse practitioner or licensed/certified physician's assistant). The major trauma patient shall be resuscitated and transferred to a higher level of care from the emergency department as appropriate. This categorization does not contemplate the availability of surgeons, operating rooms or intensive care services.

(a) Facility Organization.

(i) Trauma Program. There must be a commitment on behalf of the entire facility to the organization of trauma care. A trauma program shall be established and recognized by the institution. The trauma program shall come under the overall organization of a physician who is committed and willing to provide off-line administration of the program. In a facility staffed by physician's assistants or nurse practitioners, it most likely will be their supervising physician.

(ii) Trauma Program Director. There shall be a qualified physician director of the trauma program. In this instance, the physician shall work with all members of the trauma team to develop a quality improvement process for the facility.

Through this process, he shall have overall responsibility for the quality of trauma care rendered at the facility. The director shall be given administrative support to implement the requirements specified by the Wyoming Trauma Plan. The director shall assist in the development of standards of care and assure appropriate policies and procedures are in place for the safe resuscitation and transfer of trauma patients. The physician director should be currently certified in ATLS and participate in CME related to trauma care.

(iii) Trauma Team. The facility shall have a policy describing the role of all personnel on the trauma team. The composition of the trauma team in any facility will depend on the characteristics of the facility and its staff. The team leader shall be a qualified physician or a qualified mid-level practitioner.27 Suggested composition of the trauma team may include:

(A) Laboratory technician;

(B) Nurses;

(D) Physicians;

(E) Prehospital care providers;

(F) Radiology technicians;

(G) Respiratory therapists; and

(H) Social services/pastoral care.

(iv) Trauma Nurse Coordinator. A TRF shall have a person to conduct many of the administrative functions required by the trauma program. Specifically, this person, with the physician director, shall coordinate optimal patient care for all injured patients. Many requirements for data collection and coordination, quality improvement, education and prevention activities are incumbent upon this position.

(v) Multi Disciplinary Trauma Committee.

(A) The purpose of the committee is to provide oversight and leadership to the entire trauma program. The major focus shall be quality improvement activities, policy development, communication among all team members, development of standards of care, education and outreach programs, and work with appropriate groups for injury prevention. In a TRF, this does not need to be a separate distinct body; however, the functions of this committee may be performed in conjunction with other ongoing committees in the facility.

(B) Suggested membership for the Committee includes representatives (if available in the community) from:

(I) Administration;

(II) Emergency Department;

Qualified physicians or mid-level practitioners directing the resuscitation of trauma patients shall have current ATLS certification or proof of audit of an ATLS course or maintain certification of attendance to an ACEP accredited trauma conference every two (2) years, and must show commitment to trauma care by maintaining competence in airway management, central venous access, cervical immobilization, and long bone fracture stabilization.

(III) Medical Records;

(IV) Pediatrics;

(V) Prehospital care providers;

(VI) Radiology/Laboratory;

(VII) Rehabilitation;

(VIII) Respiratory therapy; and

(IX) Trauma Nurse Coordinator.

(C) The clinical managers or designees of the organizational areas involved with trauma care shall play an active role with the committee.

(b) Facility Standards.

(i) Emergency Department.

(A) The facility shall have an emergency department staffed so that trauma patients are assured immediate and appropriate initial care. It is not anticipated that a physician will be available on call to the emergency department in a TRF. This requirement may be met by a qualified mid-level practitioner on call from outside the facility.28 A system shall be developed to assure early notification of the on call practitioner. Compliance with this criteria shall be documented and monitored by the quality improvement process.

(B) The TRF shall have a written policy for notification and mobilization of an organized trauma team. Additionally, written policy shall be in place for pre-activation of the transfer team from the field based on prehospital triage criteria. There shall be written transfer protocols with other trauma facilities in the region. A policy shall be in place to facilitate and expedite the transfer sequence to assure the most appropriate care is rendered. Protocols shall be in place for specialty referral for pediatrics, burn, spinal cord injuries and rehabilitation.

Qualified physicians or mid-level practitioners directing the resuscitation of trauma patients should have current ATLS certification, or proof of audit of an ATLS course, or maintain certification of attendance of an ACEP accredited trauma conference every two (2) years, and must show commitment to trauma care by maintaining competence in airway management, central venous access, cervical immobilization, and long bone fracture stabilization.

It is highly recommended that emergency nurses demonstrate successful completion

(D) Adequate numbers of registered nurses shall be available to meet the needs of the trauma patient.

(c) Clinical Support Services. In addition to licensure requirements, a TRF shall have the following service capabilities:

(i) Radiology Services. X-ray capabilities shall be immediately available twenty-four (24) hours per day to meet the resuscitative needs of the trauma patient. A licensed radiological technician shall be available to meet the immediate needs of the trauma patient. The technician may be on call from home with a mechanism in place to assure the technician is available. The quality improvement process shall document and monitor the process.

(ii) Clinical Laboratory Services.

(A) Clinical laboratory services shall be immediately available to the trauma patient. It is not anticipated that blood banking facilities be available; rather, access and blood storage capacities. Toxicology studies may be performed off site if necessary. The clinical laboratory shall have standard analysis of blood, urine and other body fluids services available twenty-four (24) hours per day.

(B) If this requirement is fulfilled by technicians not in house, quality improvement shall document and monitor the availability of testing, blood access and the prompt recording of accurate results.

(iii) Social Service/Pastoral Care. A TRF may utilize community resources as appropriate to meet the needs of trauma patients and their families.

(iv) Prevention/Public Education. A TRF shall work collaboratively with RTCs and ATHs to develop education and prevention programs for their professional staff and the public. The plan shall include implementation strategies to assure information dissemination to all residents in the region.

(v) Transfer Protocols. Transfer protocols shall be written with all trauma receiving facilities and appropriate specialty centers (e.g., burn, pediatrics and rehabilitation). All facilities shall work together to develop transfer guidelines indicating which patients should be considered for transfer and procedures to assure the most expedient, safe transfer of the patient. All designated facilities shall agree to provide services to trauma patients regardless of their ability to pay. The transfer guidelines need to assure feedback is provided to the facilities and assure this information eventually becomes part of the trauma registry. All transfer protocols shall be written in accordance with COBRA/OBRA and EMTALA regulations. of TNCC (or equivalent education), evidence of continuing education in trauma nursing and participation in the ongoing quality improvement process of the trauma program.

(vi) Quality Improvement/Evaluation. All designated facilities shall participate in the trauma registry and submit data to OEMS. The RTCs, ATHs and CTHs shall be responsible to assist the TRFs in establishing the data collection process and, if necessary, provide data entry into the registry from abstracted patient records. Each TRF shall develop an internal quality improvement plan that addresses, at a minimum, the following key components:30

(A) An organizational structure which facilitates the process of quality improvement (multi disciplinary trauma committee);

(B) Clearly stated goals and objectives of the quality improvement plan;

(D) A process to delineate privileges for all physicians participating in trauma care;

(E) Participation in the statewide trauma registry;

(F) Established quality indicators (audit filters). The plan must include, at a minimum, the recommended audit filters by the ACS and the JCAHO. The plan should define adverse outcomes by using an explicit list of well-defined complications;

(G) A systematic, informed peer review process utilizing a multi disciplinary method including prehospital care providers; and

(H) A method for computing survival probability and comparing patient outcomes.

(I) The TRFs shall participate in the statewide WTC and the RAC of their TSA.

Section 5: Superseding Effect. This Chapter supersedes all prior rules or policy statements issued by the Department including manuals, bulletins, and policy statements, which are inconsistent with this Chapter. Autopsy information on all trauma patients is highly recommended. Complete anatomical diagnosis of injury is essential to the quality improvement process.

History

Effective 2008-11-20

181 Tumor Registry, Central

Chapter 1 General Provisions

Wyo. Code R. 048.0057.1.07151998 General Provisions

TUMOR REGISTRY RULES AND REGULATIONS

CHAPTER 1

GENERAL PROVISIONS

Section 1. Authority. The statutory authority for these rules is W.S. § 35-1-240(b) and P.L.102-515.

Section 2. Definitions. The following definitions shall apply in the interpretation and enforcement of these rules and regulations.

(a) "ACoS" means the American College of Surgeons Commission on Cancer.

(b) "Billing Period" means January 1 through December 31 of each calendar year.

(d) "Case Eligibility Criteria" means criteria determined by the ACoS as reportable cases of cancer, supplied by the State Agency.

(e) "Case Finding" means screen hospital listing of patient admit and outpatient visits by ICD-9 code to determine patients with a new diagnosis or history of cancer. Screen pathology depart- ment autopsy, cytology and pathology reports to determine patients with a new diagnosis or history of cancer.

(f) "Clinical Laboratory" means a facility for the microbiological, serological, chemical, hematological, biophysical, cytological or pathological examination of materials derived from a human body for the purpose of obtaining information for the diagnosis, prevention or treatment of disease or assessment of medical conditions.

(g) "Completed Registration" means all of a cancer patient's available data items required by the ACoS in format specified in manuals required by the State Agency.

(h) "Confidential statistical records" means a group of any records under the control of an agency from which information is retrieved by the name of the individual or by some identifying num- ber, symbol, or other identifying particular assigned to the individual.

(i) "Epidemiologist" means one who specializes in the practice of the science concerned with the study of the factors determining and influencing the frequency and distribution of disease, injury, and other health-related events and their causes in a defined human population for the purpose of establishing programs to prevent and control their development and spread.

(j) "Health Care Provider" means a person who is licensed, certified or otherwise authorized by the law of this state to provide health care in the ordinary course of business or practice of a profes- sion, but does not include a person who provides health care solely through the sale or dispensing of drugs.

(k) "Hospitals" means establishments with organized medical staffs, with permanent facili- ties that include in-patient beds; and with medical services, including physician services and continuous nursing services; to provide diagnosis, treatment, and continuity of care for patients.

(l) "Hospital Authority" means administrator or person appointed by the administrator.

(m) "Hospital Cancer Registrar" means a person on staff or contracted by a Wyoming Hospi- tal, who is assigned the responsibility of completed registration of all required cancer cases to the State Agency.

(n) "Infirmaries of Wyoming Institutional Facilities" means a place where ill persons are cared for within lodging facilities owned and operated by the State of Wyoming.

(o) "ICD-9" means International Classification of Diseases.

(p) "NAACCR" means North American Association of Central Cancer Registries.

(q) "Nonconfidential statistical data" means nonidentifying masses of numerical data which summarize disease factors.

(r) "Nursing Care Facilities" means a facility which is currently licensed and certified to provide skilled nursing services and/or intermediate nursing services.

(s) "Patient" means an individual who receives or has received health care and/or a deceased individual who has received health care.

(t) "Patient Follow-up" means annual investigation and recording of patient status and of patient's disease required by ACoS.

(u) "Physician" means a term used to indicate individuals appropriately licensed in Wyo- ming.

(v) "Private Office" means a term used to indicate office space used by physician in private practice.

(w) "Rules" means to be construed to embrace and be synonymous with the term "regula- tion".

(x) "Semi-Annually" means every six months (twice a year). Schedule will be established and agreed on between each individual hospital and the State Agency.

(y) "Shall" means State Agency requirement.

(z) "State Agency" means the Wyoming Department of Health, Division of Public Health, Preventive Medicine Branch, office of the Wyoming Central Tumor Registry.

Section 3. Applicability.

(a) Chapters 1, 2 and 3 of these regulations shall apply to all hospitals, physicians and other health care providers licensed and performing patient care in Wyoming.

(i) Exception: Wyoming State (Psychiatric) Hospital.

(b) Chapters 1 and 4 of these regulations shall apply to any person employed by the State Agency, epidemiologist, researcher and any other persons or organizations utilizing statewide cancer registry data.

Section 4. Immunity from Civil Action.

(a) Any person who complies with W.S. § 35-1-240(b) is immune from any civil action with respect to a cancer case report provided to the State Agency or with respect to access to cancer case information provided to the registry.

Section 5. Standards. The State Agency has adopted the latest version of "Standards for Cancer Registries" published by the North American Association of Central Cancer Registries (NAACCR).

(a) Data Completeness: 95% of unduplicated, expected malignant cases of reportable cancer occurring in Wyoming residents in a diagnosis year shall be reported to the state cancer registry.

(b) Data Timeliness: Cancer cases shall be reported to the state cancer registry within six (6) months of diagnosis date.

(c) Data Quality: Comply with standards for data quality including standardized data format as promulgated by the NAACCR.

History

Effective 1998-07-15

Chapter 2 Uniform Registration and Report of Cancer Cases

Wyo. Code R. 048.0057.2.07151998 Uniform Registration and Report of Cancer Cases

CHAPTER 2

UNIFORM REGISTRATION AND REPORTING OF CANCER CASES

Section 1. Training.

(a) All hospitals shall arrange for a minimum of one (1) person and a maximum of three (3) persons, to attend initial training at the State Agency unless a waiver is granted to the hospital by the State Agency. Waivers will be granted at the sole discretion of the agency upon a showing of good cause; i.e., proof of contract with an independent contractor or proof that current hospital personnel have previously received training.

(b) Initial educational training of Hospital Cancer Registrars shall be done in the State Agency offices by a qualified trainer at no cost to the hospital. Hospital's employee expenses shall be the responsibility of the hospital.

(c) Hospitals shall be responsible for utilizing the initially trained employees to train other personnel to insure a continuum of trained personnel.

(d) Additional training of Hospital Cancer Registrars shall be provided by the State Agency or a suitable alternative within a reasonable time of individual hospital's request.

Section 2. All Hospitals, Physicians and Other Health Care Providers.

(a) Hospitals, physicians and other health care providers shall grant State Agency access to all records that would identify cases of cancer or would establish characteristics of the cancer, treatment or medical status of any identified patient.

(b) Hospitals, physicians and other health care providers shall not be held liable in any civil action with respect to a cancer case report provided to the statewide cancer registry, or with respect to access to cancer case information provided to the statewide cancer registry per W.S. § 35-2-609 (Disclo- sure without patient's authorization).

Section 3. All Hospitals.

(a) Hospitals shall perform case finding to determine all patients with a new diagnosis of cancer or history of cancer which meets the case eligibility criteria.

(b) Hospitals shall provide semi-annually to the State Agency a listing of cancer cases by ICD-9 codes which includes the diagnosis of cancer and history of cancer. The State Agency shall be authorized to inspect same, to verify the completeness of cancer reporting.

(c) Hospitals shall perform patient follow-up on all living patients annually per ACoS guide- lines. Follow-up shall be submitted to the State Agency on a monthly basis.

(d) All hospitals shall have the right to establish a contract, to meet Tumor Registry require- ments, with an independent contractor or hospital previously trained.

Section 4. Registration Options

(a) All hospitals shall select one of the following options relative to the registration of cancer patients seen in their hospital:

(i) Option 1.

(A) Submit completed registration to the State Agency of all cases within the facility which meet case eligibility criteria. New case registrations shall be reported to the State Agency on a monthly basis.

(ii) Option 2.

(A) Pay the designated fee per cancer case as defined in Chapter 3, Section 1.

(B) Mail all required documentation to the State Agency on a monthly basis for case registration to be completed within the State Agency.

(b) Hospitals selecting option 2 shall notify the State Agency in writing of their selection no later than July 1, 1998.

(c) Option selection may be reviewed and/or changed after July 1, 1998 by hospital authority or by State Agency by providing thirty (30)days written notice.

Section 5. Physicians.

(a) Physicians shall report to the State Agency, all cancer patients who meet case eligibility criteria who are diagnosed and/or treated in a private office and who are not admitted to a Wyoming Hospital.

(b) Physicians shall supply all available information requested by the State Agency concern- ing cancer patients who meet case eligibility criteria.

(c) Physicians shall supply all available information requested by their Hospital Cancer Registrar, concerning cancer patients who meet case eligibility criteria.

Section 6. Other Health Care Providers.

(a) Clinical Laboratories in Wyoming shall provide copies of all tissue, cytology and autopsy reports on cancer patients seen outside a Wyoming Hospital.

(b) Infirmaries of Wyoming Institutional Facilities shall supply all available information requested by the State Agency concerning cancer patients who meet case eligibility criteria.

(c) Nursing Care Facilities shall supply all available information requested by the State Agency concerning cancer patients who meet case eligibility criteria.

History

Effective 1998-07-15

Chapter 3 Registration Fees

Wyo. Code R. 048.0057.3.07151998 Registration Fees

CHAPTER 3

REGISTRATION FEES

Section 1. Fee Assessment.

(a) Fees shall be assessed only to those hospitals which select option 2 as defined in Chapter 2, Section 4(ii).

(b) Hospitals which select option 2 as defined in Chapter 2, Section 4(ii), shall be assessed a fee of twenty-five dollars ($25) per new case.

(d) Cancer case count for assessment of fees shall be calculated by State Agency's record of cases added to each hospital's file during each billing period.

(e) State Agency shall assess hospital fees annually for each cancer case registered within each billing period.

(f) Fees shall be payable to the state general fund within sixty (60) days of receipt of billing.

(g) Individual physicians shall not be assessed fees.

History

Effective 1998-07-15

Chapter 4 Public Law

Wyo. Code R. 048.0057.4.07151998 Public Law

CHAPTER 4

PUBLIC LAW 102-515

Section 1. Disclosure of Data

(a) Confidential Case Data. The protection and release of confidential statistical records shall be in accordance with W.S. § 16-4-201, et seq, the Wyoming Public Records Act, and the Wyo- ming Department of Health Information Practices Rules.

(b) Nonconfidential Statistical Data. Nonconfidential statistical data shall be released to all hospitals, physicians, other health providers and interested persons in compliance with the latest written policies set forth by the Wyoming State Epidemiologist.

History

Effective 1998-07-15

182 Veterans Home of Wyoming

Chapter 1 General Provisions

Wyo. Code R. 048.0058.1.10032022 § 1 Authority

This Chapter is promulgated by the Wyoming Department of Health pursuant to Wyoming Statute (W.S.) § 25-9-101 through 25-9-106 and W.S. § 25-14-101 through 25-14-105.

History

Effective 2022-10-03

Wyo. Code R. 048.0058.1.10032022 § 2 Purpose

This Chapter is to define the following as they will pertain to the Veterans' Home of Wyoming (VHW) or the Wyoming Veterans' Skilled Nursing Facility (WVSNF).

History

Effective 2022-10-03

Wyo. Code R. 048.0058.1.10032022 § 3 Definitions

(a) "Resident" means any individual admitted the VHW or WVSNF.

(b) "Veteran" means a person honorably discharged from the armed forces of the United States as proved by providing a DD214, Veterans Administration Statement of Service or a Disabled Veterans Certification as defined by United States Code, as currently adopted (This publication is on file from the U.S. Government Publishing Office, www.gpo.gov).

History

Effective 2022-10-03

Chapter 2 General Operation

Wyo. Code R. 048.0058.2.10032022 General Operation

CHAPTER 2

GENERAL OPERATION

Section 1. Authority.

This Chapter is promulgated by the Wyoming Department of Health pursuant to Wyoming Statute (W.S.) § 25-9-101 through 25-9-106 and W.S. § 25-14-101 through 25-14-105.

Section 2. Purpose and Applicability.

The following rules will define the operation of Veterans' Home of Wyoming (VHW) and Wyoming Veterans' Skilled Nursing Facility (WVSNF) shall provide for the general operations of the VHW or the WVSNF.

Section 3. Administration.

(a) The VHW or the WVSNF is under the direction of the Department of Health and is supervised by the Facility Administrator. All programs and activities within the VHW or WVSNF shall be consistent with the Department of Health's direction.

(b) A comfortable and pleasant environment shall be a priority of the VHW and the WVSNF.

(c) The VHW or the WVSNF shall work closely with the Department of Veterans' Affairs, various community hospitals, and various state and local agencies in providing and coordinating services for residents.

(d) Services provided by the VHW or WVSNF shall comply with applicable state and federal standards governing the institution.

(e) The VHW and WVSNF shall maintain records for each resident and make those records available to the resident.

(f) The VHW and WVSNF shall establish a system for investigating and reporting incidents, accidents or injuries occurring after admission to the home.

(i) Written records shall be completed for each occurrence.

(ii) The system shall also address suspected incidents of resident neglect or abuse.

(iii) The VHW and WVSNF shall report any unusual deaths, serious incidents or accidents to the appropriate authorities, including the Office of Healthcare Licensing and Survey (OHLS) and the Department of Veteran Affairs.

(iv) The VHW and WVSNF shall establish a resident grievance method that complies with federal and state requirements.

Section 4. Care of Residents.

The VHW and WVSNF shall provide domiciliary and skilled nursing care to residents.

Section 5. Additional Care.

(a) The Facility Administrator may authorize the VHW or WVSNF to provide care to persons with conditions other than those specified in the provisions governing those state institutions in Title 25 of the Wyoming Statutes when the following conditions are met and documented:

(i) There is a need for such care;

(ii) The care can be provided effectively;

(iii) Sufficient number of qualified staff, with appropriate training to treat the residents, and who represent the various disciplines required for appropriate care.

Section 6. Residents Rights.

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department of Health has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules.

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in this section; and

(iii) The incorporated code, standard, rule, or regulation is maintained at the Department of Health and is available for public inspection and copying at cost at the same location.

(iv) The Department incorporates the Veterans' Home Wyoming Resident Manual and Bill of Rights adopted by the Veterans' Home of Wyoming Revised 08/2021 found at: 700 Veterans' Lane, Buffalo, Wyoming 82834, in the Administration Office.

