(a) All certified waiver providers that provide direct care services to participants in a facility they own or lease shall meet all applicable federal, state, city, county, and tribal health and safety code requirements. A facility includes the provider's home, if services are provided in that setting.
(b) All 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 self-advocate 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 residential settings serving five (5) or more participants will not be certified.
(e) Provider facilities certified prior to the effective date of this rule shall continue to provide services in settings that do not meet this requirement, but shall begin transition to HCBS compliance by June 2021. Providers that do not start the transition process in good faith by June 2021 may be decertified.
(f) Provider facility inspections. - (i) For each location where services are provided to a participant, except the participant's own home, the provider shall receive a facility inspection by an outside entity at least once every thirty six (36) months. The Division may require more frequent inspections if the Division suspects that the provider or employee's facility would not pass the inspection.
- (ii) The facility inspection 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) Other appropriate contractor inspecting a part of the facility within the scope of the contractor's license.
- (iii) Facility inspections 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 facility is free of any other significant health or safety concerns, including structural concerns, wiring problems, plumbing problems, and any major system concerns.
- (iv) Facility inspections shall include a written report that describes the items checked and recommendations to address areas of deficiencies.
- (v) If the facility inspection 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 should address all identified deficiencies and the intended completion dates.
- (B) The Division may request additional corrective actions or proof of corrected problems based on the inspector's report.
- (C) No services shall be provided in a facility that does not pass the initial inspection until all deficiencies have been corrected.
- (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.
- (vii) Providers that are not required to have a home or facility inspection shall sign a form designated by the Division to verify they are not providing services in any provider-owned or leased facility.
- (viii) Providers shall not provide services in a facility 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 or self-directed employee when they are subsequently found to be providing services in a facility owned or leased by the provider or employee, which has not previously passed inspection.
(g) Self-Inspections. A provider providing services in a facility they own or lease shall complete an annual self-inspection of the facility to verify that the provider is in compliance with this section.
(h) Emergency plans. - (i) Providers shall have written emergency plans and procedures for:
- (C) Natural disasters, including but not limited to earthquakes, blizzards, floods, tornadoes, wildfires;
- (E) Medical/behavioral emergencies/missing person;
- (F) Safety during violent or other threatening situations;
- (G) Vehicle emergency; and
- (H) 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.
- (I) 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.
- (ii) The emergency plans shall include a contingency plan that assures that there is a continuation of essential services when emergencies occur.
- (iii) If the provider is providing 24 hour services, the provider shall document the review of all applicable emergency plans, with staff and participants, at least once every twelve (12) months on each shift. 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.
- (iv) If provider is not providing 24 hour services, the provider shall document the review of all applicable emergency plans, with staff and participants, during normal working hours at least once every twelve (12) months, on each shift. 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.
(i) Other service standards. All service settings owned or controlled by a provider shall meet the following requirements: - (i) In residential service and day service facilities, 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 (o) 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) The 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, or 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 cleansers, and toilet tissue at all times.
- (x) Toilet facilities shall be kept clean and sanitary, and maintained in good repair.
- (xi) The overall condition of the home or facility 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 or sensors may be used where appropriate, and shall be documented in the participant's individualized plan of care.
- (xiii) A provider facility with a private water supply shall have a bacterial test conducted every three (3) years, and the written results shall be submitted to the Division within thirty (30) days of receiving test results.
- (xiv) Providers shall ensure that all participants residing in a provider owned or leased facility 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, county, and city where the facility is located. A participant shall not be asked to leave their residence on a regular basis to accommodate the provider;
- (B) Freedom and support to control their schedules and activities;
- (C) The right 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 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 participants are legally related or joint sleeping accommodations are specifically requested by the participant, and specified in the approved 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 12, 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.
- (xv) Written policies to address health, safety, and rights when:
- (I) Any occupants or visitors of the home smoke, a policy on smoking that assures protection of health of the participant.
- (II) Any occupants or visitors have pets, a plan to protect participant, including verification that the pets are current with vaccinations.
- (III) Any occupants or visitors have weapons in the home, a policy on weapons that shall include the requirements that weapons are stored in a locked cabinet or in an inaccessible location and that, for firearms, ammunition is stored in a separate location from the firearm.
- (IV) Providers shall share policies with participants before the participant formally chooses the provider.
(j) 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.
(k) Unless otherwise directed by the participant's licensed medical professional, or is otherwise indicated in the individualized plan of care, residential providers shall ensure each participant receives a medical evaluation every twelve (12) months.
(l) 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 any potential participants and legally authorized representative(s) before the provider is chosen to provide services.
(m) 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.
(n) 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.
(o) Settings that include any modification 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.
(p) Settings that include any restriction to 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.
048-45 Wyo. Code R. § 45-13