REGULATIONSOR LICENSURE OF HOME HEALTH AGENCIES

CHAPTER 10

Section 1. Authority. These rules are promulgated by the Department of Health pursuant to the Health Facilities Licensure Act at W. S. 35-2-901 et seq. and the Wyo- ming Administrative Procedures Act at W. S. 16-3-101 et seq.

Section 2. Purpose. These rules have been adopted for the licensure of Home Health Agencies. These standards are designed to protect the health and safety of clients and employees.

Section 3. Severability. If any portion of this rule is found invalid or unenforce- able, the remainder shall continue in effect.

Section 4. Definitions.

1. (a) “Acceptable plan of correction” means Wyoming Department of Health, Office of Health Quality, Planning and Program Evaluation (Office of Health Quality) ap- proved the plan to correct the deficiencies identified through an onsite survey. The plan of correction shall be a written document and must contain who is responsible for correc- tion, what was done to correct the problem and who will monitor to ensure that the situa- tion does not develop again and must contain a timely date for completion of the correc- tion.
2. (b) “Age of majority” is the age at which a child becomes an adult. This age is currently defined by W.S. §14-1-101 as the age of eighteen years.
3. (c) “Branch office” means a location or site from which a home health agency provides services within a portion of the total geographic area served by the parent agency. The branch office is part of the home health agency and is located sufficiently close to share administration, supervision, and services in a manner that renders it unnec- essary for the branch independently to meet the licensure as a home health agency. Ex- ception: Branch offices from out of state will be individually licensed in the State of Wyo- ming.
4. (d) “Central Registry” means the registry operated by the Wyoming Department of Family Services pursuant to Wyoming Statute §14-3-213, which indexes perpetrators of child abuse or neglect and abuse, neglect, exploitation or abandonment of disabled adults. The registry information is available by calling 307-777-5366.
5. (e) “Dietitian” means a person who is registered by the American Dietetic Asso- ciation and provides nutritional and dietary consultation services.
6. (f) “Fidelity bond” means a contract of fidelity insurance. One agrees to insure another against loss arising from the want of honesty, integrity or fidelity of an employee of the home health agency.
7. (g) “Governing body” means the individual(s), group, or agency that has ultimate authority and responsibility for establishing patient care policies, personnel policies, and providing for organization management and planning.
8. (h) “Health Care Services” includes but is not limited to nursing, physical therapy, speech pathology, occupational therapy, respiratory therapy, medical social work, home health aide, and dietary services. All staff shall be registered according with the Wyoming State Statutes.
9. (i) “Homemaker” is a person who assists with environmental services such as housekeeping, basic meal preparation, shopping and laundry. They provide no personal care.

10. (j) “Home Health Agency” means any group, public agency, private organiza- tion, or any individual person who is primarily engaged in arranging for and directly provid- ing two or more care services to persons at their residence.

    Exclusion: The Wyoming Senior Centers providing ONLY homemaker ser- vices OR homemaker services and one care service are exempt from this definition.

11. (k) “Home Health Aide” is a nursing assistant certified by the Wyoming Board of Nursing who has received sixteen hours of additional training on home health issues, approved by the Wyoming Board of Nursing.
12. (l) “Licensed Practical Nurse (LPN)” is a person who is licensed to practice as a licensed practical nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.

13. (m) “Medical Social Services” are those services provided by a qualified social worker or by a qualified social work assistant under the supervision of a qualified social worker, and according to the client’s plan of care.

