Wyoming Administrative Code
Agency 053 - Workforce Services, Department of
Sub-Agency 0021 - Workers' Compensation Division
Chapter 10 - MISCELLANEOUS MEDICAL PROTOCOLS
Section 10-17 - Nursing Services

Universal Citation: WY Code of Rules 10-17

Current through September 21, 2024

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.

Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.