History

Effective 2022-10-03

Chapter 3 Donations

Wyo. Code R. 048.0058.3.06142017 § 1 Acceptance of Donations

The superintendent shall acknowledge and document all donations accepted by the agency for the Veterans' Home of Wyoming pursuant to Wyo. Stat. Ann. § 25-9-103.

History

Effective 2017-06-14

Chapter 4 Admissions & Discharge

Wyo. Code R. 048.0058.4.10032022 Admissions & Discharge

CHAPTER 4 ADMISSION AND DISCHARGE

Section 1. Authority.

This Chapter is promulgated by the Wyoming Department of Health pursuant to Wyoming Statute (W.S.) § 25-9-101 through 25-9-106 and W.S. § 25-14-101 through 25-14-105.

Section 2. Purpose and Applicability.

The purpose of this Chapter is to establish the admission and discharge practices for the Veterans' Home of Wyoming (VHW) or the Wyoming Veterans' Skilled Nursing Facility (WVSNF).

Section 3. Eligibility for Veterans' Home of Wyoming or the Wyoming Veterans' Skilled Nursing Facility.

(a) To be eligible for admission to the VHW or WVSNF an applicant shall be:

(i) A veteran as defined by United States Code, Title 38, section 101; or

(ii) Spouse or surviving spouse of a Veteran as defined by United States Code, Title 38, section 3.50; or

(iii) A parent, all of whose children died while serving in the Armed Forces of the United States; or

(iv) The individual meets one or more of the admission categories outlined in Wyoming Statute 25-14-10; and

(v) The individual is determined eligible through clinical review on a case-by-case basis and federal, state, and facility approved standardized assessments.

(b) To be eligible for the WVSNF the individual meets state and federal criteria for a skilled nursing facility.

(c) Eligible applicants, as determined by the Facility Administrator shall be scheduled for admission to the VHW and WVSNF or placed on a waiting list if no beds are available.

(d) Priority for admission to the VHW or the WVSNF is as follows:

(i) Former residents of the VHW who are eligible for readmission;

(ii) Medal of Honor recipients;

(iii) Wyoming resident veterans;

(iv) Non Wyoming resident veterans;

(v) Other applicants.

Section 4: Discharge.

(a) It is the policy of the VHW and WVSNF to provide a comfortable living environment for our residents. The facility will initiate discharge planning for residents who may be discharge under one of the following conditions:

(i) The resident desires to leave the facility and transfer somewhere else;

(ii) The resident imposes an imminent danger to self and/or others;

(iii) Resident is asked to leave for violation of facility's rules, regulations, or policies; or

(iv) There is a change in the resident's level of care.

(b) Residents shall receive a thirty (30) day written notice prior to any facility initiated transfer or discharge, unless the resident imposes an imminent danger to self and/or others or the resident's level of care exceeds that which can be provided by an assisted living/domiciliary licensure.

(i) The facility has had its license revoked, not renewed, or voluntarily surrendered;

(ii) The facility cannot meet the resident's needs;

(iii) The resident or responsible person has a documented established pattern, in the facility, of not abiding by agreements necessary for our facility;

(iv) Non-payment of charges;

(v) The resident engages in behavior which imposes an imminent danger to self and/or others; or

(vi) For any other reason the facility deems necessary.

(d) Residents shall have the right to object to the notice to leave, except where undue delay might jeopardize the health, safety, or well-being of the resident or others.

(i) Residents who object to the notice to leave the facility shall be given the opportunity of an informal conference.

(A) This informal conference must be requested within ten (10) days of the resident's notice to leave the facility.

(B) The purpose of the conference is to determine if a satisfactory resolution can be reached.

(C) Participants in the conference may include a facility representative, the resident, and at the resident's request, a family member, and/or legal representative of the resident, and the Long Term Care Ombudsman along with the facility administrator and social worker.

(D) The informal conference is not considered to be an administrative hearing.

(e) Residents transferred to another health care facility shall be given written transfer/discharge notice which include:

(i) The name of the resident;

(ii) The reason for the transfer/discharge;

(iii) The effective date of the transfer/discharge;

(iv) The location to which the resident is transferred/discharged;

(v) The name, address, and telephone number of the Ombudsman; and

(vi) A listing of all outside contracted services.

(f) The facility shall provide sufficient preparation and orientation to residents to ensure an orderly transfer/discharge from the facility.

(g) The primary care provider will write a note of discharge which will be kept in the resident's medical record concerning the discharge.

Section 6: Admission Denial or Involuntary Discharge.

If a resident is denied admission or is involuntarily discharged they may request an administrative hearing. The hearing procedures shall be outlined in the VHW Manual.

History

Effective 2022-10-03

183 Vital Records Services

Chapter 1 General Provisions

Wyo. Code R. 048.0059.1.03202018 § 1 Manuals and Bulletins

(a)The State Registrar of Vital Records may issue manuals, bulletins, or both, to interpret the provisions of these rules. Such manuals and bulletins shall be consistent with and reflect the policies contained in these rules. The provisions contained in manuals or bulletins shall be subordinate to the provisions of these rules.

(b)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 these rules.

History

Effective 2018-03-20

Wyo. Code R. 048.0059.1.03202018 § 2 Definitions

The following definitions shall apply in the interpretation and enforcement of these rules.

(a)"Attendant at birth" means the person who assists the mother in giving birth.

(b)"Certificate" means a form provided by Vital Statistics Services for the registration of a birth, death, stillbirth, marriage, divorce or foreign-born adoption.

(c)"Certified copy," means any reproduction of a vital record bearing the seal of Vital Statistics Services and the signature of the State Registrar or of a designated representative, or the authorized facsimile thereof.

(d)"Certifier" means the person who signs the certificate attesting to the time, date, place of the birth or cause of death.

(e)"Court of competent jurisdiction" means a Wyoming district court, a court of comparable jurisdiction in another state, or a federal or tribal court.

(f) "Conformed copy" means a clerk stamped copy of the exact copy of an original document that was filed with a clerk. The clerk may not certify conformed copies of vital records.

(g) "Delayed certificate" means a certificate of a birth, death or marriage registered one year or more after the date of the occurrence, which is prepared and filed by the State Registrar.

(h)"Deputy local registrar" means the person appointed by the State Registrar or designee to perform the duties of the local registrar in the absence or incapacity of the local registrar.

(i)"Documentary evidence" means an original, official, or legal paper, which is used to furnish proof for correcting a certificate or for establishing a delayed certificate. It includes, but is not limited to census, hospital, and school records.

(j)"Form" means any document with blanks for the insertion of details or information, supplied or approved by Vital Statistics Services for use in the vital records system.

(k)"Foundling" means a living child of unknown parentage, also known as a "safe haven" child.

(l)"Health care facility" means any establishment, public or private, which provides in-patient or outpatient medical care.

(m)"Immediate family" means the mother, father, child or spouse of the deceased person.

(n)"Informant" means the person supplying the personal information regarding the registrant required by a birth or death certificate.

(o)"Legal age" means the statutory age of majority.

(p)"Legal parents" means those parents recognized as such under law.

(q)"Local registrar" means the person appointed by the State Registrar to promote and supervise vital registration in his assigned registration district.

(r)"Natural father" means the biological father.

(s)"Natural parents" means, the biological parents.

(t)"Next of kin" means the surviving spouse of the decedent, or if there is no surviving spouse, the closest living relative.

(u)"Personal particulars" means any of the following items required on a birth certificate: parent's state of birth, parent's date of birth, parent's age at the time of the child's birth, mother's residence.

(v)"Registrant" means the person to whom the certificate pertains.

(w)"Registration" means the acceptance by Vital Statistics Services and the incorporation in its official records of certificates of births, deaths, stillbirths, marriages, and divorces.

(x)"System of vital records" includes the registration, collection, preservation, amendment, and certification of vital records and activities related thereto including the tabulation, analysis, and publication of statistical data derived from such records.

(y) "True copy" means a copy of a document that is authenticated to be an official copy of the original.

(z)"Vital records" means certificates of birth, death, stillbirth, marriage, and divorce; other forms used in the vital records system; and data relating thereto.

(aa)"Vital Statistics Services" means the state office established by the Department of Health to operate the system of vital records throughout the state.

History

Effective 2018-03-20

Wyo. Code R. 048.0059.1.03202018 § 3 Official Forms

All forms and certificates used in the system of vital records are the property of Vital Statistics Services and shall be surrendered to the State Registrar of Vital Statistics Services upon request. Only those forms prescribed or approved and distributed by the State Registrar of Vital Statistics Services shall be used in the reporting of vital statistics. Such forms shall be used only for prescribed purposes.

History

Effective 2018-03-20

Chapter 2 Local Registrars

Wyo. Code R. 048.0059.2.04212008 Local Registrars

CHAPTER 2

LOCAL REGISTRARS

Section 1. Appointment. Each local registrar or deputy local registrar of vital records shall be appointed by the State Registrar and notified of the appointment in writing. Such appointment shall remain in effect until the local registrar resigns or is removed as provided for in Section 2.

Section 2. Removal. The local registrar or the deputy local registrar of vital records may be removed by the State Registrar for reasonable cause, including but not limited to failure to carry out the provisions of the vital records act or applicable regulations. Notification of such action shall be in writing and shall be sent to the person so removed by certified mail.

Section 3. Duties. Local registrars shall serve as agents of the State Registrar of Vital Records in their registration districts and shall:

(a) Maintain an adequate inventory of all forms prescribed or approved and distributed by the State Registrar of Vital Records and supply these to such persons requiring them;

(b) Notify the person responsible for the filing when any certificate submitted for registration is not completed in accordance with these rules and request proper completion;

(d) Complete a transmittal form to accompany each shipment of certificates sent to the State Registrar;

(e) Provide assistance to physicians, health care facilities, funeral directors and others in matters related to the system of vital records;

(f) Provide assistance to the certifier of a home birth in filing a birth certificate.

Section 4. Absence. The local registrar shall notify the deputy local registrar of her absence or incapacity unless unable to do so. The deputy local registrar shall thereupon immediately assume all duties and responsibilities of the local registrar. In case of any extended absence, the State Registrar shall be notified in writing by the local registrar or deputy local registrar.

Section 5. Resignation. A local registrar or a deputy local registrar shall submit his resignation in writing to the State Registrar of Vital Records.

History

Effective 2008-04-21

Chapter 3 Birth Registration

Wyo. Code R. 048.0059.3.04212008 Birth Registration

CHAPTER 3

BIRTH REGISTRATION

Section 1. General Requirements.

(a) For births which occur in a health care facility, the person in charge or that person's representative shall secure all necessary information and signatures on the certificate.

(b) For births which occur either in a health care facility or en route to a health care facility, the physician in attendance shall certify the facts of birth and provide the medical information required by the certificate within seven (7) days after birth. If the attendant has not signed the certificate within seven (7) days of the date of the birth, the person in charge of the institution or a designated representative shall complete and sign the certificate.

(c) When a birth occurs outside a health care facility, the certificate shall be prepared and filed by one of the following in the indicated order of priority:

(i) The physician in attendance at or immediately after the birth, or in the absence of such a person;

(ii) Any other person in attendance at or immediately after the birth; or

(iii) The father, the mother, or in the absence of the father and the inability of the mother, the person in charge of the premises where the birth occurred.

(d) The informant, preferably the mother (or the father, or another adult having personal knowledge of the facts concerning the birth) is responsible for providing the facts and signing the hospital worksheet to certify that the information is correct.

(e) All certificates of birth shall be filed with the local registrar within ten (10) days.

(f) If the birth certificate is filed after ten (10) days, but within one (1) year from the date of birth, the State Registrar of Vital Records may require documentary evidence supporting the facts of birth. This evidence may include evidence of the pregnancy, evidence that the infant was born alive, and evidence that the mother was present in the state on the date of birth.

Section 2. Name of Father on Birth Certificate.

(a) Requirements when the mother was married at the time of Effective 04/21/2008 conception or birth of the child, or between conception and birth:

(i) The husband shall be entered on the birth certificate as the father of the child, unless paternity has been determined otherwise by a court of competent jurisdiction; or the husband has signed an affidavit denying that he is the father and the mother and the person to be named as the father have signed an affidavit acknowledging paternity.

(ii) If the husband has signed an affidavit denying that he is the father and the mother and another man have signed an affidavit acknowledging paternity, the man signing the affidavit acknowledging paternity shall be listed as the father.

(iii) If a court of competent jurisdiction has determined that the husband is not the father of the child and the mother and another man have signed an affidavit acknowledging paternity, the man signing the affidavit acknowledging paternity shall be listed as the father. A certified copy of the court order must accompany the affidavit acknowledging paternity.

(iv) If a court of competent jurisdiction has determined paternity, the information stated in the court order concerning the father shall be listed on the birth certificate. A certified copy of the court order must be forwarded to Vital Records Services.

(b) If the mother was not married at the time of conception or birth of the child or between conception and birth, the name of the father shall not be entered on the birth certificate unless an affidavit acknowledging paternity signed by both natural parents is received; or unless paternity has been determined by a court of competent jurisdiction.

(i) Affidavits acknowledging or denying paternity must be on forms supplied by Vital Records Services.

(ii) Affidavits acknowledging or denying paternity must be signed under penalty for false swearing. All signatures must be notarized.

(iii) An affidavit acknowledging paternity or denying paternity signed by a minor must also be signed by the legal guardian of the minor.

(iv) Affidavits acknowledging or denying paternity may be signed before the birth of the child.

(d) After a valid affidavit acknowledging paternity has been filed the father's name may only be removed from a birth certificate by court order.

(e) If the father is not named on the certificate of birth, no other information about the father shall be entered.

Section 3. Infants of Unknown Parentage. The certificate of an infant of unknown parentage shall be registered by the State Registrar and shall:

(a) Have "Foundling" plainly marked in the top margin of the certificate;

(b) Show the approximate date of birth;

(d) Contain no statements on parentage;

(e) In place of the signature of the attendant at birth, show the signature of the custodian of the child and indicate the custodian's title, if any.

History

Effective 2008-04-21

Chapter 4 Substitution of Birth Certificates

Wyo. Code R. 048.0059.4.04212008 Substitution of Birth Certificates

CHAPTER 4S

SUBSTITUTION OF BIRTH CERTIFICATES

Section 1. Adoptions.

(a) A new certificate of birth shall be prepared by the State Registrar of Vital Records for a child born in this state upon receipt of the following:

(i) An adoption report submitted on a form prescribed and supplied by Vital Records Services or a form supplied by another state which contains the information needed to file a new birth certificate in compliance with these rules. The report must include:

(A) Information needed to locate the original birth certificate;

(B) Information required to complete the new birth certificate;

(ii) A certified copy of an adoption decree from the court. One certified copy of the original decree shall be furnished for each child adopted.

(b) All information in the report of adoption and the adoption decree relative to the child to be adopted shall be consistent with the information on the original birth certificate.

(c) The new certificate of birth shall be on the form in use at the time of birth, if possible, and shall include the following items and other information required on the certificate:

(i) The name of the child as ordered in the decree;

(ii) The date and city and county of birth as indicated on the original certificate;

(iii) The names of the adoptive parents as stated in the decree. In the case of a stepparent adoption, the information on the natural parent is the same as on the original birth certificate;

(iv) In the case of a single parent adoption, information for one parent only shall be shown. Effective 04/21/2008

(v) The name of the attendant and registrar as listed on the original birth certificate;

(vi) The state file number that was assigned to the original certificate;

(vii) The original filing date.

(d) After preparation of the new certificate, the existing certificate and the evidence upon which the new certificate was issued are to be placed in a special sealed file. This file can only be opened for examination and issuance of copies of the material filed therein, upon receipt of a certified copy of a court order from the court which issued the decree of adoption, a Wyoming district court, or a federal court; or by the State Registrar for purposes of properly administering the vital records program. Only those materials specified by the court order may be copied and issued.

Section 2 Legitimation. If the natural parents marry subsequent to the birth of a child, a new certificate of birth may be prepared for a child born in this state by the State Registrar of Vital Records upon receipt of an affidavit acknowledging paternity signed by the natural parents of said child, together with a certified copy of the parents' marriage certificate.

(a) A new certificate may be prepared under this section only when:

(i) There is not another man listed as the father on the original certificate;

(ii) The mother is listed as unmarried on the original certificate; and

(iii) The mother was not married within three hundred (300) days prior to the birth.

(b) Certified copies of divorce certificates may be required to document the mother's marital status.

(c) The new certificate of birth shall be on the form in use at the time of birth, if possible, and shall include the following items and such other information necessary to complete the certificate:

(i) The name of the child corrected to show the surname as specified in the affidavit acknowledging paternity;

(ii) The date and place of birth as transcribed from the original certificate. Effective 04/21/2008

(iii) The maiden name and personal particulars concerning the natural mother as shown on the original certificate and the personal particulars concerning the father;

(iv) The name of the attendant and registrar;

(v) The state file number that was assigned to the original certificate;

(vi) The original filing date.

(d) After preparation of the new certificate, the original certificate shall not be subject to inspection except upon order of a court of competent jurisdiction.

Section 3. Court Determination of Paternity. A new certificate of birth shall be prepared by the State Registrar of Vital Records for a child born in this state upon receipt of a certified copy of a court determination of paternity.

(a) The new certificate shall be on the form that was in use at the time of the birth, if possible.

(b) The surname of the child shall remain the same unless otherwise ordered by the court.

(c) The additional personal particulars required for the new certificate regarding the natural father shall be included if it is specified in the court order or in a notarized affidavit signed by the natural father.

(d) After preparation of the new certificate, the original certificate shall not be subject to inspection except upon order of a court of competent jurisdiction.

Section 4. Acknowledgment of Paternity. A new certificate of birth may be prepared for a child born in this state by the State Registrar of Vital Records when a valid affidavit acknowledging paternity is received.

(a) If the mother was married to someone other than the natural father within 300 days prior to the date of the birth, one of the following is required in addition to the affidavit acknowledging paternity:

(i) A certified copy of a court order determining that the husband or ex-husband is not the father of the child; or

(ii) An affidavit denying paternity signed by the husband or ex- husband.

(b) An affidavit denying paternity is only valid if an affidavit Effective 04/21/2008 acknowledging paternity is filed. Both affidavits must be filed within five years of the date of birth.

(d) The new certificate shall be on the form that was in use at the time of the birth, if possible.

(e) The name and personal particulars of the natural father and surname of the child shall be as specified in the affidavit acknowledging paternity.

(f) After preparation of the new certificate, the original certificate shall not be subject to inspection except upon order of a court of competent jurisdiction.

Section 5. Foreign Born Adoptions. The State Registrar may prepare a new birth certificate for a child born in a foreign country who has been adopted by persons who were residents of Wyoming at the time of the adoption.

(a) The adoption decree must have been issued by a Wyoming court.

(b) The certificate will be on a form approved by the State Registrar.

(i) The name of the child as shown in the decree;

(ii) The date and place of birth as indicated by the decree and/or report of adoption;

(iii) The names and personal particulars of the adoptive parent(s) or of the natural parent if a stepparent adoption;

(iv) Documents upon which the new certificate is based.

(d) The certificate shall be filed and numbered separately from certificates of persons born in this state.

(e) Upon completion of the new birth certificate the evidence upon which it has been based is to be placed in a special file. The file may be examined only upon receipt of an order of a Wyoming district court or a federal court.

History

Effective 2008-04-21

Chapter 5 Death Registration

Wyo. Code R. 048.0059.5.04212008 Death Registration

CHAPTER 5

DEATH REGISTRATION

Section 1. Responsibility for Filing. The funeral director who first assumes custody of a dead body shall:

(a) Complete all items on the death certificate except the physician's, county health officer's or coroner's statement attesting to the time, date, place and cause of death;

(b) Secure all necessary signatures and review the certificate for completeness and accuracy;

(c) If the death occurred without medical attendance, if the physician last in attendance refuses or fails to sign the certificate, or if circumstances suggest the death was not due to natural causes, immediately notify the local registrar who shall refer the case to the county health officer or county coroner.

(d) File the certificate with the local registrar.

Section 2. Medical Certification.

(a) The medical statement of cause of death shall be completed and signed within twenty-four (24) hours after the death by the physician in charge of the patient's care, unless inquiry is required by a post-mortem examination. If such an inquiry is required, the medical statement shall be completed and signed pursuant to Chapter 5, Section 3, (c) of these rules.

(b) In the absence or inability of the physician in charge of the patient's care, another physician may certify to the cause of death in any case where that physician has access to the medical history of the deceased and views the deceased at the time of death or at some point after death. In all other cases in which the physician in charge of the patient's care is unavailable, the local registrar shall refer the case to the local health officer or coroner who shall prepare and file the medical certification of cause of death.

(c) In cases of death from other than natural causes, the coroner shall complete and sign the medical certification with the assistance of a competent physician within twenty-four (24) hours after taking charge of the case.

(d) The cause of death shall be stated as accurately and specifically as possible.

(e) If the death was not from natural causes, the certificate must state the type of injury which caused the death. Effective 04/21/2008

Section 3. Time Limits.

(a) The death certificate shall be filed with the local registrar of the county in which the death occurred within three (3) days of the date of death.

(b) When a death certificate cannot be completed within three (3) days of the date of death, the local registrar may grant an extension of time, not to exceed forty-eight (48) hours. In all cases a death certificate must be filed with the local registrar within five (5) days of the date of death.

(c) If the cause of death cannot be determined within the time limits specified above, the person responsible for the medical certification shall sign the certificate and mark the cause of death "Pending."

