No fee under this section shall be allowed by the Division
without first reviewing the fee for appropriateness and reasonableness in
accordance with its adopted fee schedules.
(a) Home Health Nursing Services
(i) Home Health Nursing Services shall be
intermittent, medically necessary, related to the work injury, documented in a
plan of treatment, expected to last six (6) months or less, and ordered by a
physician.
(ii) Initial
prescriptions/orders for home health nursing services shall include the reason
for home health skilled nursing, frequency, and duration.
(iii) Face to face visit. All new home health
orders shall be accompanied by documentation of a face to face visit having
occurred within ninety (90) days prior to the start of home health
services.
(iv) Only independent
Medicare/Medicaid certified agencies may provide home health nursing
care;
(v) Only Certified Nursing
Assistants, Licensed Practical Nurses, Licensed Vocational Nurses or Registered
Nurses working for a Medicare/Medicaid certified agency can provide home health
nursing care;
(vi) If the injured
worker's residence is not within a fifty (50) mile radius of a
Medicare/Medicaid certified agency, the Division may approve other alternatives
such as Private Duty Nursing Services. Any such arrangement must have prior
approval from the Division.
(vii)
Home Health Nursing Services beyond six (6) consecutive months shall be
reviewed by the Division to determine continued medical necessity.
(viii) Private Duty Services/Attendant Care.
Private duty services/attendant care for long term daily care at home not being
provided by a Home Health Agency, includes but not limited to; personal care
for activities of daily living.
(ix) Initial prescriptions/orders for
services shall include the reason for private duty services/attendant care,
frequency, and duration.
(x)
Private duty services/attendant care shall be provided by individuals who are
approved by the primary treating health care provider.
(xi) Private duty services/attendant care
shall be paid for a maximum of twelve (12) hours per day per
provider.
(xii) Private duty
services/attendant care required beyond twelve (12) consecutive months shall be
reviewed by the Division; every twelve (12) months thereafter to determine
continued medical necessity.
(b) Disclaimer of Employment. Persons
performing services in the home of an injured worker are not employees of the
State of Wyoming. The provider or the provider's employer shall retain all
responsibility for the payment of any and all federal income tax, state or
federal unemployment insurance, state or federal social security premiums, and
workers' compensation premiums that may be due.
(c) Fees. See Chapter 9, Section
3 for specific information on fees for home
health nursing, private duty services and attendant care.
(d) Nursing Facility Care Referral Process
(i) A referral for nursing facility placement
shall be made by the treating health care provider. The referral shall be
communicated to the Division by the treating health care provider and, when
possible, the nursing facility, indicating the injured worker's medical needs
require admission to or on the premises of a nursing facility. The request
shall be reviewed by the Division for relatedness to the work injury and
approved by the Director or designated representative. See Chapter 10, Section
28, Special Agreements for additional
information on fee schedules and/or payment rates.