Chapter 6 - Long Term Care Choices Program
CHAPTER 6 - LONG TERM CARE CHOICES PROGRAM
42-6-101. Short title.
Thisact shall be known and may be cited as the "Wyoming Long Term Care ChoicesAct".
42-6-102. Definitions.
(a) As used in this act:
(i) "Adult foster care" means care in a home licensedas an adult foster home and care provided to a resident of the home whiletemporarily away from the adult foster home;
(ii) "Adult foster home" means any family home orfacility in which residential care is provided in a homelike environment forfive (5) or fewer adults who are not related to the provider by blood, marriageor adoption. "Adult foster home" does not include any residentialfacility otherwise licensed or funded by the state of Wyoming. The homes shallbe regulated in accordance with W.S. 35-2-901 through 35-2-912 and this actwhich shall govern in case of conflict;
(iii) "Alternative eldercare home" means a facility andprogram which:
(A) Provides services and care at the highest level required bya resident and as permitted under the applicable facility;
(B) Shall be licensed as a health care facility pursuant toW.S. 35-2-901 through 35-2-912;
(C) Creates communities that allow long-term residents todevelop lasting relationships with other residents and staff;
(D) Maintains residences as units independent from each other;
(E) Provides, at a minimum, a private bedroom and bathroom foreach resident;
(F) Provides services to Medicaid supported residents at theMedicaid reimbursement rates;
(G) Maintains all common spaces within the house, includingsecured exterior space, accessible and open to all residents during wakinghours;
(H) Provides an office space for a nurse within each house;
(J) Provides a common area in each house including a seatingarea;
(K) Provides public and staff bathroom facilities;
(M) Creates a residential home environment in all aspects,using residential materials and designs appropriate to the style of thecommunity;
(N) Is committed to a restraint free environment;
(O) Implements a culture of learning and participation by theresidents and honors the elder hood stage of life.
(iv) "Assisted living facility" means as defined inW.S. 35-2-901(a)(xxii);
(v) "Department" means the department of health;
(vi) "Home medical testing" means medical testingdesigned to be done in the home of the person being tested by a person who isnot a licensed health care professional and includes but is not limited totesting done using a home blood pressure monitor or a home diabetes managementblood sugar monitor;
(vii) "Long term care assessment" means a form and anassessment process conforming with relevant federal regulations and designed tomeasure the abilities and disabilities of a person in the activities of dailyliving to determine the person's need for long term care. As of January 1,2007 the department of health form LT-101 entitled "Assessment of MedicalNecessity for Long Term Care" and the assessment needed to complete itshall be the long term care assessment;
(viii) "Medicaid" means the program administered by thestate pursuant to the Wyoming Medical Assistance and Services Act and this actand partly funded by the federal government pursuant to Title XIX of the federalSocial Security Act;
(ix) "Nursing home" means a nursing care facility asdefined in W.S. 35-2-901(a)(xvi) and licensed pursuant to Wyoming Statutes,article 9, chapter 2, title 35;
(x) "Residential care" means the provision of roomand board and services that assist the resident in activities of daily livingincluding but not limited to bathing, dressing, grooming, eating, medicationmanagement, incontinence care, home medical testing, money management orrecreation;
(xi) "This act" means W.S. 42-6-101 through 42-6-108.
42-6-103. Rulemaking; guidance.
The department is authorized to promulgaterules and regulations to implement this act. The rules and regulations shallseek to implement the objectives of this act by expanding the long term caresystem to one emphasizing consumer choice and home, home like and communitybased care alternatives.
42-6-104. Alternative long term care home pilot programs authorized.