(d) If the funeral director is unable to obtain the personal information within the specified time limit, the certificate shall be filed with the information that is available.

(e) When an incomplete death certificate is filed, a supplemental report providing the missing information shall be filed with the State Registrar as soon as possible.

Section 4. Presumptive Death. When a death is presumed to have occurred within this state but the body cannot be located, a death certificate may be prepared by the State Registrar only upon receipt of an order of a court of competent jurisdiction, which shall include the finding of facts required to complete the death certificate. Such a death certificate shall be marked "Presumptive" and shall show on its face the date of death as determined by the court, the date of registration, and shall identify the court and the date of the decree.

History

Effective 2008-04-21

Chapter 6 Stillbirth Registration

Wyo. Code R. 048.0059.6.04212008 Stillbirth Registration

CHAPTER 6

STILLBIRTH REGISTRATION

Section 1. Responsibility for Filing. A stillbirth certificate shall be filed for all stillbirths with a gestation of twenty (20) or more completed weeks.

(a) The funeral director who first assumes custody of a stillbirth shall:

(i) Notify the coroner if the stillbirth occurred without medical attendance;

(ii) Complete all items except those in the section pertaining to cause of death;

(iii) Obtain all necessary signatures and review the certificate for completeness and accuracy;

(iv) File the certificate with the local registrar of the county in which the stillbirth occurred.

(b) In the absence of a funeral director, the person in attendance at or after the delivery shall prepare and file the stillbirth certificate.

(c) When a stillbirth occurs in a health care facility, the person in charge of the facility shall make available information regarding that stillbirth for the purpose of completing the certificate.

Section 2. Medical Certification.

(a) The medical certification shall be completed and signed within twenty- four (24) hours after delivery by the physician in attendance at or after the delivery, except when inquiry is required by a post-mortem examination.

(b) When a stillbirth occurs without medical attendance at or after the delivery, the coroner shall complete and sign the medical certification within twenty-four (24) hours after taking charge of the case.

Section 3. Parentage on Stillbirth Certificate. The name of the father on the stillbirth certificate shall be governed by the same regulations as for live births. See Chapter 3 Section 2. 6−1 Effective 04/21/2008

Section 4. Time Limits.

(a) A stillbirth certificate shall be filed with the local registrar of the county in which the stillbirth occurred within three (3) days of the date of the stillbirth.

(b) An extension of not more than forty-eight (48) hours may be granted by the local registrar for the filing of a stillbirth. In all cases the certificate shall be filed within five (5) days of the delivery.

(c) When an incomplete stillbirth certificate is filed, or the cause of death is marked "Pending" on a stillbirth certificate, the missing information shall be forwarded to the State Registrar as soon as possible.

History

Effective 2008-04-21

Chapter 7 Burial-Transit and Disinterment Permits

Wyo. Code R. 048.0059.7.04212008 Burial-Transit and Disinterment Permits

CHAPTER 7

BURIAL-TRANSIT AND DISINTERMENT PERMITS

Section 1. Permit Required - Time Limit.

(a) A burial-transit permit is required for all bodies and stillbirths regardless of the method of disposal or storage.

(b) The funeral director or person acting as such shall obtain a burial-transit permit from the local registrar of the county in which the death occurred within seventy- two (72) hours after the death, and prior to the final disposition or removal from the state of the body or stillbirth.

Section 2. Removal of Body. After taking charge of a dead human body or stillbirth, the funeral director or person acting as such shall:

(a) Contact the attending physician to ascertain whether the death is from natural causes and if the death is from natural causes that the physician will certify to the cause of death; or

(b) If the physician refuses to certify to the cause of death, the death was unattended, or the circumstances suggest that the death was not due to natural causes, contact the local registrar who shall refer the case to the local health officer or coroner.

Section 3. Issuance of Permit Prior to Filing of Certificate. The local registrar may issue a burial-transit permit prior to the filing of a death or stillbirth certificate if the following conditions are met:

(a) The attending physician is contacted and assurance is received that the death was from natural causes and that the physician will certify to the cause of death; or

(b) If the case is within the local health officer's or the coroner's jurisdiction, that official is contacted and permission is received for the intended disposition of the body.

Section 4. Retention of Burial-Transit Permits. Burial-transit permits must be retained by the local registrar for a period of ten (10) years from the date of issuance.

Section 5. Disinterment Permits.

(a) The disinterment permit shall be authorization for disinterment, transportation, and reinterment. 7−1 Effective 04/21/2008

(b) The disinterment permit shall be issued by the local registrar upon receipt of a written application signed by the next of kin and the person who is in charge of the disinterment, or upon receipt of an order of a court of competent jurisdiction directing such disinterment.

(c) Upon receipt of a court order or signed permission of the next of kin, the local registrar may issue one (1) permit to authorize disinterment and reinterment of all remains in a mass disinterment provided that, insofar as possible, the remains of each body be identified and the place of disinterment and reinterment specified.

(d) A dead body properly prepared by an embalmer and deposited in a receiving vault shall not be considered a disinterment when removed from the vault for final burial.

History

Effective 2008-04-21

Chapter 8 Marriage Registration

Wyo. Code R. 048.0059.8.03202018 § 1 County Clerk's Responsibility

(a) The County Clerk or a designated representative shall:

(i) Obtain the information required to complete the marriage license on the Vital Statistics Services Application Questionnaire or authorized intake form;

(ii) Secure the signature of each person to be married on the certificate;

(iii) Review the license upon its return for completeness and accuracy;

(iv) Submit the file within the statutory allotted time by:

(A) Completing the marriage license and marriage certificate on the Vital Statistics Services system; or

(B) Exporting the marriage license and marriage certificate by any other approved electronic means to the Vital Statistics Services system.

History

Effective 2018-03-20

Wyo. Code R. 048.0059.8.03202018 § 2 Officiant's Responsibility

(a) The person performing the marriage ceremony shall:

(i) Confirm the license is valid, by ensuring the ceremony occurred within one (1) year of the license issuance date;

(ii) Verify the parties to be married are eligible and capable of entering into the civil contract of marriage;

(iii) Enter the ceremony information on the marriage license;

(iv) Certify the fact of Marriage by obtaining the signatures and addresses of the two (2) witnesses to the ceremony, and sign the certificate; and

(v) Return the certificate to the County Clerk who issued the license within ten (10) days of the ceremony.

History

Effective 2018-03-20

Wyo. Code R. 048.0059.8.03202018 § 3 Certified Copies, True or Conforming Copies, and Disclosure

(a) A County Clerk shall issue one (1) original certificate to the married couple in accordance with W.S. § 20-1-107(c).

(b) Except as required in subsection (a) of this section, a County Clerk may not issue a certified copy of the vital record.

(c) In accordance with W.S. § 35-1-427(a) only the office of Vital Records may issue a certified copy of any vital record certificate or record.

(d) A County Clerk may issue a true or conforming copy of the marriage license or marriage certificate to the married couple. A Clerk may charge a fee for a true or conforming copy.

(e) If there is a public request, a County Clerk may disclose or release information contained in the marriage license application questionnaire. The marriage license application questionnaire is considered a part of the county public record. If a County Clerk creates a marriage license or marriage certificate, this license or certificate is considered a vital record and may only be disclosed pursuant to W.S. § 35-1-427(a).

History

Effective 2018-03-20

Chapter 9 Divorce Registration

Wyo. Code R. 048.0059.9.04212008 Divorce Registration

CHAPTER 9

DIVORCE REGISTRATION

Section 1. Responsibility of the Clerk of District Court. The clerk of the district court or a designated representative shall:

(a) Obtain the personal information necessary to complete the divorce certificate from the attorney for the plaintiff or the plaintiff if he or she has no legal representative;

(b) Complete all items of the divorce certificate;

Section 2. Time Limitations. Certificates should be forwarded to the State Registrar by the tenth of the month following the month in which the divorce was granted.

History

Effective 2008-04-21

Chapter 10 Corrections and Amendments

Wyo. Code R. 048.0059.10.03132026 § 1 Corrections and Amendments

General Provisions for Amendments within the First Year. See succeeding sections for specific documents.

(a) Amendments of obvious errors such as transpositions of letters in words of common knowledge on certificates may be made by the State Registrar of Vital Records within the first year after the date of birth, death, marriage or divorce, either upon his or her own observation or query or upon request of a person with a direct interest in the certificate.

(b) The following types of corrections may be made upon receipt of a signed statement from the person or office that filed the original certificate.

(i) Corrections of typographical errors in transferring information from the worksheet or other medical record to the certificate;

(ii) Clarification of inconsistent entries made in response to a query from this office;

(iii) Entry of items which were previously omitted.

(d) Prior to one (1) year of the date of the birth, death, marriage, or divorce recorded on the certificate, corrections or additions may be made by lining through the incorrect information so as not to obliterate it and entering the correct information. A notation as to the source of the information, together with the date the change was made, and the initials of the authorized clerk making the change, shall be made on the certificate.

(e) After an item has been amended, it can only be changed by a court order.

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 2 Corrections and Amendments

General Provisions for Amendments after the First Year. After one (1) year no corrections shall be made on the face of the original certificate. Unless otherwise provided in the regulations or by statute, all amendments to vital records shall be supported by an Affidavit of Correction form and one piece of documentary evidence.

(a) Affidavits of Correction.

(i) Affidavits of Correction must set forth information to identify the certificate, the incorrect item(s) as it is listed on the certificate, the correct item(s) as it should appear, and a description of the evidence used to support the correction.

(ii) Only those eligible to apply to correct the certificate may sign the affidavit. (See succeeding sections for who is eligible to apply.)

(iii) The applicant shall not alter the affidavit.

(iv) The affidavit must be signed before an official authorized to administer oaths.

(b) Documentary evidence.

(i) Evidence must have been established at least five (5) years prior to

the date of the first application for amendment or within seven (7) years of the date of the

event.

(ii) With the exception of the item or items on the certificate to be corrected, evidence must correspond with the original certificate as to all other pertinent information.

(iii) Documents used as evidence must contain the item(s) of information exactly as it is to be corrected on the certificate.

(iv) Documents that have been altered will not be accepted.

(v) Only one (1) document can be used as evidence. All information to be corrected must be shown on that document.

(vi) A copy of a document from an organization must be certified as a true copy of the original by the custodian of the document and show the date the document was originally made.

(vii) Copies of certified copies will not be accepted.

(viii) Supporting evidence will be copied and returned to the applicant upon completion of the amendment.

(ix) The State Registrar of Vital Records shall evaluate the evidence submitted in support of any amendment to a certificate. When he or she finds reason to question the validity or adequacy of evidence submitted, the amendment may be rejected and the applicant advised of the reasons for this action.

(c) Corrections to a certificate made by affidavit must be completed within one (1) year from the date of the application for correction. After one (1) year the file will be closed. The file can be opened again by the resubmission of acceptable evidence.

(d) After an item on a certificate has been amended, that item can only be amended or changed again by a court order.

(e) All corrections to a certificate made by affidavit must be done at one time. Any corrections thereafter will require a court order.

(f) The Affidavit of Correction shall become a part of the original certificate.

(g) A certificate which has been prepared or amended by court order can only be changed or amended again by a court order.

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 3 Corrections and Amendments

Amendments by Court Order.

(a) An item on a certificate can be changed upon receipt of a certified copy of a court order from a court of competent jurisdiction.

(b) The court order must be specific as to the changes to be made on the certificate.

(c) If the court order specifies that a new certificate be prepared, the original certificate and relevant correspondence shall be retained on file in Vital Records Services. The new certificate shall be prepared on the form in use at the time the original certificate was prepared if possible.

(d) If the court order does not specify that a new certificate be prepared, an abstract of the court order will be attached to the existing certificate. The abstract will state the date of the order, the order number, the name and location of the court, the data appearing on the original certificate that is to be changed and the new data. The abstract will become part of the certificate.

(e) The certified copy of the court order will be retained by Vital Records Services.

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 4 Corrections and Amendments

Birth Certificate Correction.

(a) Application for correction. The following persons may apply to correct an item on the birth certificate:

(i) One of the parents listed on the certificate;

(ii) A legal guardian upon presentation of proof of guardianship;

(iii) The registrant if of legal age;

(iv) The individual responsible for preparing the certificate.

(b) Correction or addition of given names.

(i) Within the first year following birth, given names may be changed, added, deleted or corrected upon receipt of a signed request of the parents named on the certificate, or the guardian or agency having legal custody. Before the first birthday, the name is added to the face of the birth certificate.

(ii) The child's name may be added before the child's seventh birthday on certificates bearing no given name upon receipt of a signed request of the parents named on the certificate, or the guardian or agency having legal custody. After the first birthday, the name is added by affidavit and the certificate is marked "Amended." After the seventh birthday, the name is added by affidavit and documentary evidence is required.

(i) The surname cannot be changed except upon receipt of a certified copy of a court order of a court of competent jurisdiction.

(ii) Within the first year of birth, spelling and typographical errors may be corrected by a request signed by the parents named on the certificate, or the hospital responsible for preparing the birth certificate.

(iii) After the first year spelling and typographical errors may be corrected by affidavit and documentary evidence.

(iv) Surname suffixes such as Jr., II, etc. are considered part of the surname and the above rules apply.

(d) Date, place and hour of birth. Within the first year of birth corrections to date, place and hour of birth may be made upon receipt of a signed statement from the hospital where the birth occurred or from the attending physician. In the absence of the above, the certifier may make the correction with acceptable evidence.

(e) Sex as stated on birth certificate.

(i) The sex may only be amended by receipt of a signed statement from the hospital or attending physician where the birth occurred indicating sex at birth. In the absence of the above, the State Registrar may correct the sex designation on a birth record if there is acceptable evidence that an error occurred in the recording of the person's sex at the time of birth. If the State Registrar believes the evidence submitted by the applicant is fraudulent, inadequate, or not authentic, the application for a change to the sex designation will be denied, whereupon the applicant will be advised in writing of the State Registrar's decision.

(f) If the State Registrar ascertains a correction should be made on a certificate and correction proceedings are not completed by the registrant, any copies of the certificate issued shall be stamped "Pending Correction."

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 5 Corrections and Amendments

Death Certificate Correction.

(a) Application for correction. The following persons may apply to amend a death certificate with the exception of the medical certification:

(i) Next of kin;

(ii) Informant listed on certificate;

(iii) Funeral director listed on certificate.

(b) Marital status and surviving spouse.

(i) These items will not be changed on the face of the death certificate.

(ii) Changes can be made only by an Affidavit of Correction form signed by the person listed as the informant on the death certificate or upon receipt of a court order.

(iii) Additional evidence may be required to substantiate the amendment.

(c) The medical certification of cause of death may be changed only upon receipt of a signed statement from the physician or coroner who signed the certificate. In the case of the death or incapacity of the certifying physician, a signed statement from an associate physician with access to the medical records may be accepted. In case of the death or incapacity of the certifying coroner, a signed statement from the coroner's successor may be accepted.

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 6 Corrections and Amendments

Marriage Certificate Correction.

(a) Application for correction. The following person may apply to amend a marriage certificate:

(i) Groom;

(ii) Bride;

(iii) Officiant;

(iv) County Clerk.

(b) When marriage certificates are amended, the county clerk who issued the license shall be informed of the items corrected and what evidence was used to justify the correction.

History

Effective 2026-03-13

Wyo. Code R. 048.0059.10.03132026 § 7 Corrections and Amendments

Divorce Certificate Correction. No corrections may be made on a divorce certificate unless the court granting the divorce authorizes such corrections in a signed statement submitted to the State Registrar of Vital Records.

History

Effective 2026-03-13

Chapter 11 Delayed Registration

Wyo. Code R. 048.0059.11.04212008 Delayed Registration

CHAPTER 11

DELAYED REGISTRATION

Section 1. Births. All births registered one (1) year or more after the date of birth are to be registered on a special "Delayed Certificate of Birth" form. Delayed birth registrations may not be filed for deceased persons.

(a) The following individuals may request delayed registration of a birth if it occurred in this state and has not been previously recorded:

(i) The person whose birth is to be registered if of legal age in Wyoming;

(ii) If the person whose birth is to be registered is under legal age in Wyoming, or unable to make the request, the registrant's parent or legal guardian.

(b) The Delayed Certificate of Birth shall provide the following information supported by documentary evidence:

(i) The full name of the person at time of birth;

(ii) The date of birth;

(iii) The state of birth and either the city or county of birth;

(iv) The full maiden name of the mother;

(v) The full name of the father in accordance with the provisions of Chapter 3, Section 2.

(i) If the registrant is under twelve (12) years of age, one piece of documentary evidence shall be required.

(ii) If the registrant is twelve (12) years of age or over, three (3) pieces of documentary evidence are required. One (1) piece of evidence must have been established prior to the registrant's twelfth birthday.

(d) Documentary evidence:

(i) The document must have been established at least five (5) years prior to the starting of the delayed file unless the registrant is under the age of twelve (12);

(ii) If the registrant is under the age of twelve (12), the document must have been established prior to the starting of the delayed file and within the first three (3) years of life.

(iii) The document must show the date it was originally established;

(iv) The document must show the information exactly the same as the information to be placed on the certificate;

(v) The copy of the document must be certified as a true copy of the original by the custodian of the document and show the date the copy was issued;

(vi) Affidavits of personal knowledge are not acceptable as evidence.

(e) The upper portion of the Delayed Certificate of Birth form must be signed and sworn to before a notary public or an official authorized to administer oaths. The applicant shall not alter the form.

(i) If the registrant is under legal age in Wyoming, the delayed form shall be signed by the registrant's parent or legal guardian.

(ii) If the registrant is of legal age in Wyoming, the registrant shall sign the delayed form. If the registrant is female, she must sign her maiden name plus her married name, if applicable. If the registrant is legally incompetent, the delayed form shall be signed by the registrant's legal guardian.

(f) The State Registrar of Vital Records, or a designated representative, shall abstract on the Delayed Certificate of Birth a description of each document submitted to support the facts shown on the delayed birth certificate. This description shall include:

(i) The title or description of the document;

(ii) The name and address of the custodian of the document;

(iii) The date the document was created;

(iv) The information regarding the birth facts contained in the document.

(g) All documents submitted in support of the delayed birth registration, shall be returned to the applicant after completion of the filing.

(h) For all delayed certificates prepared by Vital Records Services, the State Registrar, or a designated representative, shall certify:

(i) That no prior birth certificate is on file for the person whose birth is to be recorded;

(ii) That the evidence submitted has been reviewed and found it to be sufficient to establish the facts of birth;

(iii) The abstract of the evidence appearing on the Delayed Certificate of Birth accurately reflects the nature and content of the documents submitted to establish the facts of birth.

(i) When the State Registrar finds reason to question the validity or adequacy of the documentary evidence submitted, applications for delayed certificates may be dismissed. Upon dismissal, the applicant shall be advised in writing of the State Registrar's decision. A fee for searching the birth files as provided for by Chapter 14, Section 3, (f), will be retained. All remaining fees will be returned to the applicant by Vital Records Services.

(j) Once a delayed certificate has been accepted for filing, it cannot be changed except by court order.

(k) When an adoption decree is received, and no original birth certificate is on file, a delayed certificate of birth shall be established before the substitute certificate is completed. The delayed certificate and evidence shall be placed in a sealed confidential envelope subject to inspection only by court order. (See Chapter 4, Section 1

(d) )

Section 2. Deaths. All deaths registered one (1) year or more after the date of death shall be registered on the standard certificate of death in the following manner:

(a) If the attending physician or the coroner at the time of death and the funeral director or person who acted as such are available, they shall complete and sign the death certificate. The certificate must be accompanied by affidavits from them stating that the information it contains is based on records kept in their files.

(b) In the absence of the attending physician or coroner or the funeral director or person who acted as such, the certificate may be filed by the next of kin of the deceased and shall be accompanied by:

(i) An affidavit of the person filing the certificate swearing to the accuracy of the information on the certificate;

(ii) Two documents which were established at the time of death and which identify the deceased and the date and place of the death.

(d) The face of the certificate shall be marked "Delayed" and show the date of the delayed registration.

(e) A summary statement of the evidence submitted in support of the delayed registration shall be included on the certificate.

Section 3. Marriage. The registration of a marriage after one (1) year of the date of the marriage shall be registered on the standard certificate of marriage form in the following manner:

(a) The registration shall be supported by:

(i) A copy of the license or the application for license if the license was granted;

(ii) A statement signed by the officiant at the marriage ceremony, or the custodian of the records of the officiant, and from one (1) witness to the marriage ceremony stating that there was a marriage and the date and place of the marriage.

(b) The State Registrar may require additional documentary evidence to prove the facts of marriage.

(c) The certificate shall be marked "Delayed" and the date of the delayed registration shall be shown on the face of the certificate.

(d) A summary statement of the evidence submitted in support of the delayed registration shall be included on the certificate.

(e) After a Delayed Certificate of Marriage is filed by the State Registrar, a certified copy must be sent to the county clerk of the county issuing the license.

History

Effective 2008-04-21

Chapter 12 Disclosure of Vital Records

Wyo. Code R. 048.0059.12.04212008 Disclosure of Vital Records

CHAPTER 12

DISCLOSURE OF VITAL RECORDS

Section 1. Requests - Who May Have Copies. The State Registrar of Vital Records shall not permit inspection of, or disclose information contained in vital records, or copy or issue a copy of all or part of any such record unless the applicant is authorized to obtain information under these rules.

