048-45 Wyo. Code R. §§ 45-13 - 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.

(c) Settings that are not considered home and community-based include, but are not limited to:

(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

(C) An appropriate contractor inspecting a part of the service setting within the scope of the contractor's license.

(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;

(C) Natural disasters, including but not limited to earthquakes, blizzards, floods, tornadoes, wildfires;

(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

(C) Evidence of one fire drill, including an evacuation of the premises.

(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;

(C) Freedom to access the community;

(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.

Notes

048-45 Wyo. Code R. §§ 45-13

Amended, Eff. 6/21/2017. Amended, Eff. 7/26/2018. Amended, Eff. 12/20/2019.