Current through December 21, 2024
(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.