(a) Birth Records may be obtained by:

(i) Registrant, if of legal age;

(ii) Either parent named on the certificate;

(iii) A lawyer representing either the registrant or the parent(s);

(iv) A legal guardian upon presentation of a certified copy of the guardianship papers;

(v) The judicial branch or a department of the federal, state or local government if needed in the performance of their duties. The State Registrar may require the signature of one of the above (i-iv).

(b) Death records may be obtained by:

(i) A member of the immediate family;

(ii) A lawyer representing the immediate family;

(iii) A bank, executor of the estate, insurance company, or anyone requiring a death certificate to pay a policy or death benefit on the decedent;

(iv) A funeral home acting for the immediate family;

(v) The judicial branch or a department of the federal, state or local government if needed in the performance of their duties. The State Registrar may require the signature of a member of the immediate family.

(i) Either party;

(ii) A lawyer acting for either party;

(iii) The judicial branch or a department of the federal, state or local government if needed in the performance of their duties. The State Registrar may require the signature of one of the above (i-ii).

(d) Divorce records may be obtained by:

(i) Either party;

(ii) A lawyer acting for either party;

(e) Affidavits acknowledging or denying paternity may be obtained by:

(i) A signatory of the acknowledgment or denial;

(ii) The child support enforcement agency of any state;

(iii) The judicial branch of the federal, state, or local government.

(f) Individuals and organizations other than those listed above may be authorized to obtain certified copies when they demonstrate that the information is needed for the determination of a personal or property right.

(g) Whenever it shall be deemed necessary to establish an applicant's right to information from vital records, the State Registrar of Vital Records may require identification of the applicant or a sworn statement of identity.

(h) When one hundred (100) years have elapsed after the date of birth or fifty (50) years have elapsed after the date of death, marriage, or divorce, certified copies of such certificates shall be made available to any person upon submission of an application containing sufficient information to locate the certificate. These certificates may be made available by the State Registrar of Vital Records in microfilm format to the State Archives for public research.

Section 2. Confidentiality.

(a) Nothing in these regulations shall be construed to permit disclosure of information contained in the "Confidential Information for Medical and Health Use Only" section of the birth certificate and the "Information for Statistical Purposes Only" section of the marriage and divorce certificates unless specifically permitted by the State Registrar for statistical research.

(b) Information obtained from records in Vital Records Services shall be treated as confidential by employees of Vital Records Services and others who may have access to the records.

Section 3. Verifications.

(a) Verifications of dates and places of events contained in vital records may be furnished by the State Registrar of Vital Records to any agency or person representing the interest of the registrant.

(b) Such verifications shall be on the forms prescribed and furnished by the State Registrar of Vital Records or on forms furnished by the requesting agency and acceptable to the State Registrar of Vital Records.

(d) Written verifications will be issued for genealogical research rather than certified copies of vital records.

Section 4. Research Purposes. The State Registrar of Vital Records may permit the use of data from vital records for statistical research purposes, subject to such conditions as the State Registrar of Vital Records may impose, as required by law. No data shall be furnished from vital records for research purposes until the State Registrar of Vital Records has received an agreement signed by a responsible agent of the research organization agreeing to meet with and conform to such conditions as may be imposed by the State Registrar, as required by law.

Section 5. Administrative Purposes. The State Registrar of Vital Records may disclose information from vital records to federal, state, county or municipal agencies of government which request such data in the conduct of their official duties.

Section 6. Misrepresentation or Fraud. When the State Registrar of Vital Records finds that a certificate was registered through misrepresentation or fraud, a certified copy of such certificate shall not be issued until a court determination of the facts has been made.

Section 7. Local Registrars. Local Registrars shall take necessary measures to maintain the confidentiality of vital records in their custody. Copies of certificates are not to be issued by the local registrar.

History

Effective 2008-04-21

Chapter 13 Copies of Vital Records

Wyo. Code R. 048.0059.13.04212008 Copies of Vital Records

CHAPTER 13

COPIES OF VITAL RECORDS

Section 1. Types of Copies.

(a) Full or short form certified copies of vital records may be made by mechanical, electronic, or other reproductive processes, except that the information contained in the "Confidential Information for Medical and Health Use Only" section on birth and stillbirth certificates and "Information for Statistical Purposes Only" on marriage and divorce certificates shall not be included.

(b) In accordance with Chapter 12, Section 4 herein, non-certified copies may be issued for statistical purposes only.

Section 2. Certification.

(a) When a certified copy is issued, it shall contain a statement including:

(i) The State Registrar's signature or authorized facsimile thereof; or the signature of a designated representative or authorized facsimile thereof;

(ii) The date issued;

(iii) The seal of the office of Vital Records Services.

(b) Copies of death certificates issued by funeral directors must be plainly marked "Conformed Copy." These copies shall not purport to be certified copies pursuant to W.S. 35-1-425.

History

Effective 2008-04-21

Chapter 14 Fees

Wyo. Code R. 048.0059.14.03202018 § 1 Advance Payment, Copies for Government Use, Replacement Copies

(a) Fees for services provided by Vital Statistics Services must be paid in advance.

(b) Vital Statistics Services may issue, free of charge, one (1) verification or certified copy to federal, state, and local government agencies for official purposes.

(c) Vital Statistics Services shall issue free of charge, a corrected copy of a birth certificate that has been corrected within the first year of the birth date.

History

Effective 2018-03-20

Wyo. Code R. 048.0059.14.03202018 § 2 Fees

(a) The fees for copies, corrections, amendments, and searches of vital records are as follows:

(i) A computer abstract of a death certificate is $10.00 for the first copy and $5.00 for each additional copy within the same order. A certified copy of the original record is $20.00.

(ii) A computer abstract of a birth, stillbirth, marriage, or divorce certificate is $15.00. A certified copy of the original record is $20.00.

(iii) A certified copy of an Affidavit Acknowledging Paternity (AAP) is $15.00.

(iv) A verification of the facts of birth, death, stillbirth, marriage or divorce is $15.00 and $10.00 for each additional copy within the same order.

(v) Correcting an error on a certificate is $15.00 and a replacement certificate issued following the correction is $10.00.

(vi) A record search covering a five (5) year period, when the event date is unknown, is $20.00. If a record is found, a certified copy or verification of the event is included in the record search fee.

(vii) Completing a delayed or court ordered action; e.g., adoptions (domestic and foreign born), court ordered paternities, court ordered name changes, or any other court ordered change to a certificate is $40.00. A certified copy of the certificate following the order is included in the fee.

(viii) An amendment to a certificate, as a result of an affidavit acknowledging paternity, or court order paternity including one (1) certified copy of the amended certificate is $25.00. A certified copy following the amendment is included in the fee.

(ix) Opening a sealed file, not including issuing a certified copy or verification, is $25.00. A copy of the contents of the sealed file is $15.00.

(x) A statistical report using existing data queries is $35 per hour with a one-hour minimum charge.

(xi) A statistical report, requiring system changes or updates, with an Enterprise Technology Services administrative fee is $95 per hour with a one-hour minimum fee per request. Each request will be administered a State of Wyoming Enterprise Technologies Fee.

History

Effective 2018-03-20

386 Volunteer Health Services Program

Chapter 1 Volunteer Health Services Program

Wyo. Code R. 048.0073.1.02202019 § 1 Authority

(a) This Chapter is promulgated by the Department of Health pursuant to the Volunteer Health Services Program Act at Wyoming Statutes §§ 35-31-101 through 35-31-103.

History

Effective 2019-02-20

Wyo. Code R. 048.0073.1.02202019 § 2 Purpose

(a) The rules in this chapter are adopted to implement a volunteer health services program under which the Department may execute contracts with health care providers and medical facilities to deliver volunteer health care services to low income persons, and the Wyoming Governmental Claims Act shall apply to those providers and facilities.

(b) The Department may issue manuals and bulletins to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the policies contained in this chapter. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this Chapter.

History

Effective 2019-02-20

Wyo. Code R. 048.0073.1.02202019 § 3 Definitions

(a) The definitions contained in Wyoming Statute § 35-31-101 are incorporated. Except as otherwise specified, the terminology used in this Chapter has the standard meaning used in health care.

History

Effective 2019-02-20

Wyo. Code R. 048.0073.1.02202019 § 4 Volunteer Health Services, Application of Claims Act, Requirements

(a) For purposes of the Volunteer Health Services Program (the program), a health care provider, in order to be considered a public employee, or a medical facility, in order to be considered a medical facility of the state, shall enter into a fully executed volunteer health services contract with the Department, on a form approved by the Wyoming Attorney General, before providing volunteer health care covered by the program. The contract shall be in substantial compliance with the provisions of Wyoming Statute § 35-31-102(b) through (e).

(b) Before treating a patient who will be covered under a contract pursuant to the program, the treating health care provider or facility shall obtain the signature of the patient or the patient's representative on a disclosure form that meets the requirements of Wyoming Statute § 35-31-103, is approved by the Department, and attests that the patient meets the qualifications of Wyoming Statute § 35-31-101(a)(iv).

(c) The Department, health care provider, or medical facility may terminate the contract upon written notice of its intent to terminate at least five (5) business days before the contract termination date, unless the Department determines that immediate termination is necessary to protect the safety of patients. A contract with a provider shall be deemed terminated immediately upon suspension or revocation of the provider's authority to practice pursuant to the applicable chapter of Title 33 of the Wyoming Statutes. A contract with a medical facility shall be deemed terminated immediately upon suspension or revocation of the facility's license pursuant to Wyoming Statute § 35-2-905.

History

Effective 2019-02-20

Wyo. Code R. 048.0073.1.02202019 § 5 Superseding Effect

(a) This Chapter supersedes all prior rules or policy statements issued by the Wyoming Department or its designee, including manuals and bulletins that are inconsistent with this Chapter.

History

Effective 2019-02-20

Wyo. Code R. 048.0073.1.02202019 § 6 Severability

(a) If any portion of these rules is found invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2019-02-20

1431 Wyoming Adult Hearing Aid Program

Chapter 1 Wyoming Adult Hearing Aid Program

Wyo. Code R. 048.0081.1.04102025 § 1 Authority

The Wyoming Department of Health (Department) promulgates these rules pursuant to Wyoming Statutes § 35-25-601, et. seq., the Wyoming Adult Hearing Aid Program.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 2 Purpose and Applicability

(a) These rules shall apply to and govern the Wyoming Adult Hearing Aid Program (Program).

(b) Subject to available state funding, the Department shall provide hearing aids for eligible adults, including hearing aid fitting and ear molds.

(c) Eligibility, administration, and implementation of the Program under this section shall be determined by the Department or its designee. The Program shall be consistent and reflect the rules contained in this Chapter. The Department may issue manuals, bulletins, or policies to interpret these rules. The provisions contained in any manuals or bulletins shall be subordinate to the sections of these rules.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 3 Definitions

Except as otherwise specified in Wyoming Medicaid Rules Chapter 1, Title 35 of the Wyoming Statutes, or this Section, the terminology used in this Chapter is the standard terminology and has the standard meaning as used in health care, Medicaid, and Medicare.

(a) "Audiogram" means the visual result of an audiometry hearing test administered by an audiologist or other health professional.

(b) "Audiologist" means an individual currently licensed to practice audiology in the State of Wyoming.

(c) "Eligible Adult" means a Wyoming resident not less than eighteen (18) years of age who has been diagnosed by a physician or audiologist with a profound hearing impairment that requires hearing aids and who has a monthly modified adjusted gross family income at or below two hundred percent (200%) of the federal poverty level.

(d) "Hearing aid" means as defined by W.S. 33-35-102(a)(ii).

(e) "Hearing aid accessory" means a chest harness, tone and ear hooks, carrying cases, and other accessories that not included in the cost of the hearing aid but that are necessary to recipient's use of the hearing aid.

(f) "Hearing aid service provider" means:

(i) All in-state Wyoming providers and out-of-state providers that are currently enrolled in the Wyoming Medicaid program to dispense hearing instruments.

(ii) Any individual or entity that has a current provider agreement, is licensed and/or certified to provide hearing services in the method being provided and is enrolled by the Department;

(iii) An audiologist; or

(iv) An otolaryngologist.

(g) "Hearing aid services" means the services provided by a hearing aid services provider that are necessary to dispense hearing aids and provide hearing aid accessories and repairs.

(h) "Hearing test" is an evaluation administered by a hearing aid services provider of an individual's ability to hear that includes the following components:

(i) Testing of air-conducted stimuli at thresholds of five hundred hertz (Hz), one thousand Hz, two thousand Hz, and four thousand Hz;

(ii) Assessment of air-conducted speech awareness or speech reception threshold;

(iii) Establishment of most comfortable and most uncomfortable listening levels;

(iv) Pure-tone conduction audiometry (unless an individual's age or capability precludes such testing.

(i) "Otolaryngologist" means a physician specializing in diseases of the ear and larynx who is board eligible or board certified by the American Board of Otolaryngology.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 4 Covered Hearing Aid Services

The services and supplies specified under this subsection are covered services if medically necessary, subject to any exclusions or limitations contained in these rules and the Rules and Regulations of the Wyoming Department of Health. An eligible adult for services under this Program shall receive:

(a) Up to one (1) hearing aid per ear at a cost of not more than the rate paid for hearing aids under the Wyoming Medical Assistance and Services Act and including hearing aid insurance for loss or damage;

(b) A hearing aid fitting at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act; and

(c) An initial set of ear molds at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 5 Eligibility

(a) General Requirements

(i) All applicants must be eighteen (18) years of age or older at the time of submission of their application.

(ii) Submission of a complete application as determined by the Department within the designated timeframe.

(iii) Individual must have hearing loss of 35 decibels (dB) in one ear, or 30 dB in both ears to qualify for this Program.

(iv) Individual is not eligible to receive hearing aids through private insurance, Medicaid, Medicare or any other available third-party payor.

(A) If individual cost sharing exceeds $500 for hearing aids, this is not considered full coverage as defined by Statute, and the Department shall serve as a secondary payor.

(v) Applicants shall not receive more than one (1) hearing aid, monaural or set, under this Program in any five (5) year period.

(vi) Applicants must have a monthly modified adjusted gross family income at or below two hundred percent (200%) of the federal poverty level.

(b) Medical Criteria

(i) An audiogram or other form pre-approved by the Department that reports the hearing evaluation test or dB loss must include for both right and left ears:

(A) Hearing thresholds at 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz for air conduction, and

(B) 500, 1000, 2000, and 4000 Hz for bone conduction.

(ii) If the hearing test shows an average hearing loss in one ear of 35 dB or greater, based on the standard pure-tone average (PTA) (500, 1000, 2000 Hz) for that ear, a monaural aid shall be allowed.

(iii) Binaural hearing aids are reimbursed by the Department only under one of two circumstances:

(A) Must be medically verified that the individual has an average hearing loss of 30 dB based on the standard PTA for both ears.

(B) The individual is blind, and it has been medically determined that a monaural hearing aid may be contraindicated.

(iv) Hearing loss that is correctable by other means is not eligible for a hearing aid under this Program.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 6 Application

(a) Timeframe

(i) If funding is available, the Department shall announce any application period no less than thirty (30) days before the opening of such period.

(ii) Applications shall be received for at least sixty (60) days per state fiscal year as announced by the Department. The Department may extend or reopen the application period as funding becomes available.

(iii) All applications received shall be documented and tracked by the Department.

(b) The Department shall establish and administer an application process.

(c) Any information received shall be protected as necessary under the Department's personally identifiable information (PII) policies and rules.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 7 Prioritization

(a) Eligible individuals with the greatest hearing loss must be served first until the Program funding is exhausted. The following prioritization of eligible applicants shall be established:

(i) Hearing loss as documented in the audiogram or other form pre-approved by the Department that reports the hearing evaluation test submitted with the application.

(ii) Time and date of application submission

(A) Electronic applications shall be recorded at time of submission of a complete application.

(B) Complete applications submitted by mail shall be recorded as 12:00PM MST on the postmarked date.

(b) The Department shall maintain a waitlist to provide additional hearing aids to applicants as funding is appropriated and approved.

(i) Waitlist order shall be established based on the prioritization described above.

(ii) Waitlist shall be maintained for two (2) years from date of application submission.

(iii) An updated audiogram, or other form pre-approved by the Department, that reports the hearing evaluation test or dB loss for both right and left ears may be submitted for consideration of waitlist priority.

(iv) The waitlist shall be fulfilled as funding becomes available.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 8 Payment

(a) Payment shall be made pursuant to the provider manual for this Program.

(b) This Program must not exceed Medicaid reimbursement and additional per person limits established by the Department.

(c) Reimbursement for an individual shall be limited to three thousand dollars ($3,000.00) for both ears in a 5-year period. Additionally, the following limitations shall apply to hearing aids:

(i) Up to one (1) hearing aid per ear at a cost of not more than the rate paid for hearing aids under the Wyoming Medical Assistance and Services Act and including hearing aid insurance for loss or damage;

(ii) A hearing aid fitting at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act; and

(iii) An initial set of ear molds at a cost of not more than the rate paid under the Wyoming Medical Assistance and Services Act.

(d) Hearing aid services provider must accept payment made pursuant to these rules as payment in full for hearing aid services. No further reimbursement or cost sharing may be sought from the eligible individual.

(e) Cost limits shall be regularly revisited by the Program to ensure medically appropriate equipment can be purchased within the cost limit established by the Department.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 9 Employees

The Department is authorized to hire no more than one (1) at-will employee contract position to administer and implement this Program.

History

Effective 2025-04-10

Wyo. Code R. 048.0081.1.04102025 § 10 Severability

If any portion of these rules is found to be invalid or unenforceable, the remainder shall continue in effect.

History

Effective 2025-04-10

187 Wyoming Cancer Program

Chapter 1 Wyoming Colorectal Cancer Screening Program

Wyo. Code R. 048.0063.1.01032024 § 1 Authority

The Wyoming Department of Health (Department) promulgates these rules pursuant to Wyoming Statutes 35-25-203 and -204.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 2 Purpose

These rules implement the Department's Wyoming Colorectal Cancer Screening Program (WCCSP), as contemplated by the Wyoming Cancer Control Act at W.S. 35-25-204.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 3 Definitions

(a) For the purpose of these rules, the following definitions apply:

(i) "Adverse event" means an injury or complication resulting from the colorectal cancer screening procedure.

(ii) "Underinsured" means an applicant has a large out-of-pocket cost sharing required by their health insurance plan that they cannot afford.

(iii) "Participating healthcare provider" means an entity that has executed a contract with Wyoming Medicaid and has a qualifying taxonomy code.

(iv) "Applicant" means an individual who has completed an enrollment form for the WCCSP.

(v) "Client" means an individual that has been accepted to participate in the WCCSP.

(vi) "Evidence-based colorectal cancer screening" means a test to screen for colorectal cancer that is supported by a large amount of scientific research.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 4 Client Eligibility Requirements

(a) An individual is eligible to participate in the WCCSP as a client if the individual:

(i) has been a resident of the State of Wyoming for at least one (1) year immediately prior to receiving their evidence-based colorectal cancer screening;

(ii) meets appropriate age requirements in accordance with national evidence-based recommendations which is publicly available on the program's website; and

(iii) is uninsured or underinsured; and

(iv) has a gross income before taxes at or below 250% of the Federal Poverty Guidelines.

(b) To participate in the WCCSP as a client, an eligible individual shall submit a completed application in the form and manner prescribed by the Department.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 5 Client Eligibility Decision

(a) Upon receipt of a complete application, the Department shall determine if the applicant is eligible to enroll in the WCCSP as a client.

(i) If the Department determines that an applicant is eligible, the Department shall enroll the applicant in the WCCSP as a client and provide written notice of its decision.

(A) The Department may dis-enroll a client at any time if the Department determines that the client is no longer eligible to participate in the WCCSP.

(B) The Department shall provide the client written notice of the Department's decision to dis-enroll, including the basis for its decision.

(ii) If the Department determines that an applicant is not eligible, the Department shall provide the individual written notice of its decision, including the basis for its decision.

(iii) If the Department determines that an applicant is ineligible to enroll or that a client is no longer eligible to participate in the WCCSP, the applicant or client may submit a request for reconsideration in the form and manner prescribed by the Department. An applicant or client is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 6 Client Participation

(a) A client is enrolled in the WCCSP for a period of one (1) year from the client's enrollment date.

(b) A client may receive colorectal cancer screening services only from a WCCSP participating healthcare provider.

(i) A client may receive coverage for one (1) evidence-based colorectal cancer screening every year. Colonoscopy coverage is limited to one (1) every ten (10) years.

(ii) A client may apply, in the form and manner prescribed by the Department, to receive an additional evidence-based colorectal cancer screening if medically indicated based on national evidence-based guidelines. If the Department denies the application, the client may submit a request for reconsideration, with clinical documentation from the participating healthcare provider, in the form and manner prescribed by the Department. The client is not entitled to request a contested case proceeding pursuant to the Wyoming Administrative Procedure Act.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 7 Covered Services

(a) For a client enrolled in the WCCSP, the Department shall cover the costs related to an evidence-based colorectal cancer screening, according to the following provisions:

(i) The Department shall reimburse a participating healthcare provider only for the services and at the rates identified on the WCCSP's Current Procedural Terminology (CPT) codes list which is publicly available on the program's website; and

(ii) The Department may not reimburse a participating healthcare provider for:

(A) Services related to adverse events; and

(B) Follow-up surgery or additional care needed if cancer or another condition requiring additional medical care is found.

History

Effective 2024-01-03

Wyo. Code R. 048.0063.1.01032024 § 8 Provider Eligibility, Reimbursement, and Billing

(a) A healthcare provider may automatically participate in the WCCSP if they are approved as a Wyoming Medicaid provider with a qualifying taxonomy code.

