CHAPTER 1

 

General Provisions

 

Section 1.                Authority.

 

The Wyoming Department of Health (Department) adopts these rules pursuant to Wyoming Statutes § 9-2-106 and § 25-5-105.

 

Section 2.                Purpose & Applicability.

 

(a) This chapter has been adopted to govern the administration of the Wyoming Life Resource Center (WLRC).

 

Section 3.                Definitions.

(a)              The following definitions apply to the WLRC rules, unless otherwise specified: 

 

(i)                "Adverse action" means the termination, reduction, or denial of services provided to a resident; the denial or withdrawal of admission certification; the discharge from services at the WLRC; or other action which, by law, may result in a contested case hearing before the Department. An adverse action excludes:

(A)            The decision whether or not to offer a specific type of service at the WLRC;

(B)             The staffing decisions made by the Department in its ordinary course of business; and

 

(C)             The reduction or denial of services provided or any other action caused solely by a change in Federal or State statutes or regulations.

 

(ii)              "Certification" means the satisfaction of federal standards of participation and a valid agreement between the Centers for Medicare and Medicaid Services and the WLRC.

(iii)           "Director" means the Director of the Department, or the Director's agent, designee, or successor.

 

(iv)            "Disability," as defined in W.S. § 25-5-102, means a developmental disability as defined in 42 U.S.C. 15002 or a disability resulting from an acquired brain injury.

 

(A)            A "developmental disability," in general, means a severe, chronic disability of an individual that meets criteria pursuant to 42 U.S.C. 15002.

 

(B) A "developmental disability," in the context of infants and young children, means an individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition, may be considered to have a developmental disability without meeting three or more of the criteria described in the definition of disability if the individual, without services and supports, has a high probability of meeting those criteria later in life.

 

(v)              "Discharge" means the movement of a resident from the WLRC where the resident's return to the WLRC is not expected.

 

(vi)            "Division" means the Department's Behavioral Health Division, its agent, designee, or successor.

 

(vii)         "Empowered staff" means direct care staff who work within self-managed work teams and have the primary responsibility for the day-to-day care of residents and the smooth functioning of the homes. They work in partnership with nurses and other clinical support team members to meet the needs of residents.

 

(viii)       "Facility Administrator" means the on-site supervisor and manager of the WLRC or designee. This term is equivalent to the statutory term "Program Manager." When interpreting and construing these rules, the term "Facility Administrator" is used in lieu of "Program Manager."

 

(ix)            "Intermediate Care Facility for Individuals with Intellectual Disabilities" as defined in W.S. § 25-5-102(b)(xxii), means an intermediate care facility for individuals with intellectual disabilities (ICF/IID), which provides active treatment and related services for eligible individuals requiring intermediate care.

 

(x)              "Legacy population" is any person residing at the Wyoming Life Resource Center prior to April 1, 2016.

 

(xi)            "Meaningful life" means the ability to determine choice, control, autonomy, close relationships, and other attributes as determined by each resident.

 

(xii)         "Minimum Data Set (MDS)" means the federally mandated process for clinical assessment of all residents in Medicare and Medicaid certified skilled nursing facilities. The MDS process provides a comprehensive assessment of each resident's functional capabilities and helps WLRC staff identify health issues in order to create an individualized comprehensive care plan.

 

(xiii)       "Neurocognitive Disorder" means decreased mental functioning as determined by diagnostic criteria defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Neurocognitive disorders includes acquired brain injury and organic brain syndrome.

 

(xiv)        "Non-Residential services" means outreach and outpatient services, upon request, to those individuals not admitted to one of the residential programs.

 

(xv)          "Person centered planning" means a process directed by a resident that identifies a resident's strengths, capacities, preferences, needs, and the services needed to meet those needs. Person centered planning allows a resident to exercise choice and control over the process of developing and implementing the individual program plan. Person centered planning includes:

 

(A)            "Baseline person centered care planning" means a plan of care developed within forty-eight (48) hours of a resident's skilled nursing facility admission including the minimum healthcare information necessary to properly care for the resident;

 

(B)             "Comprehensive person centered care planning" means the development and implementation of a plan that includes measurable objectives and timeframes to meet a resident's medical, nursing, mental, and psychosocial needs, while describing individualized resident goals, preferences, and desired outcomes.