    “Social Worker” means:

    1. (i) A person who has a master’s degree from a school of social work accredited by the Council on Social Work Education, and has one year of social work experience in a health care setting; or
    2. (ii) A person who has a baccalaureate degree in social work, psychology, sociology, gerontology, or other field related to social work, and has had at least one year of social work experience in a health care setting; or
    3. (iii) A person who has two years of appropriate experience as a social worker and is under the supervision of a consultant with a Master of Social Worker de- gree.
14. (n) “Occupational Therapy Assistant” means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Certified Occupational Therapy Assistant pursuant to W.S. §33-40-102.
15. (o) “Occupational Therapist” means a person who is licensed by the Wyoming Board of Occupational Therapy to practice as a Registered Occupational Therapist pursu- ant to W.S. §33-40-102.
16. (p) “Occupational Therapy” means the use of purposeful activity with clients who are limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, or the aging process, to maximize independence, prevent disability and to maintain health. Occupational therapy will include evaluation, treatment, and consultation. Occupational therapy is provided by an occupational therapist or by a certi- fied occupational therapy assistant under the supervision of an occupational therapist.
17. (q) “Personal care” means activities such as but not limited to, bathing, groom- ing, feeding, ambulating, exercising, oral hygiene, and skin care.
18. (r) “Physical Therapy Assistant” means a person who is licensed to practice in the State of Wyoming as a physical therapy assistant pursuant to W.S. §33-25-101.
19. (s) “Physical Therapy” means the evaluation, instruction or treatment of a hu- man being to prevent, correct, alleviate or limit physical disability due to injury, disease or any other physical or mental condition by the utilization of physical measures and rehabili- tative procedures including training in functional activities and the performance and inter- pretation of tests and measurements of body functions as an aid in the examination, evaluation or treatment of any human condition for the purpose of correcting or alleviating an individual’s physical or mental disability. Physical therapy is provided by a physical therapist or by a physical therapy assistant under the supervision of a physical therapist.
20. (t) “Physical Therapist” means a person who is licensed to practice physical therapy in the State of Wyoming pursuant to W.S. §33-25-101.
21. (u) “Registered Nurse (RN)” Is a graduate of an approved school of professional nursing, who is currently licensed to practice as a registered nurse by the Wyoming Board of Nursing pursuant to W.S. §33-21-120.
22. (v) “Respiratory Care” means the health specialty responsible for the treatment, management, diagnostic testing, control, and care of clients with deficiencies and abnor- malities associated with the cardiopulmonary system.
23. (w) “Skilled Services” means any services provided by a Registered Nurse, Li- censed Practical Nurse, Physical Therapist, Occupational Therapist, Speech Language Pathologist, Respiratory Therapist, Social Worker, or Registered Dietitian.
24. (x) “Speech Language Pathologist” means a person who is licensed in the State of Wyoming to practice speech language pathology.
25. (y) “Speech Pathology” means the application of principles, methods, and proce- dures for the evaluation, monitoring, instruction, habilitation, or rehabilitation related to the development and disorders of speech, voice, or language for preventing, identifying, evaluating and reducing the effects of such disorders and conditions.
26. (z) “Therapy services” include physical therapy, occupational therapy, and speech language therapy.

Section 5. Licensing.

1. (a) Licensing requirements. The Office of Health Quality has been authorized to issue licenses to Home Health Agency programs and has established a system of licen- sure to comply with minimum requirements for the purpose of protecting the health, welfare and safety of clients receiving this type of service.

2. (b) Licensing procedure.

   1. (i) For an initial license to be issued the Office of Health Quality shall receive:

      1. (A) A completed application form as supplied by the Office of Health Quality and shall be submitted to the Office of Health Quality.
      2. (B) The required licensure fee outlined in Chapter 1 Rules and Regu- lations for Health Care Facilities Licensure Fees. The check or money order shall be made payable to the Treasurer, State of Wyoming.
      3. (C) Demonstrated compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation shall be available through the Office of Health Quality following the onsite survey.

      4. (D) The effective date of the initial license shall be;

         1. (I) The date of the survey, if there are no deficiencies, or
         2. (II) If deficiencies exist, the date that an acceptable plan of correction is developed after the survey.
      5. (E) The length of the license shall be from the effective date of the license until the next June 30.

   2. (ii) For renewal of a full license for one year beginning July 1, and unless suspended, or revoked, shall expire on June 30 of the following year, the Office of Health Quality shall receive:

      1. (A) A completed application form returned by the date indicated in the cover letter.