(b) A participating healthcare provider may not receive reimbursement for covered services rendered to a client enrolled in the WCCSP unless the provider submits the appropriate clinical documentation for the services performed, in the form and manner prescribed by the Department.

(c) The Department shall reimburse a participating healthcare provider for covered services rendered to a client enrolled in the WCCSP at the current Wyoming Medicaid allowable rates for the date of service.

(d) A participating healthcare provider shall accept the Department's payment for covered services as paid in full.

(e) A participating healthcare provider may not bill the client, or any member of the client's family, for services covered by the WCCSP. This prohibition includes imposing additional charges for covered services.

(f) A participating healthcare provider may bill a client enrolled in WCCSP if services provided are not covered by the WCCSP, and, prior to providing services, the provider informs the client in writing that the service is non-covered and the client is responsible for those charges.

(g) For persons who are underinsured, the program shall only pay for expenses not covered by insurance.

1-1

History

Effective 2024-01-03

391 Wyoming Frontier Health Information Exchange (WYFI) Program

Chapter 1 Wyoming Frontier Health Information Exchange

Wyo. Code R. 048.0074.1.01032024 Wyoming Frontier Health Information Exchange

Chapter 1

Wyoming Frontier Health Information Exchange

Section 1. Authority. The Wyoming Department of Health (the Department) promulgates this Chapter pursuant to the authority granted in Wyoming Statute § 9-2-106(a)(vii) and W.S. § 9-2-131.

Section 2. Purpose and Applicability.

(a) The Department adopts this Chapter to govern the establishment and operation of the Wyoming Health Information Exchange by the Wyoming Frontier Health Information Program ("WYFI"). This Chapter establishes how data is used, stored, and exchanged between participants and authorized users. It also establishes the Department's collection of reasonable participation fees for use of the Health Information Exchange.

(b) The Department may issue manuals and bulletins to participating providers and other affected third parties to interpret the provisions of this Chapter. Such manuals and bulletins shall be consistent with and reflect the provisions contained in this Chapter.

Section 3. Definitions.

(a) Except as otherwise specified, the terminology used in this Chapter is the standard terminology and has the standard meaning used in healthcare, including the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health Act (HITECH).

(b) For the purpose of these rules and regulations, the following definitions shall apply:

(i) "Authorized User" means an individual or entity authorized by a participant or the WYFI to use the Health Information Exchange for a permitted use as outlined in the WYFI Policy and Procedure Manual.

(ii) "Data" means protected health information, or information that identifies a patient that is used, stored, or exchanged between participants and authorized users with the Health Information Exchange.

(iii) "Health Information Exchange" means the system operated by the WYFI that allows participants and authorized users to electronically use, store, or exchange data.

(iv) "Participant" means an entity that has entered into a participant agreement with the WYFI to use the Health Information Exchange.

(v) "Patient" means an individual who has received or will receive treatment for healthcare services from a WYFI participant, authorized user, from authorized users of other health information exchanges, or whose records are stored in a public health registry.

Section 4. General Provisions.

(a) The Health Information Exchange is established as a federated data repository that facilitates the exchange of data among participants and authorized users, including other health information exchanges and public health registries.

(b) This Chapter is intended to implement and be read in conjunction with applicable Wyoming Statutes and federal law.

Section 5. Collection and Exchange of Data.

(a) All data will be stored in a secure hosting facility provided by the WYFI contractor, with access regulated and controlled in accordance with state and federal laws, including HIPAA and HITECH.

(b) The Health Information Exchange will include data from participants contributing data unless a patient has opted out.

(c) All data used, stored, transmitted, or exchanged by the Health Information Exchange under this Chapter is not subject to disclosure under the Wyoming Public Records Act, Wyoming Statute §16-4-201(a)(v). This includes information accessible by the Department and assigned contractors.

Section 6. Participation and Health Information Exchange Access.

(a) Access and participation in the Health Information Exchange by participants and authorized users is voluntary.

(i) An agency, organization, facility, or other health information exchanges may apply to participate in the Health Information Exchange by submitting a request and then entering into a participant agreement with the WYFI.

(ii) A Department program, or a business associate, including those of a participant, may apply to participate in the Health Information Exchange as an authorized user by submitting a request.

(iii) All participants, authorized users, and their workforce members, agents, or contractors shall be required to electronically agree to the WYFI Health Information Exchange End User License Agreement (EULA) prior to accessing the Health Information Exchange data and services.

(b) Participants and authorized users that elect to participate in the Health Information Exchange shall notify their patients in writing and provide the opportunity for patients to opt-out of their data being used or exchanged with the Health Information Exchange.

Section 7. Use of Data.

(a) Participants and authorized users may only use the Health Information Exchange and data for the following purposes:

(i) For treatment, payment, and healthcare operations, as defined by HIPAA;

(ii) For any other use that is permitted or required under HIPAA, the WYFI Policy and Procedure Manual, or other applicable law governing the use and disclosure of data; or,

(iii) To facilitate the implementation of meaningful use criteria as required under the American Recovery and Reinvestment Act of 2009, the 21st Century Cures Act, and their related federal regulations, as permitted by HIPAA

(b) A participant shall not modify information submitted to the Health Information Exchange by another participant.

(c) The Department may use de-identified data for the purpose of analysis to inform policy and program funding needs, public health activities, and to conduct population health reporting.

(d) The Department may use data for treatment, payment, healthcare operations, public health activities, or patient safety.

(e) Use or disclosure of data not otherwise authorized by this Chapter requires a signed authorization from the patient or court order.

Section 8. Patient Requests to Opt-Out.

(a) Patients may request to opt-out of having their data in the Health Information Exchange by submitting a request to an active participant.

(b) The participant shall then forward the patient's opt-out request to WYFI.

(d) If a patient has elected to opt-out, all participants and authorized users shall not have access to that patient's data in the Health Information Exchange.

(e) A patient may elect to opt back in at any time by submitting a written request directly to WYFI.

Section 9. Patient Requests for Verification.

(a) A patient who has opted out may submit a request to WYFI for verification that their data is properly excluded from the Health Information Exchange.

(b) The written request shall contain:

(i) The name of the patient filing the request;

(ii) A statement requesting the WYFI review information and verify the patient's data is properly excluded from the Health Information Exchange;

(iii) The date of the patient's initial request to opt-out and any related communication from the WYFI or the participant;

(iv) Information explaining why the patient believes their data was not properly excluded from the Health Information Exchange.

(c) Upon receipt of such a request, the WYFI shall review the request and verify whether the patient's data is properly excluded. WYFI shall complete the review within 20 days of receiving the request and respond to the patient, verifying their data is properly excluded from the Health Information Exchange.

Section 10. Participation Fees.

(a) The Department shall assess reasonable participation fees for connection and access to the Health Information Exchange.

(b) Fees shall be payable in the exact amount and are non-refundable.

(c) The Department shall assess fees based on a participant or authorized user's taxonomy and usage category, which shall be determined by the Department upon initial connection or request for access.

(d) The Department may periodically conduct revalidation of the participant or authorized user's category by requesting the resubmission of information provided at the time of initial connection.

(i) The Department may assess a different fee after revalidation is completed for participants who no longer qualify in their initial fee category.

(ii) The Department shall not revalidate participants more than once every year.

(e) Unless otherwise specified, all participant categories shall be given full use of all functionality and features available to any participant.

(f) The fee schedule for connection and access to the WYFI Health Information Exchange shall be as follows:

| Category | Pricing | Fee | Maximum Fees | | --- | --- | --- | --- | | Medicaid | Per member per year | $2 | No Max | | Health Plans | Per member per year | $2 | No Max | | Critical Access Hospitals and Surgical Hospitals | Per year | $5,000 | $5,000 | | Hospitals of any type with twenty-six (26) to ninety-nine (99) beds | Per year | $7,500 | $7.500 | | Hospitals of any type with over (100) beds | | $10,000 | $10,000 | | Hospice Facilities | Per year/ per location | $250 | $250 | | Long -Term Care -Skilled Nursing Facilities and Nursing Home Facilities | Per year/ per location | $250 | $250 | | Assisted Living Facilities | Per year/ per location | $250 | $250 | | Federally Qualified Health Centers | Per year/ per location | $250 | $250 | | Indian Health Services and Tribally Run Facilities | Per year | $250 | $250 | | Rural Health Clinics | Per year/ per location | $250 | $250 | | Pharmacy Facilities | Per year/ per location | $250 | $250 | | Ambulance or Emergency Medical Services agencies connecting outside of the WDH-provided Emergency Medical Services and Trip reporting system | Per year | $0 | $0 | | County Healthcare Facilities: for example jails and Public Health offices | Per year | $250 | $250 | | Individual healthcare providers & multi-provider offices who contribute data to the Health Information Exchange | Per year/ per location | $250 | $250 | | Individual healthcare providers & multi-provider offices who do not contribute data to the Health Information Exchange | Per licensed provider per year for access, up to a practice maximum | $50 | $1,000 | | Mental Health and Substance Use Disorder Providers | Per licensed provider per year for access, up to a practice maximum | $0 | $0 | | Non-Profits serving Social Determinants of Health services (SDOH) | Per year | $0 | $0 | | Other authorized users who request access to the Health Information Exchange not already identified within this table | Per member per year or per custom quote | $2 | No Max | | Emergency First Responders | Per year | $0 | No Max | | Federal Healthcare Provision Agencies | Per year | $0 | No Max | | Wyoming State Agencies or their contractors | Per year | $0 | No Max | | Other Health Information Exchanges | Per Mutual Agreement | $0 | No Max | | Patient Authorized Data Requests: for example the Social Security Administration | Per patient query | $15 | No Max |

(g) Fees for participants or authorized users who request ad hoc data products or special reports shall be scoped on a case-by-case basis and quoted based upon the time needed to complete the project request.

(i) The WYFI shall deny requested data products or special reports that violate Section 7 of this Chapter governing the use of data.

(ii) The WYFI may delay or deny requested data products or special reports if it lacks the staffing or technical resources to complete the project request in a timely manner.

(h) The Department may adjust any of the fees listed in the schedule by three percent (3%) annually. Written notice of fee adjustments shall be given to participants affected. This section will be amended to reflect a total fee increase greater than fifteen percent (15%).

(i) The Department reserves the right to waive or lower fees as needed during emergencies or as alternate funding sources become available to cover the costs of administering and maintaining the Health Information Exchange.

(j) The Department reserves the right to not assess fees on other state entities and federal entities as defined in the WYFI Policy and Procedure Manual.

History

Effective 2024-01-03

194 Wyoming Home Services

Chapter 1 Wyoming Home Services (previously Community Based In-Home Services)

Wyo. Code R. 048.0070.1.03172025 Wyoming Home Services (previously Community Based In-Home Services)

CHAPTER 1

WYOMING HOME SERVICES

Section 1. Authority. These rules are promulgated by the Wyoming Department of Health, Aging Division, pursuant to Wyo. Stat. Ann. § 9-2-1208, W.S. § 35-1-229, and the Wyoming Administrative Procedures Act at W.S. § 16-3-101 et seq.

Section 2. Purpose. The purpose of these rules is to establish standards for the delivery of Wyoming Home Services for adults at risk of premature institutionalization.

Section 3. Scope of Program. The goals of the program are to foster self-sufficiency, prevent abuse, neglect or exploitation, maintain individuals in the least restrictive and safest environment, and prevent inappropriate or premature institutionalization, by offering short term and long-term services. In addition to the services listed in W.S. § 9-2-1208, the following services may be provided:

(a) Care Coordination;

(b) Home Modifications;

(d) Personal Emergency Response System; and

(e) Medication Set Up

Section 4. Interpretive Notices. The Division may issue manuals, bulletins, notices, or letters to interpret the provisions of these rules. Such manuals, bulletins, notices, and letters shall be consistent with and reflect the policies contained in these rules. The provisions contained in the manuals, bulletins, notices, or letters shall be subordinate to W.S. § 9-2-1208 and these rules.

Section 5. Definitions.

(a) "Access Care Coordinator (ACC)" means an individual certified, by the Division, as an Access Care Coordinator to provide Care Coordination to Wyoming Home Services Program recipients.

(b) "At-risk" means an individual unable to perform normal daily tasks independently due to multiple problems which can include, but are not limited to, physical, emotional, or cognitive functioning, environment, abuse, or neglect.

(c) "Care Coordination" means a set of logical steps and processes of interaction within a service network that assure that a client receives needed services in a supportive, cost-effective manner.

(d) "Central Registry" means the registry maintained by the Wyoming Department of Family Services pursuant to W.S. § 14-3-213 and W.S. § 35-20-115.

(e) "Certified Nursing Assistant (CNA)" means a person who is currently certified as a Certified Nursing Assistant by the Wyoming State Board of Nursing.

(f) "Chore" services that may include snow removal, yard maintenance, deep cleaning of household appliances or other services per the discretion of the Grantee.

(g) "Client" means an At-risk adult who is the recipient of Wyoming Home Services.

(h) "Division" means Aging Division.

(i) "Grantee" means an organization that provides services outlined in an approved grant funded by the Division.

(j) "Homemaker" means a person who assists with environmental services such as, but not limited to, housekeeping, basic meal preparation, shopping, and laundry.

(k) "Home Modifications" means minor modifications not to exceed three hundred dollars ($300) per Client per year that are necessary to facilitate the ability of At-risk adults to remain in their homes and that are not available under other programs.

(l) "Level of Care" means the level of services a Client may need such as in home, intermediate, or institutional.

(m) "Personal Care" means activities which includes, but is not limited to, bathing, grooming, feeding, ambulating, exercising, oral hygiene, and skin care.

(n) "Personal Emergency Response System (PERS)" means a Grantee provided electronic device worn by the Client to summon emergency help.

(o) "Service Plan" means documentation of demographic information, the time frame in which services will be provided, services that will be provided, the agreed upon amount to be paid for services, and eligibility information to meet the needs and goals of the Client.

(p) "Sliding Fee Scale" means a formula, created by the Division, to determine a Client's ability to pay for services rendered.

(q) "Wyoming Home Services" means a Program provided to Wyoming residents per W.S. § 9-2-1208.

Section 6. Eligibility. To be eligible for Wyoming Home Services, Clients must be an At-risk adult, be at least 18 years of age; Be determined through an ongoing assessment to be facing the possibility of premature institutionalization; Meet but not exceed the Level of Care available by the participating provider, and; Reside within the State of Wyoming.

Section 7. Funding. Funding will be disbursed statewide through contracts with the Division based on a funding formula developed by the Division. Program income received must be utilized as part of the Grantee's program budget.

Section 8. Client Fees. Clients will be assessed using the Department approved Income Verification and Sliding Fee Scale Form. Based on the results of this Form the clients will be asked to pay a percentage of the cost of their care. This contribution will be considered program income. The Department's Income Verification and Sliding Fee Scale Form can be obtained by calling (307)-777-7995.

(a) Clients being charged for services will be provided with monthly statements. Fees may be accrued for sixty (60) days on a statement to the Client, after sixty (60) days the Grantee shall decrease the balance to zero.

(b) The service provider may choose to reduce services or place a client on the waiting list if the client is unable to contribute to the cost of services as determined by the Sliding Fee Scale.

Section 9. Cost Sharing. The Access Care Coordinator (ACC) must document all information needed to establish eligibility on the Division's approved form.

(a) The Grantee may not determine a Client to be ineligible for services due to the participant's income, assets and other resources.

(b) The Grantee may determine that due to limited resources to focus providing services to Clients in the greatest economic and social need.

(c) If the Grantee is unable to provide immediate services to a Client, the Grantee may place that Client on a waiting list. While on the waiting list, the Grantee will make referrals to other service providers and/or services, provide services under a private pay program if applicable and/or promote additional resources.

Section 10. Hiring Procedures. The following will apply to all Licensed Nurses, CNAs and Homemaker/Chore personnel hired at the effective date of this rule.

(a) Due to the nature of the Wyoming Home Services Program providing services to At-risk adults, any individual who appears on the Central Registry or who has been convicted of a felony, or a misdemeanor related to abuse, neglect, exploitation, and/or abandonment of adults or children shall not provide in-home services as listed in Section 3.

(b) Prior to working independently in a client's home, the following reference checks must be completed and documented in the employees' personnel file:

(i) Written documentation of at least two (2) character references from a previous employer, if any, or other knowledgeable and objective sources prior to employment or volunteering (e.g., letters of reference; notations of telephone reference checks including the name of the person(s) contacted, the date(s) of contact, the firm(s) contacted, and the result(s).

(ii) The Grantee must contact the Wyoming Department of Family Services, for all personnel who are not licensed or certified by the Wyoming State Board of Nursing, to ensure the individual does not appear on the Central Registry.

(iii) The Grantee must contact the Wyoming State Board of Nursing for those staff who are licensed and/or certified by the Wyoming State Board of Nursing, to ensure the individual is in good standing with the board.

Section 11. Staff Development.

(a) Grantees shall ensure that all staff have a general orientation completed during the first week of employment and prior to direct Client contact.

(i) The orientation shall include, but is not limited to, the following areas as related to job responsibilities:

(A) Confidentiality, including training on state, local and federal legislation related to privacy and security;

(B) Emergency procedures;

(D) Grantee rights and responsibilities;

(E) Abuse reporting procedures;

(F) Communication;

(G) Understanding and working with various Client populations, and;

(H) Understanding basic human needs.

(b) Documentation of all staff orientation shall be kept on file for as long as staff is employed and six (6) years thereafter.

Section 12. Care Coordination. All Grantees shall employ an Access Care Coordinator.

(a) Access Care Coordinator Qualifications. As of the effective date of this rule all newly hired Access Care Coordinators must:

(i) Be at least 21 years of age and have a high school diploma, or equivalent, and;

(ii) Meet at least one of the following criteria:

(A) Have completed at least forty-eight (48) semester hours or seventy-two (72) quarter hours of post-secondary education in health care, elderly care, health care management, facility management, or other related fields from a college or institution, or;

(B) Have at least two (2) years of experience in social services working with the elderly or people with disabilities.

(b) Access Care Coordinator responsibilities include, but are not limited to:

(i) Completing contact hours of job related continuing education, each State fiscal year starting July 1 through June 30, as specified by the Division;

(ii) Performing Client assessments as specified in Section 13; and,

(iii) Monitoring of all service provisions.

Section 13. Homemakers. The Homemaker assists with instrumental activities of daily living. The Homemaker does not provide any Personal Care.

(a) Examples of duties include, but are not limited to:

(i) Light Housekeeping;

(ii) Shopping;

(iii) Laundry;

(iv) Linen Change; and,

(v) Basic meal preparation.

(b) Supervision of Homemakers

(i) Homemakers shall be supervised by the Access Care Coordinator as frequently as the Client's condition requires, but at least every ninety (90) days.

(A) The Homemaker shall be present during the supervisory visit;

(B) The supervisory visits shall occur at the Client's home; and,

Section 14. Certified Nursing Assistant. CNAs shall follow the rules and regulations according to the Wyoming Nurse Practice Act W.S. § 33-21-119 through W.S. § 33-21-157.

Section 15. Client Evaluation. All evaluations will be documented on a form approved by the Division and are preferably conducted in the Client's home.

(a) Eligibility Screening. Prior to service provision each Client shall be screened to determine eligibility based on the definition of "At-risk".

(b) Initial Evaluation. The Grantee shall conduct a written initial evaluation of each Client based upon the information presented by the Client, family members, friends, and responsible parties. A Service Plan will be developed based on the evaluation and established goals.

(c) Quarterly Evaluations. Evaluation of a Client must be made by a case manager in the Client's home to evaluate the quality and need for services at least every ninety (90) days. Adjustments in the Service Plan will be made as necessary.

(d) Annual Evaluation. The ACC shall complete an evaluation, utilizing the initial evaluation form, at least annually or as a significant change in condition dictates.

Section 16. Service Plan. During all phases of the assessment process the Service Plan shall be developed, reviewed and/or modified as indicated to meet the needs of the Clients.

(a) Service Plan:

(i) A Service Plan shall be developed by an Access Care Coordinator and shall consist of the following:

(A) The specific services to be done;

(B) The frequency of the services;

(ii) Written Service Plan instructions must be provided to the Homemaker and/or Personal Care attendant before services are initiated.

(iii) If a change in a Client's Service Plan occurs, the Access Care Coordinator must provide a copy of the revised Service Plan to the Client. The Client or legal representative must sign the revised plan for implementation.

Section 17. Maintenance of Records. The Grantee must maintain a record of each Client for the Wyoming Home Services program. All Client records relating to the program are subject to state, local and federal privacy and security regulations.

(a) Documentation. The Grantee shall ensure that the program maintains an adequate system of record keeping to comply with these rules.

(b) The record must include but is not limited to the following:

(i) All eligibility and evaluation material;

(ii) Signed copy of the Division's Client's rights and grievance procedure;

(A) Documentation of all Client related contact; and,

(B) Disposition of referral, Service Plans, termination and all other Documentation pertinent to the Client's care.

(c) Upon written consent from the Client or legal representative, Client records shall be shared with other facilities/agencies upon referral or termination.

(d) All Client files required by these rules shall be kept in a locked cabinet or area and retained by the Grantee at least six (6) years after Client termination date.

(e) All records, case files and other forms of documentation pertinent to the Wyoming Home Services Program are considered property of the Grantee and subject to protections under state and federal law as of the effective date of this rule. The State of Wyoming shall have access to documentation pertinent to the Wyoming Home Services Program for purposes including but not limited to audit, quality assurance, program transfer and complaint reviews. The Grantee shall fully cooperate with any requests made by the Division for records.