(a) Three (3) pilot program grants are authorized to study thefeasibility of innovation in long term care facilities. Eligible recipientsshall include cities, counties and any entity planning for long term care needsor providing long term care including private nonprofit and private for profitentities. The department shall solicit proposals for the grants through arequest for proposals developed in consultation with the advisory council onaging. The department, in consultation with the council, shall select therecipients from the proposals received. The department shall negotiate anyspecific provisions of the grant award needed and shall administer the grants. In selecting the recipients, the council shall:
(i) Consider the extent to which the proposal moves the staffof the facility to a more patient centered culture;
(ii) Consider one (1) project to reconfigure an existing nursinghome to achieve a resident-centered cultural change;
(iii) Fund one (1) study relating to the creation of an alternativeeldercare home, as defined in W.S. 42-6-102(a)(iii), provided that anacceptable project proposal is received in response to the request forproposals;
(iv) Fund one (1) study relating to the creation of analternative eldercare home, as defined in W.S. 42-6-102(a)(iii), which shallrequire that the home:
(A) Maintains residences as units independent from otherfacilities such that there is no physical connection or shared roof structuresbetween houses;
(B) Provides a secured exterior patio or garden with coveredseating for each house accessible by all residents including those withwheelchairs and assistive devices;
(C) Provides for locked storage of hazardous materials andcontrol of kitchen access during high traffic periods of meal preparation andclean-up;
(D) Provides a den in each house to accommodate televisionviewing and limited overnight guests;
(E) Implements a self-managed work team approach to in-houseand clinical support staffing. Each house shall have its own core in-housestaffing that is specific and dedicated to a single house;
(F) Uses a home base facility for the clinical support teammembers that is outside and separate from the house; and
(G) Maintains a lift free environment by providing ceilinglifts in each resident's bedroom and bathroom.
(v) Consider the extent to which there is a market for theproposed facility or the extent to which people in need of long term care arelikely to choose the proposed facility; and
(vi) Consider the extent to which the proposed pilot projectwill determine the effectiveness of its approach to elder care in a timelymanner.
(b) Each grant proposal shall include plans for a local orapplicant match of twenty-five percent (25%) of the grant amount.
(c) For applicants that have completed any appropriate needsstudy or market study, the grant funding may be used for design and developmentof the facility and the organization which will operate it. If this is done,the grant recipient shall agree to accept Medicaid clients in the facilitywithout discrimination.
(d) The department is directed to work with grant recipients inthe development of rules and regulations which are compatible with the cultureof the homes and which will assure appropriate licensure for the care providedand the needs of the elder residents. The department shall inform the jointlabor, health and social services interim committee if legislation is needed toauthorize any necessary rules and regulations.
(e) As a condition of receiving the grants, each grantee shallagree to provide training and reports to other parties in the state interestedin innovative long term care approaches.
42-6-105. Adult foster care homes; licensure; suspension orrevocation.
(a) The department may initiate and license an adult fostercare pilot project subject to the following:
(i) The applicant shall pay a one-time fee of one hundreddollars ($100.00) which shall be deposited in the general fund;
(ii) The department, a public health nurse or other employee ofa local department of health shall complete an inspection of the proposed adultfoster care home;
(iii) The proposed home shall comply with all state and localbuilding, sanitation, utility, fire and zoning codes applicable to singlefamily dwellings;
(iv) The home shall have the ability to evacuate all residentclients within three (3) minutes in case of emergency;
(v) The home shall provide a private room with a handicappedaccessible bathroom for each resident client. Spouses occupying the same roomby mutual consent shall be deemed to have a private room;
(vi) The pilot program shall consist of no more than five (5)adult foster homes. At least three (3) of the homes shall be in counties witha population of thirty thousand (30,000) or less.
(b) The department may, after notice and opportunity forhearing, revoke or suspend any license issued pursuant to this section, mayprohibit a facility from accepting new resident clients, may place conditionson the continuation of a license, or may require a facility to take specifiedremedial actions within a specified time, if:
(i) There is a threat to the health, safety or welfare of anyresident client;
(ii) There is credible evidence of abuse, neglect orexploitation of any resident client;
(iii) The facility is not operated in compliance with this act orany rules and regulations promulgated pursuant to this act.
