Wyo. Code R. 048-0053-10
State Hospital
Chapter 10: Standards for Convalescent Leave
Effective Date: 07/03/2012 to 04/04/2017
Rule Type: Superceded Rules & Regulations
Reference Number: 048.0053.10.07032012
Section 1. Authority. This Chapter is promulgated by the Department of Health (“the Department”) pursuant to Hospitalization of Mentally Ill Persons (“the Act”) codified at W.S. §§ 25-10-101 through 127 and the Wyoming Administrative Procedure Act at W.S. § 16-3-101, et seq.
(a) These rules have been adopted to establish and implement the procedures and corresponding responsibilities for releasing a patient on convalescent status pursuant to W.S. § 25-10-127.
(b) The Department may issue manuals, bulletins, or both to interpret the provisions of this rule. Such manuals and bulletins shall be consistent with and reflect the policies contained in this rule and regulation. The provisions contained in manuals or bulletins shall be subordinate to the provisions of this rule and regulation.
(a) Convalescent Leave may be utilized when:
(i) The patient has previously been involuntarily hospitalized and has demonstrated an inability to follow past discharge plans or has demonstrated a history of noncompliance with outpatient treatment;
(ii) The patient will need additional assistance and support to adequately comply with the required plan of treatment on an outpatient or nonhospital basis; or
(iii) The patient will likely need and will benefit from community-based services and support to avoid decompensation and additional involuntary hospitalizations, and those services and support are available in the community the patient wishes to return to, or in the community best suited to provide such aftercare of the patient.
(b) Convalescent Leave may only be considered when at least one of the above requirements are met, and when the treating medical provider, after consultation with the treatment team and appropriate parties, believes it is in the best medical interests of the patient.
(c) No person placed at the Wyoming State Hospital with active or pending legal charges will be eligible for Convalescent Leave.
(a) Request for Convalescent Leave.
(i) Treatment team. Members of the patient's treatment team must meet to discuss the potential benefits of Convalescent Leave. Although all members of the treatment team do not need to agree to the leave, all members of the team must be a part of the decision-making process. If the members of the treatment team do not arrive at a consensus for the use of Convalescent Leave, the patient's treating medical provider leading the treatment team will make the final decision. If a decision is made to pursue Convalescent Leave, the request must be documented and include the applicable conditions contained in Section 3(a) as justification for the request.
(ii) Patient and Appropriate Parties. After a request for Convalescent Leave is made by the treatment team, one or more members of the treatment team shall provide written, email, or fax notice to and consult with the patient and appropriate relevant parties, including, when applicable, the guardian, parent, and community treatment provider. Members of the treatment team shall document the date of notice to and consultation with the above parties, noting the participants of the consultation and any concerns or support expressed by these parties.
(b) Convalescent Leave Plan.
(i) Once the treatment team has obtained input from the patient and all appropriate parties, a written Convalescent Leave Plan will be developed by the patient's treatment team, with the documented input of the patient and the community treatment provider.
(ii) The Convalescent Leave Plan shall include:
(A) The roles and responsibilities of the patient and the appropriate parties and any areas for which the Wyoming State Hospital will retain responsibility while the patient is on Convalescent Leave;
(B) The community treatment services, medication, and supports to be provided, the entity responsible for providing the services, medication, and supports and how they will be paid. Wyoming State Hospital staff will assist patients in applying for Medicaid and securing Social Security benefits, if applicable. Community treatment providers will bill third party pay sources prior to billing the patient for services provided;
(C) Provisions for quarterly reports from the community treatment provider to the Wyoming State Hospital on the status and progress made by the patient. If more than one community treatment provider is selected by the patient to provide outpatient services and supports, the plan shall specify the community treatment provider responsible for coordinating care and providing quarterly reports;
(D) The conditions under which Convalescent Leave will be revoked;
(E) The preferred location for detention and the method of detention of the patient if Convalescent Leave is revoked.
(iii) The Convalescent Leave Plan will be provided to the patient, the patient's treatment team and other appropriate parties for signature, thereby acknowledging its terms and the role of each entity in achieving the goals of the Convalescent Leave.
(iv) The Convalescent Leave Plan, signed by the patient, the patient's treatment team and other appropriate parties, may act as the report to the court having jurisdiction over the location in which the case originated in support of Convalescent Leave, or a separate report to the court outlining additional information may be drafted and submitted by the treating medical provider.
(v) Copies of the signed Convalescent Leave plan shall be provided to the patient and the appropriate parties in a manner to ensure receipt of the copy prior to the patient's release.
(c) Application for Convalescent Leave.
(i) Upon completion of the Convalescent Leave plan, the Wyoming State Hospital will notify the Attorney General's Office of the request for Convalescent Leave. Notification to the Attorney General's Office may be by email or by fax, and must include copies of the initial commitment documents for the patient's involuntary commitment, the signed Convalescent Leave Plan, and any other relevant information or documents, including any separate reports that are drafted in support of the Convalescent Leave.