(i) In the event a program should close, or transfer from one Grantee to another, the Division shall arrange for the transfer of all program records to the appropriate Grantee.

(ii) Case records shall be sealed and confidentiality maintained, should the change in record custody be necessary.

Section 18. Termination.

(a) The Grantee may terminate a Client from the program due to any of the following:

(i) Increasing or decreasing requirements as indicated by the Division's evaluation and Level of Care tools. An independent evaluation performed by a licensed nurse may be requested at the Division's discretion;

(ii) Cost containment requirements are exceeded as set by the Grantee;

(iii) The Client or their legal representative has signed an agreement to pay a fee for service but has not paid such fees;

(iv) The Client chooses nursing home placement or other alternatives,

(v) The Client or Client's family impedes the provision of services;

(vi) The Grantee has a reduction of funding or services;

(vii) The Grantee ceases to operate without transferring services; or,

(viii) The Client does not receive services for thirty (30) continuous calendar days.

(b) In the above referenced items (i)-(viii) Grantees must provide at least fourteen (14) days written advance notice of intent, to the Client, to terminate services. This letter must include the end date of services. The Grantee must provide services during the fourteen (14) calendar day period.

(c) A Client may be terminated immediately from the program, provided with notice of immediate termination of services, and services may not be provided during the complaint review process, if:

(i) The Client or Client's family creates a hostile, dangerous or unsafe work environment for the Grantee's staff, including but not limited to verbal or physical threats; or,

(ii) The Client becomes a danger to self or others.

Section 19. Client's Right to Self-Determination. Clients are entitled to decide where and how they live, and whether or not they wish to receive Wyoming Home Services and other forms of assistance. Grantees must recognize the civil rights of individuals they wish to serve and must terminate service at any time that a Client refuses such services.

Section 20. Capitation. Each Wyoming Home Services Program Grantee shall develop cost caps for fiscal control.

Section 21. Program Transfer.

(a) If the program is to be transferred from one Grantee to another, it is the responsibility of the transferring Grantee to inform Clients of changes in writing fourteen (14) days prior to the transfer. The information provided to the Client shall include, at a minimum;

(i) Name of the new Grantee, along with the name and telephone number of the contact person;

(ii) Information about potential changes in the provision of services;

(iii) Assurance that the Client will not be arbitrarily dropped from the program due to the transfer;

(iv) Informing the Client that a new assessment is required and will occur within ninety (90) days of transfer, and;

(v) The date of transfer.

(b) Should the program transfer from one Grantee to another, it is the new Grantee's responsibility to assess all transferred Clients within ninety (90) days. Grantees shall make all efforts to minimize interruption of services to transferred Clients.

Section 22. Quality Assurance. Quality assurance assessments for Wyoming Home Services will be implemented in a format which has been approved by the Division.

Section 23. Insurance and Bonding. The Grantee shall assure that all Access Care Coordinators, Homemakers, CNAs and Nurses are covered by liability insurance and bonding.

Section 24. Client Notification of Scheduling Changes. The Grantee shall notify the Client and/or responsible parties in a timely manner of inability to provide services at previously arranged time and/or date. Grantee shall make reasonable effort to provide services.

Section 25. Complaint Review. A complaint may be made by setting forth in writing the act done or omitted by the Grantee in violation of state and federal law, order, rule or standard over which the Division has jurisdiction. If the complaint(s) is not under the jurisdiction of the Division, the person making the complaint will be directed to the appropriate authority for review. All complaints that are within the jurisdiction of the Division will be handled in accordance with Chapter 2 of the Aging Division Operational Rules.

History

Effective 2025-03-17

377 Wyoming Immunization Program

Chapter 1 Definitions and General Provisions

Wyo. Code R. 048.0071.1.02072018 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter under the authority granted by Wyo. Stat. Ann. §§ 14-4-116, 21-4-309, 35-1-240, 35-4-101, and 35-4-139.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.1.02072018 § 2 Purpose

This chapter provides the definitions, general provisions, and incorporated references for Rules, Wyoming Department of Health, Wyoming Immunization Program. This chapter applies to all chapters promulgated under these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.1.02072018 § 3 Definitions

(a) Except as otherwise specified, the terminology used in these rules is the standard terminology and has the standard meaning used in healthcare, including the National Immunization Program and the Vaccines for Children (VFC) Program.

(b) For the purpose of these rules, the following definitions shall apply:

(i) "Administrator" means the principal or head administrator of a school or child caring facility.

(ii) "Authorized user" means an individual who is granted access to the Wyoming immunization information system (WY IIS) for the purpose of managing immunization records of individuals falling within his administrative or clinical responsibilities.

(iii) "Child" means an individual who is attending a child caring facility or school.

(iv) "Child caring facility" as defined in Wyo. Stat. Ann. § 14-4-116(a).

(v) "Electronic Health Record (EHR)" means a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.

(vi) "Health Level Seven (HL7) standard protocol" means the framework and standards for the exchange, integration, sharing, and retrieval of electronic health information.

(vii) "Immunization Unit Manager" means the individual appointed by the Department to manage the Wyoming Vaccinates Important People (WyVIP) Program, the WY IIS, and mandatory immunizations.

(viii) "Parent" means the legal guardian or custodian of a minor child, the minor child's natural parent, or if the minor child has been legally adopted, the adoptive parent.

(ix) "Primary health care provider" as defined in Wyo. Stat. Ann. § 35-22-402(c)(xiv).

(x) "Provider agreement" means the legal agreement developed by the Department that is required for a primary health care provider to enroll in the WyVIP Program.

(xi) "Provider profile" means the document utilized by the Department to capture the number of eligible patients served by a provider office as a means to compare projected vaccine needs with actual vaccine orders and inventory.

(xii) "Publicly-supplied vaccine" means a state-purchased vaccine provided by the Department to primary health care providers enrolled in the WyVIP Program.

(xiii) "School" means the following entities:

(A) "A charter school within a school" as defined in § 21-3-302(a)(i);

(B) "Elementary school" as defined in Wyo. Stat. Ann. § 21-13-101(iv);

(D) "Kindergarten" as defined in Wyo. Stat. Ann. § 21-13-101(viii);

(E) "Middle school" as defined in Wyo. Stat. Ann. § 21-13-101(vii);

(F) "New charter school" as defined in § 21-3-302(a)(iv);

(G) "Parochial, church or religious school" as defined in § 21-4-101(a)(iv);

(H) Preschool, which means any other institution that is not a child caring facility and occurs prior to entry into kindergarten; and

(I) "Private school" as defined in 21-4-101(a)(iii).

History

Effective 2018-02-07

Wyo. Code R. 048.0071.1.02072018 § 4 General Provisions

(a) In the event of a contested case under these rules, Rules, Office of Administrative Hearings, General Agency, Board of Commission Rules, Ch. 2 (2014), incorporated by reference under section 5 of this chapter, shall apply unless otherwise provided for under these rules.

(b) The Department may issue policy and procedure manuals to further facilitate interpretation of and compliance with the Wyoming Immunization Program Rules. These manuals are found at https://health.wyo.gov/publichealth/‌immunization/ and made available by the Department upon request

History

Effective 2018-02-07

Wyo. Code R. 048.0071.1.02072018 § 5 Incorporation by Reference

(a) For any code, standard, rule, or regulation incorporated by reference in these rules:

(i) The Department has determined that incorporation of the full text in these rules would be cumbersome or inefficient given the length or nature of the rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this section; and

(iii) The incorporated code, standard, rule, or regulation may be found at https://health.wyo.gov/publichealth/immunization/ and is maintained and made available by the Department for public inspection and copying at cost at the same location.

(b) The Department incorporates the following codes, standards, rules, and regulations into these rules by reference. These incorporated references are identified as:

(i) Referenced in Section 4(a) of this chapter is Rules, Office of Administrative Hearings, General Agency, Board of Commission Rules, Ch. 2 (2014), also known as the Uniform Rules for Contested Case Practice and Procedure adopted by the Office of Administrative Hearings, effective October 17, 2014, and found at: http://rules.wyo.gov;

(ii) Referenced in Chapter 2, Section 9(a)(xi) of these rules is Wyoming Department of Health, Vaccine Restitution Policy (IMM-001)(Jan. 1, 2017), available at https://health.wyo.gov/publichealth/‌immunization;

(iii) Referenced in Chapter 2, Section 9(a)(xi) of these rules is Wyoming Department of Health, Fraud and Abuse Policy (IMM-002) (May 1, 2017), available at https://health.wyo.gov/publichealth/‌immunization;

(iv) Referenced in Chapter 2, Section 9(a)(ix) of these rules is National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 through 300aa-34 (2010);

(v) Referenced in Chapter 2, Section 8(a)(xi) of these rules is Centers for Disease Control and Prevention, Vaccine Storage and Handling Toolkit (June 2016), available at https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit;

(vi) Referenced in Chapter 2, Section 9(a)(vi) of these rules is Centers for Disease Control and Prevention, Epidemiology and Prevention of Vaccine-Preventable Diseases (J. Hamborsky et al. eds., 13th ed. 2015 & Supp. 2017), available at https://www.cdc.gov/‌vaccines/‌pubs/‌pinkbook/index.html;

(vii) Referenced in Chapter 3, Section 4(b) of these rules is Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices, Recommended Immunization Schedule for Children and Adolescents Aged 18 or Younger (Feb. 10, 2017), available at: https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf;

(viii) Referenced in Chapter 5, Section 4 of these rules is Centers for Disease Control and Prevention, Immunization Information System Functional Standards, 2013-2017 (Feb. 2016), available at: https://www.cdc.gov/vaccines/programs/iis/func-stds.html; and

(ix) Referenced in Chapter 5, Sections 8(c), 9(a)(ii)(A), and 11(b)(i) of these rules is Wyoming Department of Health, IIS Authorized User Policy (IMM-003) (May 1, 2017), available at: https://health.wyo.gov/‌publichealth/immunization/; and

(x) Referenced in Chapter 5, Section 14 of these rules is Wyoming Department of Health, Creating/Editing IIS Information from an Official Immunization Record Policy (IMM-004) (May 1, 2017), available at: https://health.wyo.gov/publichealth/‌immunization/.

History

Effective 2018-02-07

Chapter 2 Wyoming Vaccinates Important People (WyVIP) Program

Wyo. Code R. 048.0071.2.02072018 Wyoming Vaccinates Important People (WyVIP) Program

Chapter 2

The Wyoming Vaccinates Important People Program

Section 1. Authority

The Wyoming Department of Health (Department) promulgates this chapter under the authority granted by Wyo. Stat. Ann. §§ 35-1-240, 35-4-101, and 35-4-139.

Section 2. Purpose

This chapter establishes the Wyoming Vaccinates Important People (WyVIP) Program as the childhood immunization program contemplated under Wyo. Stat. Ann. § 35-4-139. This chapter also identifies the vaccines provided by the WyVIP Program and establishes patient eligibility criteria, provider eligibility criteria to enroll with the WyVIP Program, and the allowable administration fee.

Section 3. Applicability

This chapter applies to primary health care providers and their staff that are enrolled or seeking enrollment into the WyVIP Program.

Section 4. Establishment of the WyVIP Program

(a) The Department shall:

(i) Administer the WyVIP Program; and

(ii) Establish policies and procedures for participation in the WyVIP Program.

Section 5. Patient Eligibility

(a) A patient is eligible to receive a vaccine provided by the WyVIP Program if the patient is:

(i) Eighteen (18) years of age or younger;

(ii) A Wyoming resident; and

(iii) Is not a "federally vaccine eligible child" under 42 U.S.C. § 1396s(b)(2) or subsequent similar federal enactment.

Section 6. Vaccine Advisory Board

The Vaccine Advisory Board (VAB) serves as the advisory group appointed by the Department Director as described in Wyo. Stat. Ann. § 35-4-139.

Section 7. WyVIP Vaccine Formulary

(a) The State Health Officer shall establish the WyVIP vaccine formulary. The WyVIP vaccine formulary must include those vaccines determined by the State Health Officer to be necessary for the healthy development of children pursuant to Wyo. Stat. Ann. § 35-4-139.

(b) The State Health Officer may, in accordance with this chapter, modify the WyVIP vaccine formulary including, but not limited to, adding or removing a vaccine antigen or brand.

(i) Whether the vaccine is necessary for the healthy development of children;

(ii) The recommendations of the VAB; and

(iii) The availability of funds.

(d) When deciding to modify the WyVIP vaccine formulary, the State Health Officer may consider:

(i) The recommendations of primary health care providers; and

(ii) Other relevant medical and economic factors.

(e) The WyVIP vaccine formulary must include vaccines for the following vaccine-preventable diseases:

(i) Diphtheria;

(ii) Haemophilus influenza type b;

(iii) Hepatitis B;

(iv) Measles;

(v) Mumps;

(vi) Pertussis;

(vii) Polio;

(viii) Pneumococcal;

(ix) Rotavirus;

(x) Rubella;

(xi) Tetanus; and

(xii) Varicella.

(f) The WyVIP vaccine formulary is found at https://health.wyo.gov/publichealth/‌immunization/ and made available by the Department upon request.

(g) The Immunization Unit Manager or the manager's designee shall coordinate the purchase, distribution, and storage and handling of each vaccine included on the WyVIP vaccine formulary in accordance with the policies and procedures established by the Department.

Section 8. Provider Eligibility and Enrollment

(a) A primary health care provider is eligible to enroll in the WyVIP Program if the provider:

(i) Is employed by an organization enrolled with the WY IIS;

(ii) Has a valid license to administer vaccines within the State of Wyoming;

(iii) Is not included on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE);

(iv) Has the capacity to order, receive, and manage vaccines, including proper vaccine storage and temperature monitoring capacity; and

(v) Agrees to program requirements, including participation in site visits and educational opportunities.

(b) To enroll as a provider in the WyVIP Program, an eligible provider must submit to the Department a provider profile on the form developed by the Department.

(c) Upon receipt of a complete provider profile, and prior to approving a provider for enrollment in the WyVIP Program, the Department shall conduct a site visit to evaluate the following factors:

(i) Availability for vaccine receipt;

(ii) Vaccine contacts;

(iii) Patient population;

(iv) Vaccine storage equipment; and

(v) Vaccine temperature monitoring.

(d) The Department shall grant a provider enrollment in the WyVIP Program if the Department finds that:

(i) Funding and vaccine stock are available; and

(ii) The provider is able to satisfy the duties imposed under this chapter.

(e) If a provider has been granted enrollment in the WyVIP Program, the provider shall complete the provider agreement before gaining access to the WyVIP vaccine formulary.

Section 9. Program-Enrolled Provider Responsibilities

(a) A program-enrolled provider shall utilize the IIS for the following:

(i) Vaccine orders, transfers, and returns;

(ii) Patient demographic and immunization information; and

(iii) Vaccine inventory.

(b) A program-enrolled provider shall:

(i) Store and handle vaccines in accordance with the vaccine insert made available with all vaccine boxes and the CDC Vaccine Storage and Handling Toolkit (June 2016), which has been incorporated by reference under Chapter 1 of these rules;

(ii) Report storage unit temperatures using the forms and methods established by the Department;

(iii) Distinguish between public and private vaccine stock;

(iv) Develop and maintain complete, accurate, and separate stock records for both publicly and privately purchased vaccines;

(v) Administer vaccines in accordance with the CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (13th ed. 2015 & Supp. 2017), which have been incorporated by reference under chapter 1 of these rules;

(vi) Screen for and document patient eligibility at each immunization encounter;

(vii) Administer publicly-supplied vaccines to eligible patients only;

(viii) In accordance with the National Childhood Vaccine Injury Act (NCVIA) 42 U.S.C §§ 300aa-1 through 300aa-34, which has been incorporated by reference under Chapter 1 of these rules:

(A) Distribute the most current Vaccine Information Statement (VIS) each time a vaccine is administered; and

(B) Report clinically significant adverse events to the Vaccine Adverse Event Reporting System (VAERS);

(ix) Maintain all WyVIP Program related records for no less than three years and be able to provide records to the Department for review upon request;

(x) Comply with the Department's Vaccine Restitution Policy (IMM-001) and Fraud and Abuse Policy (IMM-002) which have been incorporated by reference under Chapter 1 of these rules; and

(xi) Allow Department staff to conduct scheduled and unannounced site visits.

Section 10. Disciplinary Action

(a) The Department may take disciplinary action against a program-enrolled provider if the Department finds a provider failed to comply with the requirements of this chapter or the policies and procedures established by the Department. Disciplinary action may include a reprimand, conditions, restrictions, probation, suspension, termination, other appropriate action, or a combination thereof.

(b) The Department shall base its decision to terminate a program-enrolled provider from the WyVIP Program on the following factors:

(i) The provider's compliance with this chapter, the provider agreement, and established policies and procedures;

(ii) The risk posed to patient health and safety;

(iii) The risk posed to vaccine viability; and

(iv) The impact of the provider's fraud or abuse or vaccine waste, if applicable.

Section 11. Billing for Vaccine Administration

(a) A program-enrolled provider may charge an eligible patient a fee for the administration of a publicly-supplied vaccine.

(b) The administration fee charged to an eligible patient by a program-enrolled provider must not exceed twenty one dollars and seventy two cents ($21.72) multiplied by the number of antigens in the vaccine administered from the WyVIP Program.

(c) If a patient is unable to pay the administration fee, the program-enrolled provider shall waive the administration fee. Other visit or office fees may be charged as applicable.

History

Effective 2018-02-07

Chapter 3 Mandatory Immunizations for Children Attending Schools and Child Caring Facilities

Wyo. Code R. 048.0071.3.02072018 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter under the authority granted by Wyo. Stat. Ann. §§ 14-4-116, 21-4-309, 35-1-240, and 35-4-101.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 2 Purpose

This chapter establishes the mandatory immunization requirements for a child to attend a school or child caring facility according to Wyo. Stat. Ann. §§ 14-4-116 and 21-4-309.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 3 Applicability

(a) This chapter applies to a child:

(i) Attending a school, full or part time;

(ii) Participating in a school sanctioned activity; or

(iii) Attending a child caring facility, full or part time.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 4 Minimum Immunization Requirements

(a) A child must be immunized against the following vaccine-preventable diseases:

(i) Diphtheria;

(ii) Haemophilus influenza type b;

(iii) Hepatitis B;

(iv) Measles;

(v) Mumps;

(vi) Pertussis;

(vii) Polio;

(viii) Pneumococcal;

(ix) Rotavirus;

(x) Rubella;

(xi) Tetanus; and

(xii) Varicella.

(b) The administration of a vaccine required under subsection (a) of this section, including the number of doses that a child must have at any given age and the minimum intervals between these doses, must be in accordance with the Advisory Committee on Immunization Practices (ACIP), Recommended Immunization Schedule for Children and Adolescents Aged 18 or Younger (ACIP Schedule), which has been incorporated by reference under Chapter 1 of these rules. The Department will amend this incorporated reference as necessary to reflect updated ACIP recommended immunization schedules.

(c) A vaccine administered up to four (4) days prior to the minimum age listed for that vaccine is considered compliant with the ACIP Schedule.

(d) A child who has completed an immunization series following the minimum intervals in accordance with an ACIP Recommended Immunization Schedule published at the time of administration or the immunization rules in effect at the time of administration, is considered immunized against the relevant vaccine-preventable disease if the number of vaccine doses the child received conforms to the requirements of subsection (b) of this section.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 5 Proof of Immunization

(a) The following qualifies as documentary proof of immunization:

(i) An immunization record generated from the Immunization Information System (IIS) established by the Department;

(ii) An immunization record certified by a primary health care provider;

(iii) An immunization record certified by a physician licensed in the United States, or the physician's designee; or

(iv) An immunization record certified by a public health authority.

(b) An immunization record must include the following information:

(i) Source of the record;

(ii) Child's name;

(iii) Child's date of birth;

(iv) Name of each vaccine administered; and

(v) Month, day and year each vaccine was administered.

(c) The proof of immunization must establish that the minimum immunization requirements under Section 4 of this chapter have been satisfied and all immunizations are valid.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 6 Evidence of Immunity

(a) The following may be submitted as evidence of a child's immunity against a vaccine-preventable disease and in lieu of the documentary proof of immunization required for the particular vaccine-preventable disease:

(i) A positive serologic test for measles, mumps, rubella, hepatitis B, varicella, or all 3 serotypes of poliomyelitis found in the polio vaccines; or

(A) A serology result reported as equivocal is not acceptable evidence of immunity.

(ii) A written diagnosis or verification of a history of varicella or herpes zoster by a physician or the physician's designee.

(A) To verify a history of varicella, health care providers should inquire about an epidemiologic link to another typical varicella case or to a laboratory confirmed case, or evidence of laboratory confirmation, if testing was performed at the time of acute disease.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 7 Waivers

(a) A waiver of an immunization required under Section 4 of this chapter must be granted if written evidence of a religious objection is submitted to the State or County Health Officer by the child's parent. Written evidence of religious objection includes:

(i) A complete and signed religious waiver form, found at https://health.wyo.gov/publichealth/immunization and made available by the Department upon request; or

(ii) A signed statement from the child's parent, certifying religious objection to the administration of a specific immunization.