(c) If, in the professional judgment of the state healthofficer, there is a clear and present threat to the health or safety of a residentclient, the state health officer may close an adult foster home and transferthe residents to another place. The department shall also initiate proceedingspursuant to subsection (b) of this section within three (3) working days.
(d) The department shall complete a criminal records check onany individual employed by adult foster homes and on any individual, other thana resident client or a resident client's spouse, who at the time of licensureis expected to live in the adult foster home or who, after licensure, lives orcomes to live in the adult foster home. The department may refuse to license afacility or prohibit the individual from living in the facility if he has beenconvicted of a felony indicating he may abuse a resident or steal from aresident.
(e) The department shall promulgate rules and regulationsconsistent with this act to govern the pilot project.
(f) The department shall report to the joint labor, health andsocial services interim committee on the status of all adult foster care homepilot projects annually by October 1 of each year. The report shall include:
(i) The location of each pilot project home;
(ii) The licensure status of each pilot project home;
(iii) The average number of adults receiving foster care in eachhome;
(iv) Both the total number of complaints and the number ofcomplaints by pilot project home which were filed with the department and thenumber of complaints that were substantiated by the department;
(v) Both the total number of complaints and the number ofcomplaints by pilot project home filed with the long term care ombudsmanprogram and the number of complaints that were substantiated by the ombudsmanprogram;
(vi) Both the total number of complaints and the number ofcomplaints by pilot project home filed with adult protective services and thenumber of complaints that were substantiated by adult protective services;
(vii) The number of inspections conducted at each pilot projecthome by the department, a public health nurse or a local health department anda summary of the findings for each visit.
42-6-106. Home and community based waiver program expanded;requirements.
(a) The department is authorized to seek from the federalgovernment expansion of the number of slots in the home and community basedwaiver program from one thousand one hundred fifty (1,150) to one thousand fourhundred fifty (1,450). Additional expansions may be authorized through thebiennial budget.
(b) The department is authorized to increase the providerreimbursement levels by an amount up to three dollars ($3.00) per hour forhourly services or seventeen and six-tenths percent (17.6%) above the prevailingrate for nonhourly services as of December 1, 2006. The department shall reportto the joint labor, health and social services interim committee by November 1,2007 the extent to which reimbursement improvements and any other changes madehave improved the availability of home health care services and any additionalremedies that may be needed. The length of the report shall not exceed onethousand (1,000) words plus any appropriate charts and graphs. Additionalreports may be made from time to time as the need arises.
(c) The department shall set goals for expanding the number ofMedicaid home and community based clients in self directed budget options andshall report progress toward those goals to the joint labor, health and socialservices interim committee no later than November 1, 2007, November 1, 2008 andNovember 1, 2009. The department shall allow these options to be managed bypersons designated to do so in advanced health care directives.
(d) Consistent with approved budgets, the department shall makeavailable a pool of state funds to meet transitional needs of clients movingfrom a more restrictive to a less restrictive environment in circumstanceswhere Medicaid funds are not available due to federal restrictions. Ifsufficient funds are available, these state funds may also be used to meetshort term needs of clients seeking to avoid placements in more restrictiveenvironments. The department shall govern the expenditure of these fundsthough contracts, policies and rules and regulations as needed.
42-6-107. Assisted living expansion; reimbursement increase.
Thedepartment shall seek federal approval to increase the number of allowed slotsin the assisted living Medicaid waiver from one hundred forty-six (146) to onehundred sixty-eight (168) slots.
42-6-108. Adult day care.
The department shall investigate adult daycare providers in Wyoming with respect to access, rates, administration ofrules and regulations and their impact on providers and clients, and shallreport its findings to the joint labor, health and social services interimcommittee and to the advisory council on aging. The report shall not exceedtwo thousand (2,000) words in length plus appropriate charts and graphs.