 

(xvi)        "Preadmission screening assessment" means an evaluation conducted by the screening team using appropriate assessments and tools for determination of eligibility for a program at the WLRC.

 

(xvii)     "Real home" means the residential homes designed to provide an environment for the residents that is a place of comfort, safety, and refuge. The real home incorporates therapeutic attributes, outdoor spaces, private bedrooms, a shared living room, open kitchen, and dining area.

 

(xviii)   "Restraint," means processes that limit movement or behavior.  Restraint includes:

 

(A)            "Personal restraint," which means the application of physical presence without the use of any device, for the purpose of restraining the free movement of the body of the resident. Personal restraint does not include briefly holding, without undue force, a resident in order to calm or comfort the resident, or holding a resident's hand to safely escort the resident from one area to another. Personal restraint includes the use of a "time-out room," as regulated by 42 CFR 483.450(c);

 

(B)             "Mechanical restraint" means a device attached or adjacent to a resident's body that cannot easily be moved or removed that restricts freedom of movement or normal access to the body; or

 

(C)             "Drug used as a restraint" means a drug that is administered to manage a resident's behavior in a way that reduces the safety risk to the resident or others, has the temporary effect of restricting the resident's freedom of movement, and is not a standard treatment for the resident.

 

(xix)        "Senior Administrator" means the administrator of the Behavioral Health Division or designee. This term is equivalent to the statutory term "Administrator." When interpreting and construing these rules, the term "Senior Administrator" is used in lieu of "Administrator."

 

(xx)          "Services" mean diagnostic, education, training, medical, habilitation, or other services and/or respite, emergency evaluation services, equipment, therapy, or supplies appropriate to meet the needs of a resident at the WLRC.

 

(xxi)        "Skilled Nursing Facility" means a facility primarily engaged in skilled nursing care and related services for residents who require medical or nursing care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.

 

(xxii)     "Transfer" means the movement of a resident from the WLRC to another setting, usually for a temporary period. 

 

Section 4.                General Provisions.

 

(a)              The WLRC shall provide person centered planning and care based on the WLRC being the least restrictive environment, most appropriate, most integrated setting, and ensure the informed choice of the resident or legally authorized representative.

 

(b)              The WLRC shall support and maintain core values in the form of real home, meaningful life, and empowered staff.

 

(c)              As a safety net facility for the State of Wyoming, the WLRC is obligated to discharge residents when a safe and reasonable discharge is possible.

 

(d)              A legally authorized representative may at all times act on behalf of the applicant or resident to the full extent legally authorized.

 

(e)              The WLRC facility includes the Canyons Intermediate Care Facility for Individuals with Intellectual Disabilities; the Mountain View Skilled Nursing Facility; and may provide non-residential services in the form of disability, therapeutic and assistive technology services for persons with a disability; training for state employees, other service providers and caregivers on disability, medical, developmental and therapy services.

 

(i)                Within the Canyons Intermediate Care Facility for Individuals with Intellectual Disabilities in addition to regular admission, seventy-five (75) calendar day services may be delivered to an individual who does not meet regular admission criteria.

 

Section 5.                Professional Standards.

 

(a)              The WLRC shall provide each employee with training that enables the employee to perform duties effectively, efficiently, and competently.

 

(b)              A professional employed or contracted by the WLRC shall:

(i)                   Meet all licensing and certification requirements pertinent to the profession;

 

(ii)                 Meet the standards of the profession;

 

(iii)               Meet all other applicable standards by law; and

 

(iv)               Participate in ongoing staff development.

 

(c)              The WLRC shall maintain a record of all pertinent training for all employees.

 

Section 6.                Data Reporting. 

 

(a)              The WLRC shall report the following to the Director every month:

 

(i)                The number of persons served by the WLRC;

 

(ii)              The number of persons served by the WLRC by service category;

 

(iii)           The services provided to persons served by the WLRC;

 

(iv)            The data relative to the accomplishment of the criteria specified in resident individual program plan objectives in measureable terms; and

 

(v)              Significant events related to planning and assessments that contribute to understanding resident level of care needs and quality of functioning.