(b) A waiver of an immunization required under Section 4 of this chapter must be granted if written evidence of medical contraindication is submitted to the State or County Health Officer by the child's parent. Written evidence of medical contraindication includes:

(i) A complete and signed medical waiver form, found at https://health.wyo.gov/‌publichealth/immunization and made available by the Department upon request; or

(ii) A signed statement from a licensed physician certifying the medical contraindication to the administration of any required immunization that includes the date issued; the physician's name, signature, license number, and state of licensure; the child's name and date of birth; and a statement that a specific immunization is medically contraindicated.

(c) The State or County Health Officer shall grant a waiver to a child upon submission of written evidence of religious objection or medical contraindication. In the event a child submits written evidence in a form that the State or County Health Officer determines does not comply with subsections (a) or (b) of this subsection, the State or County Health Officer shall determine whether to grant a waiver consistent with Lepage v. State of Wyo., Dep't of Health, 2001 WY 26, 18 P.3d 1177 (Wyo. 2001), and Jones ex rel. Jones v. State of Wyo., Dep't of Health, 2001 WY 28, 18 P.3d 1189 (Wyo. 2001).

(d) A waiver granted under this section is limited in scope to the immunizations referenced in the submitted written evidence of religious objection or medical contraindication.

(e) If the immunization requirements under Section 4 of this chapter are amended to include a new immunization, a previously-granted waiver under this section does not apply to the newly required immunization. If the newly required immunization is objected to on religious or medical grounds, a new waiver must be requested in accordance with this section.

(f) A waiver issued by another state does not qualify as written evidence of religious objection or medical contraindication. A new waiver must be requested in accordance with this section.

(g) A child granted a religious or medical waiver by the State or County Health Officer may continue to attend a school or child caring facility unless there is a vaccine-preventable disease outbreak pursuant to Chapter 4, Section 6 of these rules.

(h) If a parent objects to the State or County Health Officer's decision on a request for a religious or medical waiver, the parent may request a review and final decision by the State Health Officer. The child shall remain in school during the review process unless there is a vaccine-preventable disease outbreak pursuant to Chapter 4, Section 7 of these rules.

(i) A County Health Officer shall provide a copy of the County Health Officer's approved exemptions to the Department within thirty (30) days of the approval.

(j) All approved waivers will be recorded in the IIS unless the parent submits a Use and Disclosure Restriction (F-12) form found at https://health.wyo.gov/admin/privacy and made available by the Department upon request.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 8 Parent Responsibilities

(a) A parent shall submit the following documentation of a child's immunization status to the school or child caring facility administrator, or the administrator's designee within thirty (30) calendar days after the date of entry.

(i) Documentary proof of immunization pursuant to Section 5 of this chapter;

(ii) Evidence of immunity pursuant to Section 6 of this chapter; or

(iii) An approved religious or medical waiver pursuant to Section 7 of this chapter.

(b) A child without the required documentation will not be permitted to attend a school or child caring facility for more than thirty (30) calendar days after the date of entry.

(c) A parent may request conditional enrollment for the child by submitting written documentation from a primary health care provider, the primary health care provider's designee, or a public health authority specifying the following:

(i) The child has received at least the first dose in each immunization series and has age-appropriate appointments to complete the immunization series according to Chapter 3 of these rules; or

(ii) The child is obtaining serologic tests within thirty (30) calendar days of notification by the parent that such testing has been requested; or

(iii) The child's serologic test(s) are negative, and therefore the child in question has appointments to be immunized within thirty (30) calendar days of notification to the parent to complete, or begin completion of the immunization series in accordance with Chapter 3 of these rules.

(d) Conditional enrollment may only be granted by a school or child caring facility administrator in accordance with Chapter 4 Section 6 of these rules.

(e) A parent may provide consent to a school or child caring facility administrator or the administrator's designee to access the child's immunization record in the IIS in accordance with Chapter 4, Section 8.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.3.02072018 § 9 Emancipated or Adult-Aged Children

The duties imposed upon and rights granted to a parent under this chapter apply to an emancipated or adult-aged child attending school, full or part-time, or participating in school sanctioned activities.

History

Effective 2018-02-07

Chapter 4 Duties of School and Child Caring Facility Administrators

Wyo. Code R. 048.0071.4.02072018 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter under the authority granted by Wyo. Stat. Ann. §§ 14-4-116, 21-4-309, 35-1-240, and 35-4-101.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 2 Purpose

This chapter establishes the duties of school and child caring facility administrators in regard to the mandatory immunizations and the control and management of communicable diseases.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 3 Applicability

This chapter applies to all Wyoming schools and child caring facilities.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 4 Administrator Responsibilities

(a) A school or child caring facility administrator or the administrator's designee shall:

(i) Inform parents of the immunization requirements described in Chapter 3 of these rules;

(ii) Not permit a child to attend a school or child caring facility for more than thirty (30) calendars days after the date of the child's entry unless the child's parents have submitted the required documentation of the child's immunization status under Chapter 3 of these rules;

(iii) Act in accordance with section 6 of this chapter in regard to conditional enrollment;

(iv) Maintain all documentation received regarding the child's immunization status in the child's school or child caring facility record;

(v) Transfer a child's documentation regarding immunization status if the child transfers to another school or child caring facility within Wyoming;

(vi) Assess the required documentation of each child's immunization status as needed in accordance with Chapter 3 of these rules;

(vii) Make a child's submitted documentation regarding immunization status available for inspection and review by authorized representatives of the Department;

(viii) Report the immunization status and conditional enrollment of each enrolled child once per year using the forms and process established by the Department; and

(ix) For the control and management of communicable diseases, refer parents to an authorized user of the Immunization Information System (IIS) established by the Department for the purpose of creating an IIS immunization record or adding immunization information to an existing record pursuant to Chapter 5, Section 15 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 5 Documentation of Immunization Status

(a) A school or child caring facility administrator shall accept the following as documentation of a child's immunization status:

(i) Proof of immunization pursuant to Chapter 3, Section 5 of these rules;

(ii) Evidence of immunity pursuant to Chapter 3, Section 6 of these rules; and

(iii) An approved religious or medical waiver pursuant to Chapter 3, Section 7 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 6 Conditional Enrollment

(a) Following the 30 day exclusion date, a school or child caring facility administrator may grant conditional enrollment to a child who is not fully immunized upon receipt of written documentation that is in accordance with Chapter 3 Section 7 Subsection (c) of these rules.

(b) A school or child caring facility administrator or the administrator's designee shall monitor and confirm that the child has completed the serologic test or subsequent dose of a vaccine according to the submitted written documentation.

(c) A school or child caring facility administrator shall not permit a child to continue attending the school or child caring facility for more than fourteen (14) calendar days without verification that the child has received the subsequent dose of a vaccine in accordance with the written documentation from the primary health care provider, the primary health care provider's designee, or by a public health authority.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 7 Exclusions During Communicable Disease Outbreaks

(a) In the event of a vaccine-preventable disease outbreak, as determined by the State Health Officer or County Health Officer, a school or child caring facility administrator shall exclude from attendance any child who is not fully immunized against the occurring vaccine preventable disease.

(b) This section applies to a child with an approved waiver, a child granted conditional enrollment, or a child without documentary proof of complete immunization or serologic evidence of immunity pursuant to Chapter 3 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 8 IIS Access for Schools

(a) A school may enroll with the IIS in accordance with Chapter 5 of these rules for the purpose of obtaining documentation of immunization status in accordance with this chapter.

(b) The school administrator shall ensure that qualifying parental consent has been obtained and documented in the child's record prior to the school administrator or the administrator's designee accessing a child's immunization record in the IIS.

(i) A completed Immunization Agreement Between Parent/Guardian and School, found at https://health.wyo.gov/publichealth/‌immunization/ and made available by the Department upon request;

(ii) Electronic consent captured in the school's computer system with language consistent with the Immunization Agreement Between Parent/Guardian and School; or

(iii) The documentation of verbal consent, including the date and place, in the child's school record.

(d) The school administrator or the administrator's designee may only access immunization information in the IIS for a child who is currently attending or who has enrolled to attend the school in which the administrator is employed.

(e) The school administrator or the administrator's designee shall complete an audit once during the year to ensure parental consent has been obtained using the forms and process established by the Department.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.4.02072018 § 9 IIS Access for Child Caring Facilities

(a) A child caring facility may enroll with the IIS in accordance with Chapter 5 of these rules for the purpose of obtaining documentation of immunization status in accordance with this chapter.

(b) The child caring facility administrator shall ensure that qualifying parental consent has been obtained and documented in the child's record prior to the child caring facility administrator or the administrator's designee accessing a child's immunization record in the IIS.

(i) A completed WDH Authorization to Release Health Records (F-011) form, found at https://health.wyo.gov/admin/privacy/ and made available by the Department upon request.

(d) A child caring facility administrator or the administrator's designee may only access immunization information in the IIS for a child who is currently attending or who has enrolled to attend the child caring facility in which the administrator is employed.

(e) The child caring facility administrator or administrator's designee shall complete an audit once during the year to ensure parental consent has been obtained using the forms and process established by the Department.

History

Effective 2018-02-07

Chapter 5 Wyoming Immunization Information System

Wyo. Code R. 048.0071.5.02072018 § 1 Authority

The Wyoming Department of Health (Department) promulgates this chapter under the authority granted by Wyo. Stat. Ann. §§ 35-1-240 and 35-4-101.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 2 Purpose

This chapter establishes the Wyoming Immunization Information System (IIS).

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 3 Applicability

This chapter applies to the IIS established by the Department, its administrators, public health care organizations, enrolled organizations and their staff, schools, child caring facilities and authorized users.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 4 Functional Standards

(a) The IIS shall meet the Centers for Disease Control and Prevention (CDC) Immunization Information System Functional Standards, 2013-2017, effective December 14, 2012, and updated February 2016, which have been incorporated by reference under Chapter 1 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 5 Organization Eligibility and Enrollment

(a) An organization shall enroll with the IIS as determined by the Department if the organization:

(i) Employs, is owned or controlled by a primary health care provider that administers vaccines; or

(ii) Contracts with an organization that employs a primary health care provider that administers vaccines.

(b) An organization may enroll with the IIS if the organization:

(i) Is not included on the Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE); and

(ii) Displays an ongoing need to access data from the IIS for the purpose of treatment, payment, or operations.

(i) Submit a request for organizational enrollment using the form and process established the Department;

(ii) Identify an individual as the organizational contact for the IIS;

(iii) Identify facilities under the jurisdiction of the organization that are requesting access to the IIS; and

(iv) Identify an individual to serve as the facility contact for each facility under the jurisdiction of the enrolled organization.

(d) The Department shall approve a request for organizational enrollment with the IIS if the Department finds that the organization is able to satisfy the conditions imposed under this chapter.

(e) If the organization has been approved for enrollment with the IIS, a responsible authority for the organization shall complete an enrollment agreement prior to being granted access to the IIS.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 6 Organization Contact Responsibilities

(a) An organization contact for an enrolled organization shall facilitate the completion of the IIS enrollment agreement.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 7 Facility Contact Responsibilities

(a) A facility contact shall complete the following for their facility using the forms and process established by the Department:

(i) Requests for authorized users;

(ii) Change request to authorized user access levels; and

(iii) Report authorized users no longer employed by the organization within 24 hours.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 8 Authorized User Eligibility and Access

(a) A facility contact may request for an individual to become an authorized user using the form and process established by the Department.

(b) An individual is eligible to become an authorized user if the individual:

(i) Is not included on the OIG LEIE; and

(ii) Is a current employee of the enrolled organization.

(c) If the Department approves an individual to become an authorized user following verification of eligibility and the source of the request, the Department shall assign the authorized user an access level in accordance with the IIS Authorized User Policy (IMM-003), which has been incorporated by reference under Chapter 1 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 9 Authorized User Responsibilities

(a) An authorized user shall:

(i) Agree to the End User License Agreement according to the frequency and method established by the Department; and

(ii) Act in accordance with:

(A) The IIS Authorized User Policy (IMM-003); and

(B) The standards required by applicable law for the security of protected health information.

(b) An authorized user may only access the IIS for the following purposes:

(i) To enter immunization information;

(ii) To determine appropriate immunization;

(iii) To confirm compliance with mandatory immunization requirements;

(iv) To control disease outbreaks;

(v) For treatment purposes; or

(vi) For program oversight.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 10 IIS Interoperability

(a) To achieve interoperability between the IIS and the electronic health record (EHR) system utilized by the organization or its facilities, a responsible authority or his designee for the organization shall:

(i) Submit a request for interoperability with the IIS using the form and process established the Department; and

(ii) Identify an individual to serve as the project lead for each facility.

(a)

(b) The facility project lead shall:

(i) Identify a project team for the facility;

(ii) Demonstrate the EHR system's ability to comply with the Health Level Seven (HL7) protocol specifications established by the Department; and

(iii) Ensure compliance with the interoperability processes and procedures established by the Department.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 11 Mandatory Reporting of Immunization Information

(a) A primary health care provider that administers immunizations shall:

(i) Report immunization information to the IIS within thirty (30) days of administration using one of the following methods:

(A) Direct online entry into the IIS;

(B) Secure transmission of electronic files from an EHR using HL7 messaging in accordance with the specifications established by the Department; or

(ii) Ensure that submitted immunization information is accurate and meets the data quality threshold established by the Department.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 12 Suspension and Termination

(a) The Department may suspend or terminate an organization's or facility's enrollment with the IIS if the organization or facility is unable to satisfy the conditions imposed under this chapter or the enrollment agreement.

(b) The Department may suspend or terminate an authorized user's access to the IIS if the authorized user violates the following:

(i) IIS Authorized User Policy (IMM-003);

(ii) End User License Agreement; or

(iii) Any other Department policy.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 13 Patient Consent

(a) A patient or parent, may request an exclusion of his or his child's immunization information from the IIS by completing the Use and Disclosure Restriction (F-12) form available at https://health.wyo.gov/admin/privacy/and and made available by the Department upon request.

(i) The Department may not retain individually identifiable information in the IIS for a patient listed on an approved Use and Disclosure Restriction (F-12) form.

(ii) Immunization information shall be maintained in aggregate format.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 14 IIS Access for Schools and Child Caring Facilities

(a) A school or child caring facility may enroll with the IIS for the purpose of meeting the requirements established in Chapter 4 of these rules.

(b) A school or child caring facility administrator may request for an individual to become an authorized user in accordance with Section 8 of this chapter.

(c) A school or child caring facility administrator is responsible for ensuring that authorized users act in accordance with Chapter 4, Sections 8 and 9 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 15 Creating/Editing IIS Records

The Department may designate an authorized user to enter immunization information into the IIS from an immunization record in accordance with the Department's policy for Creating/Editing IIS Records from an Official Immunization Record Policy (IMM-004), which has been incorporated by reference under Chapter 1 of these rules.

History

Effective 2018-02-07

Wyo. Code R. 048.0071.5.02072018 § 16 Public Health Emergency

When the State Health Officer authorizes the ordering of vaccines in response to a public health emergency, a primary health care provider who receives or administers such vaccines shall enter immunization information into the IIS within the time frame designated by the State Health Officer.

History

Effective 2018-02-07

186 Wyoming Life Resource Center

Chapter 1 General Provisions

Wyo. Code R. 048.0062.1.07052022 General Provisions

CHAPTER 1

General Provisions

Section 1. Authority.

The Wyoming Department of Health (Department) adopts these rules pursuant to Wyoming Statutes § 9-2-106 and § 25-5-105.

Section 2. Purpose & Applicability.

(a) This chapter has been adopted to govern the administration of the Wyoming Life Resource Center (WLRC).

Section 3. Definitions.

(a) The following definitions apply to the WLRC rules, unless otherwise specified:

(i) "Adverse action" means the termination, reduction, or denial of services provided to a resident; the denial or withdrawal of admission certification; the discharge from services at the WLRC; or other action which, by law, may result in a contested case hearing before the Department. An adverse action excludes:

(A) The decision whether or not to offer a specific type of service at the WLRC;

(B) The staffing decisions made by the Department in its ordinary course of business; and

(C) The reduction or denial of services provided or any other action caused solely by a change in Federal or State statutes or regulations.

(ii) "Certification" means the satisfaction of federal standards of participation and a valid agreement between the Centers for Medicare and Medicaid Services and the WLRC.

(iii) "Director" means the Director of the Department, or the Director's agent, designee, or successor.

(iv) "Disability," as defined in W.S. § 25-5-102, means a developmental disability as defined in 42 U.S.C. 15002 or a disability resulting from an acquired brain injury.

(A) A "developmental disability," in general, means a severe, chronic disability of an individual that meets criteria pursuant to 42 U.S.C. 15002.

(B) A "developmental disability," in the context of infants and young children, means an individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting three or more of the criteria described in the definition of disability if the individual, without services and supports, has a high probability of meeting those criteria later in life.

(v) "Discharge" means the movement of a resident from the WLRC where the resident's return to the WLRC is not expected.

(vi) "Division" means the Department's Behavioral Health Division, its agent, designee, or successor.

(vii) "Empowered staff" means direct care staff who work within self-managed work teams and have the primary responsibility for the day-to-day care of residents and the smooth functioning of the homes. They work in partnership with nurses and other clinical support team members to meet the needs of residents.

(viii) "Facility Administrator" means the on-site supervisor and manager of the WLRC or designee. This term is equivalent to the statutory term "Program Manager." When interpreting and construing these rules, the term "Facility Administrator" is used in lieu of "Program Manager."

(ix) "Intermediate Care Facility for Individuals with Intellectual Disabilities" as defined in W.S. § 25-5-102(b)(xxii), means an intermediate care facility for individuals with intellectual disabilities (ICF/IID), which provides active treatment and related services for eligible individuals requiring intermediate care.

(x) "Legacy population" is any person residing at the Wyoming Life Resource Center prior to April 1, 2016.

(xi) "Meaningful life" means the ability to determine choice, control, autonomy, close relationships, and other attributes as determined by each resident.

(xii) "Minimum Data Set (MDS)" means the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified skilled nursing facilities. The MDS process provides a comprehensive assessment of each resident's functional capabilities and helps WLRC staff identify health issues in order to create an individualized comprehensive care plan.

(xiii) "Neurocognitive Disorder" means decreased mental functioning as determined by diagnostic criteria defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Neurocognitive disorders includes acquired brain injury and organic brain syndrome.

(xiv) "Non-Residential services" means outreach and outpatient services, upon request, to those individuals not admitted to one of the residential programs.

(xv) "Person centered planning" means a process directed by a resident that identifies a resident's strengths, capacities, preferences, needs, and the services needed to meet those needs. Person centered planning allows a resident to exercise choice and control over the process of developing and implementing the individual program plan. Person centered planning includes:

(A) "Baseline person centered care planning" means a plan of care developed within forty-eight (48) hours of a resident's skilled nursing facility admission including the minimum healthcare information necessary to properly care for the resident;

(B) "Comprehensive person centered care planning" means the development and implementation of a plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs, while describing individualized resident goals, preferences, and desired outcomes.

(xvi) "Preadmission screening assessment" means an evaluation conducted by the screening team using appropriate assessments and tools for determination of eligibility for a program at the WLRC.

(xvii) "Real home" means the residential homes designed to provide an environment for the residents that is a place of comfort, safety, and refuge. The real home incorporates therapeutic attributes, outdoor spaces, private bedrooms, a shared living room, open kitchen, and dining area.

(xviii) "Restraint," means processes that limit movement or behavior. Restraint includes:

(A) "Personal restraint," which means the application of physical presence without the use of any device, for the purpose of restraining the free movement of the body of the resident. Personal restraint does not include briefly holding, without undue force, a resident in order to calm or comfort the resident, or holding a resident's hand to safely escort the resident from one area to another. Personal restraint includes the use of a "time-out room," as regulated by 42 CFR 483.450(c);

(B) "Mechanical restraint" means a device attached or adjacent to a resident's body that cannot easily be moved or removed that restricts freedom of movement or normal access to the body; or

(C) "Drug used as a restraint" means a drug that is administered to manage a resident's behavior in a way that reduces the safety risk to the resident or others, has the temporary effect of restricting the resident's freedom of movement, and is not a standard treatment for the resident.

(xix) "Senior Administrator" means the administrator of the Behavioral Health Division or designee. This term is equivalent to the statutory term "Administrator." When interpreting and construing these rules, the term "Senior Administrator" is used in lieu of "Administrator."

(xx) "Services" mean diagnostic, education, training, medical, habilitation, or other services and/or respite, emergency evaluation services, equipment, therapy, or supplies appropriate to meet the needs of a resident at the WLRC.

(xxi) "Skilled Nursing Facility" means a facility primarily engaged in skilled nursing care and related services for residents who require medical or nursing care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.

(xxii) "Transfer" means the movement of a resident from the WLRC to another setting, usually for a temporary period.

Section 4. General Provisions.

(a) The WLRC shall provide person centered planning and care based on the WLRC being the least restrictive environment, most appropriate, most integrated setting, and ensure the informed choice of the resident or legally authorized representative.

(b) The WLRC shall support and maintain core values in the form of real home, meaningful life, and empowered staff.

(c) As a safety net facility for the State of Wyoming, the WLRC is obligated to discharge residents when a safe and reasonable discharge is possible.

(d) A legally authorized representative may at all times act on behalf of the applicant or resident to the full extent legally authorized.

(e) The WLRC facility includes the Canyons Intermediate Care Facility for Individuals with Intellectual Disabilities; the Mountain View Skilled Nursing Facility; and may provide non-residential services in the form of disability, therapeutic and assistive technology services for persons with a disability; training for state employees, other service providers and caregivers on disability, medical, developmental and therapy services.