         1. (I) The application form shall be mailed by the Office of Health Quality to the facility.
      2. (B) The license fee is as required in paragraph (i) of this section.
      3. (C) Applicants demonstrated full compliance with the requirements for licensure as required in paragraph (c) of this section. This documentation is main- tained on file at the Office of Health Quality following the onsite surveys.

3. (c) Requirements for licensure. The Office of Health Quality shall take into consideration:

   1. (i) The home health agency shall be in conformity with all laws and stan- dards relating to communicable and reportable diseases as promulgated by the Depart- ment of Health, Division of Public Health.
   2. (ii) The existing deficiencies that may create a hazard to the health, safety or welfare of the clients.
   3. (iii) The agency shall correct existing deficiencies.
   4. (iv) There shall be adequate policies and procedures in place to guide operations.

4. (d) Transfer of license.

   1. (i) No license granted shall be assignable or transferrable. A license shall apply only to the home health agency described in the license application, covering one geographic service area.

      1. (A) Whenever ownership of a home health agency is transferred from the individual or entity named in the license application to any other individual or entity, written notification of change of ownership shall be made to the Office of Health Quality. The transferee shall notify the Office of Health Quality of the transfer and apply for a new license.

         1. (I) The transferor shall notify the Office of Health Quality at least thirty (30) days prior to the final transfer.

            1. (1) Any license granted to the transferee shall be subject to the plan of correction submitted by the previous owner as approved by the Office of Health Quality.
   2. (ii) If the home health agency’s name or address is changed, the Office of Health Quality shall be advised in writing and a new license shall be issued upon receipt of the licensure fee and application.

5. (e) Conditions or revoking a license.

   1. (i) Denial of application - suspension or revocation of license.

      1. (A) An application for license may be denied or a previously issued license may be suspended or revoked for noncompliance with minimum standards as herein set forth when noncompliance jeopardizes the health, safety or welfare of clients.

   2. (ii) Suspension of admissions.

      1. (A) The Office of Health Quality may suspend new admissions or re- admissions to a home health agency when conditions in the program are such that client needs can not be met. Conditions in a home health agency shall not jeopardize the cli- ents’ health and safety.

   3. (iii) Hearings.

      1. (A) Any home health agency aggrieved by a decision of the Office of Health Quality may request a hearing by submitting a written request within ten (10) days of the receipt date of the notice of adverse action.

      2. (B) Except in matters concerned with the spread of communicable disease as required in sections (c)(i), the Senior Management Consultant of the Office of Health Quality shall present the preliminary decisions and reasons to the aggrieved home health agency and provide an opportunity for a hearing (if such is requested within the appropriate time frame.)

         1. (I) In matters concerned with the spread of communicable disease the Wyoming State Health Officer shall present the preliminary decisions and reasons to the parties concerned and provide an opportunity for a hearing (if such is re- quested within the appropriate time frame.)
      3. (C) Hearings requested under the terms of these rules and regula- tions shall be held by the Office of Health Quality in accordance with the provisions of the Wyoming Administrative Procedures Act at W.S. §16-3-113, and with the contested case rules and regulations of the Wyoming Department of Health.

6. (f) Posting of license.

   1. (i) The current license issued by the Office of Health Quality shall be displayed in a public area within the home health agency program offices.

7. (g) Survey of home health agency.

   1. (i) The survey of home health agency programs shall be arranged by the Office of Health Quality through its duly authorized officers, agents, or consultants. The survey shall be made unannounced and at periodic intervals dependant on the results of the previous survey and funding. All records of the home health agency shall be made available to the surveyor.
8. (h) Requirements of the Office of Health Quality.

9. (i) The Office of Health Quality shall provide each home health agency with;

   1. (A) A copy of the list of deficiencies found, if any; and
   2. (B) A copy of these rules and regulations.
   3. (i) Voluntary closure
   4. (i) If a home health agency voluntarily ceases to operate, they shall notify the Office of Health Quality in writing at least five working days prior to the closure.
   5. (ii) The first working day after the closure of the home health agency the license of the home health agency shall be returned to the department.

Section 6. Organization and Administration.