(ii) The Attorney General's Office will file an application for approval of the Convalescent Leave as soon as possible upon receipt of all required information as set forth in Section 4(c)(i). A copy of the application will be sent to the county attorney who initiated involuntary hospitalization procedures, the attorney that originally represented the patient and the community treatment provider.
(iii) If no objection is filed by the county attorney or the court within fourteen (14) days of receipt of the application, the patient may be released on Convalescent Leave subject to being returned to the hospital for noncompliance.
(iv) If an objection to Convalescent Leave is filed by either the county attorney or the court, a hearing shall be scheduled by the court. At the hearing, the parties may appear to testify in support of or against the Convalescent Leave.
(v) The Wyoming State Hospital shall develop and utilize uniform forms for Convalescent Leave Plans.
(a) If the requirements of the Convalescent Leave Plan are not followed by the patient, the patient will be returned to the Wyoming State Hospital. The Wyoming State Hospital shall alone have the discretion to return the patient to its care, recognizing that the client retains the right to question this decision at a hearing.
(b) Any member of the patient's treatment team, the patient, or the appropriate parties may request that the Wyoming State Hospital return the patient to its care. Requests to return the patient to the Wyoming State Hospital must be based on the inability of the patient or unwillingness of the patient to comply with the Convalescent Leave Plan. The Wyoming State Hospital, however, must reasonably believe that a return from Convalescent Leave is in the best interests of the patient, before a return from Convalescent Leave is appropriate.
(c) If the Wyoming State Hospital refuses to return the patient to its care for a violation of the Convalescent Leave Plan, the party seeking the patient's return may request a hearing before the court that ordered the patient's involuntary hospitalization. The action shall be a continuation of the involuntary hospitalization proceeding, and the request for hearing shall be under the same docket number as the involuntary hospitalization proceeding. At this hearing, the court must determine that return to the Wyoming State Hospital from Convalescent Leave is in the best interests of the patient.
(d) Transportation for a patient returning to the Wyoming State Hospital shall be arranged by the Wyoming State Hospital.
(e) The Wyoming State Hospital shall pay for the detention and transportation expenses to detain and return the patient to the hospital, pursuant to W.S. § 25-10-127.
(f) The Wyoming Attorney General's Office shall file a Notice of Return from Convalescent Leave with the court, and will provide copies to the appropriate parties, notifying the parties that the patient is being or will be returned to the Wyoming State Hospital.
(g) Upon the patient's return to the Wyoming State Hospital, the patient shall be notified of his/her rights, including the right to contest his return to the Wyoming State Hospital, the right to an administrative hearing, and the right to counsel.
(h) If the patient is returned to the Wyoming State Hospital, the Convalescent Leave is revoked.
(a) Prior to the patient's one year anniversary on Convalescent Leave status, the patient's treatment team shall consult with the patient and each of the appropriate parties to reconsider and reexamine the facts relating to the involuntary hospitalization of the patient.
(b) If the patient's treatment team and the community treatment provider determine that involuntary hospitalization is no longer anticipated for the patient, the community treatment provider, in collaboration with the Wyoming State Hospital, shall submit a 14-81 form to the Court for the discharge of the patient, following the procedures set forth in W.S. § 25-10-116(b). With the participation of the patient, the patient's guardian, if applicable, the patient's caregiver, if applicable, the patient's family, if applicable and the community treatment provider, the Wyoming State Hospital shall prepare a discharge plan.
(c) If the patient is on Convalescent Leave but is later returned to the Wyoming State Hospital or designated hospital and then placed on Convalescent Leave status, the one year follow up shall be based on the date of the most recent Convalescent Leave.
(a) At the patient's two year anniversary on Convalescent Leave, the community treatment provider, in collaboration with the Wyoming State Hospital, shall submit a 14-81 form to the court, seeking the discharge of the patient, pursuant to W.S. § 25-10-116(b). The 14-81 form should note the client's success during the two year Convalescent Leave period, and include a discharge plan prepared by the Wyoming State Hospital in conjunction with the patient, the patient's guardian, if applicable, the patient's caregiver, if applicable, the patient's family, if applicable, and the community treatment provider. (b) If the patient is returned from Convalescent Leave to the Wyoming State Hospital or designated hospital and subsequently again placed on Convalescent Leave status, the required discharge after two (2) years of Convalescent Leave shall be based on the date of the most recent Convalescent Leave.
(a) While the patient is on Convalescent Leave, the Wyoming State Hospital shall periodically review, with the community provider, the treatment progress of the patient as documented in the quarterly report submitted by the community treatment provider. (b) Neither the physicians nor the caseworkers at the Wyoming State Hospital will have on-going responsibilities for the direct care or treatment of the patient while the patient is on Convalescent Leave, although they will be available for consultation with community treatment providers. This provision recognizes the client's best interests in being placed in his or her local community, which may be a great distance from the Wyoming State Hospital. The responsibility for the medical and/or mental health of the patient will follow the patient into the community setting as set forth in the Convalescent Leave Plan.
Section 9. Superseding Effect. When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals and/or bulletins, which are inconsistent with this Chapter.
Section 10. Severability. If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.