(i) Within the Canyons Intermediate Care Facility for Individuals with Intellectual Disabilities in addition to regular admission, seventy-five (75) calendar day services may be delivered to an individual who does not meet regular admission criteria.

Section 5. Professional Standards.

(a) The WLRC shall provide each employee with training that enables the employee to perform duties effectively, efficiently, and competently.

(b) A professional employed or contracted by the WLRC shall:

(i) Meet all licensing and certification requirements pertinent to the profession;

(ii) Meet the standards of the profession;

(iii) Meet all other applicable standards by law; and

(iv) Participate in ongoing staff development.

Section 6. Data Reporting.

(a) The WLRC shall report the following to the Director every month:

(i) The number of persons served by the WLRC;

(ii) The number of persons served by the WLRC by service category;

(iii) The services provided to persons served by the WLRC;

(iv) The data relative to the accomplishment of the criteria specified in resident individual program plan objectives in measureable terms; and

(v) Significant events related to planning and assessments that contribute to understanding resident level of care needs and quality of functioning.

History

Effective 2022-07-05

Chapter 2 Administrative Procedure

Wyo. Code R. 048.0062.2.07052022 Administrative Procedure

CHAPTER 2

Administrative Procedure

Section 1. Purpose and Applicability.

(a) This chapter governs the administrative process and procedures of the Wyoming Life Resource Center (WLRC).

Section 2. Adverse Actions.

(a) When an applicant is denied admission to the Intermediate Care Facility for People with Intellectual Disabilities (Canyons ICF), the Canyons ICF shall notify the applicant.

(i) The applicant may request that the Canyons ICF reconsider the admission denial within ten (10) calendar days after the date of the denial notification letter.

(b) Canyons ICF shall notify a resident of their discharge from the Canyons ICF ten (10) calendar days before the discharge is set to take place.

(i) A resident may request that the Canyons ICF reconsider the discharge within ten (10) calendar days of discharge notification letter.

(ii) Canyons ICF shall notify a temporary resident of the resident's discharge from a seventy-five (75) calendar day placement at the Canyons ICF within ten (10) calendar days before the discharge is set to take place.

(c) When an applicant is denied admission to the Mountain View Skilled Nursing Facility (Mountain View SNF), Mountain View SNF shall notify the applicant.

(i) The applicant may request that the Mountain View SNF reconsider the admission denial within thirty (30) calendar days after the date of the denial notification letter.

(d) Mountain View SNF shall notify a resident of the resident's transfer or discharge from the Mountain View SNF thirty (30) calendar days before the discharge is set to take place, unless an exception listed under 42 CFR 483.15(c) applies.

(i) A resident may request that the Mountain View SNF reconsider the discharge within thirty (30) calendar days of discharge notification letter.

Section 3. Reconsideration.

(a) A resident or applicant may request that the WLRC reconsider an adverse action. If a resident or applicant does not request reconsideration, the resident or applicant may not request an administrative hearing.

(b) A request for reconsideration shall contain the following:

(i) The name, address, and telephone number of the applicant or resident requesting reconsideration;

(ii) The reason for the request, including the nature of the adverse action; and

(iii) Any additional information the resident or applicant would like to provide.

(i) Any additional information requested shall be submitted within twenty-five (25) calendar days of the Facility Administrator's request.

(ii) The resident or applicant may, upon a showing of good cause, request additional time to respond to the request for additional information. The Facility Administrator may grant such requests as the Facility Administrator deems reasonable and prudent.

(d) The facility administrator may request a reconsideration meeting with the applicant or resident prior to making a determination on the reconsideration.

(e) The Facility Administrator shall complete review of the request for reconsideration and notify the resident or applicant of the reconsideration decision within forty-five (45) calendar days of the receipt of the request for reconsideration.

(f) No provision of this section shall prohibit a resident or applicant from working with the Department to establish informal proceedings for resolution during any point.

Section 4. Request for an Administrative Hearing.

(a) If the matter cannot be resolved through reconsideration, a resident or applicant may request an administrative hearing. The resident or applicant shall provide the WLRC with a written request for an administrative hearing within thirty (30) calendar days after the date of the reconsideration determination letter.

(b) Upon receipt of a request for an administrative hearing, the Department shall transmit the administrative hearing request to the Office of Administrative Hearings. The hearing shall be conducted in accordance with Rules, Office of Administrative Hearings, General Agency, Board of Commission Rules, Chapter 2, Section 6 (2017), incorporated herein by reference.

Section 5. Complaints.

(a) When the WLRC receives a complaint regarding the health and safety of a resident, the WLRC will refer the matter to investigation and determine how to handle the complaint on a case-by-case basis.

Section 6. Incorporation by Reference.

(a) For any code, standard, rule, or regulation incorporated by reference in these Rules:

(i) The Department has determined that incorporation of the full text in these Rules would be cumbersome or inefficient given the length or nature of these Rules;

(ii) The incorporation by reference does not include any later amendments or editions of the incorporated matter beyond the applicable date identified in subsection (b) of this Section; and

(iii) The incorporated code, standard, rule, or regulation may be found at https://health.wyo.gov/behavioralhealth/wlrc/ and is maintained and made available by the Department for public inspection and copying at cost at the same location.

(b) The Department incorporates the following codes, standards, rules, and regulations into these Rules by reference. These incorporated references are identified as:

History

Effective 2022-07-05

Chapter 3 Canyons Intermediate Care Facility for People with Intellectual Disabilities

Wyo. Code R. 048.0062.3.07052022 Canyons Intermediate Care Facility for People with Intellectual Disabilities

CHAPTER 3

Canyons Intermediate Care Facility for People with Intellectual Disabilities

Section 1. Purpose and Applicability.

(a) This chapter has been adopted to establish the criteria for eligibility to Canyons Intermediate Care Facility for People with Intellectual Disabilities (Canyons ICF), and to establish the admission and discharge processes.

(b) All activities and services must support the Canyons ICF's mission of being an Intermediate Care Facility for People with Intellectual Disabilities. The Canyons ICF shall ensure residents experience a well-organized, safe, and timely discharge from the Canyons ICF to their home communities or the most appropriate, least restrictive environment.

Section 2. Eligibility.

(a) An individual is eligible for admission to the Canyons ICF if:

(i) The individual qualifies for financial Medicaid assistance and meets institutional level of care requirements;

(ii) The individual has been clinically diagnosed with an intellectual disability; and

(iii) The individual demonstrates an institutional level of exceptionally difficult behaviors as determined by the Canyons ICF's formal facility-approved assessment process.

(b) All requests for admission are evaluated on a case-by-case basis to determine whether seventy-five (75) calendar day temporary services would be more appropriate for the individual than regular admission.

(i) An individual is eligible for admission to the Canyons ICF; and

(ii) Any one of the following apply:

(A) Services are unavailable due to facility licensing constraints;

(B) Services are unavailable due to limits imposed by funding; or

Section 3. Admission to the Canyons ICF.

(a) In order to apply for admission to the Canyons ICF, an individual shall submit a request for admission packet to the Canyons ICF.

(b) The formal review, including the preadmission screening and assessment, shall be completed within thirty (30) calendar days of Canyons ICF determination that an application packet is complete.

(i) The Canyons ICF shall determine membership of the screening team. The screening tem shall consist of a core group of qualified professionals with knowledge of the admission and eligibility processes.

(c) Prior to the thirty (30) calendar day formal review deadline, the screening team shall make a recommendation regarding the application for admission to the Senior Administrator.

(i) The Senior Administrator shall review the recommendation and make a determination for approval or denial of the application for admission within ten (10) calendar days receiving the recommendation.

(A) Canyons ICF shall notify the applicant in writing of the Senior Administrator's determination within two (2) business days of the determination.

(d) When the applicant is approved for admission, the Canyons ICF shall assign an interdisciplinary team to the individual. Canyons ICF shall schedule a transition meeting to include the applicant, and referring agency representative, if applicable, to coordinate transition to the Canyons ICF.

Section 4. Standards for Resident Services.

(a) The interdisciplinary team shall be comprised of the resident; and professionals and paraprofessionals who possess the knowledge, skills, and expertise necessary to accurately identify the comprehensive array of the resident's needs and design a program that is responsive to those needs. The number of individuals who comprise the interdisciplinary team is based upon each resident's individual needs and may vary.

(b) The interdisciplinary team shall use the individual program plan as a record of the current treatment and recommendations depending on the needs of the resident.

(i) To ensure informed choice, placement options are reviewed in accordance with 42 CFR 483.440(c) and resident need.

(ii) For school-aged residents between the ages of three (3) and twenty-one (21) years, the home school district develops the individualized education program and the Canyons ICF shall coordinate the individual program plan process.

(i) Each resident must receive a continuous individualized active treatment program for the resident to function with as much self-determination and independence as possible.

(ii) The Canyons ICF shall ensure the active treatment program is pervasive, systematic, and sufficient in scope to ensure that individuals are appropriately served by assessing each individual resident's needs, including but not limited to the following areas:

(A) Physical development and health, which means the resident's developmental history, results of the physical examination conducted by a licensed physician, physician assistant, or nurse practitioner, health assessment data (including a medication and immunization history), which may be compiled by a nurse, and skills normally associated with the monitoring and supervision of the resident's own health status, and administration and/or scheduling of the resident's own medical treatments;

(B) Nutritional status, which means the determination of appropriateness of diet, adequacy of total food intake, and the skills associated with eating;

(C) Sensorimotor development, which means the development of perceptual skills that are involved in observing the environment and making sense of it. Motor development includes those behaviors that primarily involve muscular, neuromuscular, or physical skills and varying degrees of physical dexterity. Assessment data identifies the extent to which corrective, orthotic, prosthetic, or support devices would impact the functional status of development;

(D) Affective (emotional) development, which means the development of behaviors that relate to the resident's interests, attitudes, values, and emotional expressions;

(E) Speech and language (communication development), which means the development of both verbal and nonverbal and receptive and expressive communication skills. Assessment data identifies the appropriate intervention strategy to be applied and which, if any, augmentative or assistive devices may improve communication and functional status;

(F) Auditory functioning, which means the extent to which a person can hear and to the maximum use of residual hearing, if a hearing loss exists, and whether or not the resident may benefit from the use of amplification, including a hearing aid or a program of amplification. Assessment may include teaching techniques for conducting the assessment or the use of electrophysiological techniques;

(G) Cognitive development, which means the development of those processes by which information received by the senses is stored, recovered, and used. It includes the development of the processes and abilities involved in memory, reasoning, and problem solving;

(H) Social development, which means the formation of self-help, recreation and leisure, and interpersonal skills that enable a resident to establish and maintain appropriate roles and fulfilling relationships with others;

(I) Adaptive behaviors or independent living skills, which means the effectiveness or degree with which residents meet the standards of personal independence and social responsibility expected of their age and cultural group. Independent living skills include, but are not limited to, such things as meal preparation, doing laundry, bed making, and budgeting. Assessment may be performed by a qualified staff member; and

(J) Vocational (prevocational) development, as applicable, which means the work interests, work skills, work attitudes, work-related behaviors, and present or future employment options.

Section 5. Discharge.

(a) The Canyons ICF shall begin discharge planning at admission.

(b) Discharge is appropriate when identified treatment goals have been met.

(i) The interdisciplinary team shall revisit the individual program plan on a monthly basis until discharge is recommended.

(i) The resident's treatment goals have been met as identified in the individual program plan; and

(ii) A transition plan has been established by the interdisciplinary team.

(d) The Canyons ICF does not have the responsibility to find community placement for residents.

(e) If requested, the Canyons ICF may coordinate with a legally authorized representative, community case manager, or both, to help locate a suitable placement with a community provider if possible.

(f) Legally authorized representative approval is not required for discharge.

(g) The Canyons ICF shall provide reasonable time to prepare the resident for transfer or discharge, except in an emergency.

(h) At the time of discharge, the Canyons ICF shall:

(i) Develop a final summary of the resident's development, behavioral, social, health, and nutritional status, and with the consent of the resident, provide a copy to authorized persons and agencies; and

(ii) Provide a transition plan of care to assist the resident in adjusting to the new living environment.

(i) The Canyons ICF shall formally discharge the resident with written notification to the resident; the court shall also be notified, as appropriate.

History

Effective 2022-07-05

Chapter 5 Temporary Services

Wyo. Code R. 048.0062.5.07052022 Temporary Services

CHAPTER 5

Temporary Services

Section 1. Purpose and Applicability.

(a) This chapter establishes the procedures to provide temporary services at the Canyons Intermediate Care Facility for People with Intellectual Disabilities (Canyons ICF).

(b) This chapter only applies to temporary services at the Canyons ICF.

Section 2. Admission for Temporary Services.

(a) The Canyons ICF shall determine if seventy-five (75) calendar day temporary services are appropriate. Immediately upon admission for temporary services, the Canyons ICF shall begin the discharge planning process. When the Senior Administrator has determined it would be appropriate for an individual to receive temporary services, the Canyons ICF shall provide an appropriate program plan for the provision of services.

(b) The Canyons ICF may pursue reimbursement for temporary services as determined by the Wyoming Department of Health.

Section 3. Temporary Services Options.

(a) The Canyons ICF shall determine if temporary services are appropriate, based on the following:

(i) Evaluation for service needs;

(ii) Recovery from medical procedures requiring follow-up care at the Canyons ICF;

(iii) Provision of appropriate services following allegations that the individual admitted for services may be a victim of abuse or neglect;

(iv) Transition between other service environments; or

(v) Provision of disability, therapeutic, and assistive technology services for an individual with a disability.

Section 4. Discharge.

(a) Upon admission for temporary services at Canyons ICF, the temporary resident's interdisciplinary team shall develop a person-centered discharge plan based on:

(i) Appropriateness of placement;

(ii) Identification of an appropriate community placement; and

(iii) Status of seventy-five (75) calendar day period and an estimated timeline for completion of discharge.

History

Effective 2022-07-05

Chapter 6 Non-Residential Services

Wyo. Code R. 048.0062.6.07052022 Non-Residential Services

CHAPTER 6

Non-Residential Services

Section 1. Purpose and Applicability.

(a) This chapter establishes the non-residential services provided through the Wyoming Life Resource Center (WLRC), which include:

(i) Therapeutic and assistive technology services for persons with disabilities; and

(ii) Training for state employees, other service providers, and caregivers on disability, medical, developmental, and therapy services.

(b) This chapter only applies to the non-residential services provided through the WLRC.

Section 2. Outpatient and outreach disability, therapeutic and assistive technology services.

(a) The WLRC may administer an outpatient and outreach program. The program may provide services to meet the needs of individuals with disabilities, including:

(i) Diagnostic and professional assessment services; and

(ii) Medical, dental, behavioral, therapy and assistive technology services.

(b) The WLRC may administer the outpatient and outreach program at any location, as necessary.

(c) An individual may request services through the outpatient and outreach program by oneself or on behalf of an individual with a disability. The WLRC may grant the request upon a determination that requested services are appropriate and resources are available.

(d) A denial of request for outpatient and outreach program services:

(i) Is not an adverse action within the scope of these rules; and

(ii) Does not meet the criteria to request reconsideration or an administrative hearing.

Section 3. Training Services.

(a) The WLRC may provide disability, medical, developmental, and therapy service conferences; seminars; and training for state employees, other service providers, caregivers, and individuals with disabilities.

(i) These services may be provided at any location, as necessary.

(ii) Any interested party may request specific training services. The WLRC shall respond to these requests based on appropriateness and availability of resources.

(iii) A denial of training services:

(A) Is not an adverse action within the scope of these rules; and

(B) Does not meet the criteria to request reconsideration or an administrative hearing.

History

Effective 2022-07-05

Chapter 7 Mountain View Skilled Nursing Facility

Wyo. Code R. 048.0062.7.07052022 Mountain View Skilled Nursing Facility

CHAPTER 7

Mountain View Skilled Nursing Facility

Section 1. Purpose and Applicability.

(a) This chapter has been adopted to establish the criteria for eligibility to the Mountain View Skilled Nursing Facility (Mountain View SNF), and to establish the admission and discharge processes.

Section 2. Eligibility.

(a) An individual is eligible for admission to the Mountain View SNF if:

(i) The individual meets one or more of the following:

(A) Persons with neurocognitive disorder who manifest exceptionally difficult behaviors;

(B) Persons with high medical need, including but not limited to, those who qualify for Medicaid extraordinary care; or

(ii) The individual has been determined to meet nursing facility level of care.

(b) The Mountain View SNF may establish a waiting list pursuant to the following criteria:

(i) An individual is eligible for admission to the Mountain View SNF; and

(ii) Any one of the following:

(A) Services are unavailable due to facility licensing constraints;

(B) Services are unavailable due to limits imposed by funding; or

Section 3. Admission to the Mountain View SNF.

(a) The individual shall submit a request for admission to the Mountain View SNF.

(b) The formal review, including preadmission screening and assessment, shall be completed within thirty (30) calendar days of Mountain View SNF determination that an application packet is complete.

(i) The Mountain View SNF shall determine membership of the screening team. The screening team shall consist of a core group of qualified professionals with knowledge of the admission and eligibility processes.

(c) Prior to the thirty (30) calendar day formal review deadline, the screening team shall make a recommendation regarding the application for admission to the Senior Administrator.

(i) The Senior Administrator shall review recommendation and make a determination for approval or denial of the application for admission within ten (10) calendar days of receiving the recommendation.

(A) Mountain View SNF shall notify the applicant in writing of the Senior Administrator's determination within two (2) business days of the determination.

(ii) If the results of the preadmission screening and assessment indicate the individual would be more appropriately served by a community nursing home, community program, or at home, the screening team shall recommend denial to the Senior Administrator.

(d) When the applicant is approved for admission, the Mountain View SNF shall assign an interdisciplinary team to the individual. Mountain View SNF shall schedule a transition meeting to include the applicant, and referring agency representative, if applicable, to coordinate transition to the Mountain View SNF.

(e) The Mountain View SNF shall require each resident admitted to the Mountain View SNF for residential services to sign an admission agreement and complete an admission packet to identify responsible parties and reflect potential charges.

Section 4. Standards for Resident Services.

(a) Upon admission, the Mountain View SNF shall begin person-centered care planning pursuant to 42 CFR 483.21, as driven by the Minimum Data Set (MDS) assessment administration process.

(i) The interdisciplinary team shall develop a baseline person-centered care plan within forty-eight (48) hours of admission that meets professional standards of quality care.

(ii) The Mountain View SNF shall develop a comprehensive care plan within seven (7) calendar days after completion of the comprehensive assessments.

(iii) The Mountain View SNF shall share summary information included in the baseline and comprehensive person-centered care plans with the resident upon request.

(iv) The Mountain View SNF shall ensure person-centered care plans incorporate strengths, needs, personal and cultural preferences, and the resident's preference and potential for discharge. The Mountain View SNF shall also ensure services outlined in the person-centered care plan translate into medical treatment, nursing related treatment, behavioral based approaches, applicable therapies, and activity preferences.

(b) The resident's interdisciplinary team shall review the person-centered care plan after each subsequent assessment and in accordance with the MDS care planning schedule.

Section 5. Transfer.

(a) In the event a resident is transferred for temporary care or treatment under W.S. § 25-5-125, the Mountain View SNF will hold the bed for a maximum of thirty (30) calendar days.

(i) If it is anticipated that the absence will exceed thirty (30) calendar days, the resident shall make a request for a bed hold extension to the Mountain View SNF.

(b) In accordance with 42 CFR 483.15(c), the Mountain View SNF shall ensure transfer planning is conducted in order to provide a safe transition in accordance with the resident's needs and preferences whenever possible. The Mountain View SNF shall invite the resident to be involved in the transfer process.

(i) The Mountain View SNF shall integrate the individualized transfer plan into the comprehensive care plan. The interdisciplinary team shall develop the comprehensive care plan in consultation with the resident.

Section 6. Discharge.

(a) The Mountain View SNF shall begin discharge planning at admission. The Mountain View SNF shall ensure discharge planning is conducted in order to provide a safe transition in accordance with the resident's needs and preferences whenever possible. The Mountain View SNF shall invite the resident to be involved in the process to ensure the resident has the tools necessary to be successful at their next destination. The Mountain View SNF's discharge planning process shall be consistent with discharge rights set forth at W.S. 25-5-124.

(b) The Mountain View SNF shall formally discharge the resident with written notification to the resident; the court shall be notified, as appropriate.

History

Effective 2022-07-05

420 Wyoming Violent Death Reporting System

Chapter 1 Wyoming Violent Death Reporting System

Wyo. Code R. 048.0080.1.04032023 Wyoming Violent Death Reporting System

Chapter 1

Wyoming Violent Death Reporting System

Section 1. Authority. The Wyoming Department of Health (Department) promulgates this Chapter pursuant to Wyoming Statutes 35-1-240(a)(i) and (vii).

Section 2. Purpose & Applicability. This Chapter requires a county coroner, law enforcement officer, and any other individual to report information regarding a violent death to the Department's Wyoming Violent Death Reporting System (WYVDRS).

Section 3. Definitions.

(a) The following definitions apply to this Chapter:

(i) "Violent death" means a death that results from the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community; and

(ii) "Wyoming Violent Death Reporting System (WYVDRS)" means the Wyoming Department of Health program to collect information on all violent deaths in Wyoming.

Section 4. Violent Death Report. Upon the Department's written request, a county coroner, law enforcement officer, or other individual possessing information related to a violent death shall submit a violent death report to the Department in the form and manner prescribed by the Department.

History

Effective 2023-04-03