1. (a) Governing Body. The home health agency shall have a governing body which has legal authority and responsibility to operate the home health agency. The governing body shall:

   1. (i) Obtain a fidelity bond for client protection arising from the want of honesty, integrity or fidelity of an employee. The bond shall consist of no less than $2500 and shall be augmented in relation to the number of employees.

   2. (ii) Provide verification of a central registry check on all employees hired at the time of or after the filing of these rules. The individual agencies or corporations are responsible to initiate and follow this process to completion.

      Central registry information can be obtained by contacting Department of Family Services at 307-777-5366. (This number may be subject to change.)

   3. (iii) Adopt, revise, and approve personnel policies; including;

      1. (A) Frequency of evaluations;
      2. (B) Insuring confidentiality of central registry information checks;
   4. (iv) Prepare an organizational chart that reflects the administrative control and lines of authority for the delegation of responsibility from management down to the client care level.
   5. (v) ab Approve a registered professional nurse as a supervisory nurse who has at least one years home health experience. This supervisory nurse must be immediately available during the normal hours of operation.
   6. (vi) ab Ensure in accordance with the State Statute 35-2-910, there is an effective, ongoing, agency wide written quality improvement program which ensures and evaluate quality of care provided to all clients.

   7. (vii) Personnel Records.

      1. (A) There shall be one person designated responsible for maintaining the confidentiality.

   8. (viii) Employee Health.

      1. (A) The home health agency must develop policies and procedures for employee health including a policy identifying communicable diseases that could put the client population at risk.
      2. (B) The home health agency must document that the employee is free of communicable diseases that could be a risk to the client population.

   9. (ix) Advanced Directives.

      1. (A) The home health agency shall adopt policies which assure that they provide information on advanced directives to clients. If the client’s advanced directives are known they shall be followed by the home health agency.

   10. (x) Notification

       1. (A) Prior to admission all perspective clients shall be notified if the Home Health Agency is not Medicare/Medicaid certified.

Section 7. Homemaker.

1. (a) If homemaker services are provided they may be furnished directly or through contract arrangement.

2. (b) The homemaker assists with instrumental activities of daily living, such as housekeeping and homemaking services, in order to preserve a safe, sanitary home and enhance family life. The homemaker does not provide any personal care.

   1. (i) Examples of duties include but are not limited to:

      1. (A) Housekeeping;
      2. (B) Shopping;
      3. (C) Laundry;
      4. (D) Essential errands;
      5. (E) Basic meal preparation;
      6. (F) Meal planning (except for clients on therapeutic diets);
      7. (G) Maintaining a safe environment; and
   2. (ii) Written instructions to the homemaker shall be provided by the super- vising professional.

   3. (iii) The written instructions shall be reviewed by the homemaker and the supervising professional as frequently as the client’s condition requires but at least once every ninety (90) days.

      1. (A) The homemaker must be present during the supervisory visit.
      2. (B) The supervisory visits shall occur at the client’s home.

3. (c) Training for homemakers:

   1. (i) The following training areas shall be incorporated into home health agency policy and completed before any client assignment.

   2. (ii) Training shall be completed in a minimum of 8 hours, and shall be documented in the homemaker’s personnel file. Training shall include:

      1. (A) Orientation to homemaker services;
      2. (B) Understanding and working with various client populations;
      3. (C) Understanding basic human needs;
      4. (D) Communication;
      5. (E) Practical knowledge and skills in home making;
      6. (F) Maintaining a clean, safe, and healthy environment;
      7. (G) Infectious disease prevention and control;
      8. (H) Emergency procedures; and
      9. (I) Client Rights and Obligations.

4. (d) Homemaker Service Plan.

   1. (i) If the only service provided is homemaker services then a service plan must be developed by a supervisor and must consist of the following:

      1. (A) The specific procedures to be done;
      2. (B) The number of times per week the procedures are to be com- pleted, appropriately spaced in the week; and
      3. (C) The day and approximate arrival time at the client’s home.
      4. (D) Procedures must be developed which are to be followed in an emergency situation.