This chapter establishes procedures and responsibilities for placing involuntarily hospitalized psychiatric patients on convalescent leave from the Wyoming State Hospital or designated hospitals. It covers the conditions required for convalescent leave, the process for developing a convalescent leave plan, notice requirements to courts and other parties, and procedures for returning patients to involuntary hospitalization if leave is revoked. Operators must follow specific timelines for one-year follow-up reviews and two-year discharge processes, and must coordinate with community treatment providers and designated gatekeepers throughout.
View official sourceHealth, Department of
State Hospital
Chapter 10: Standards for Convalescent Leave
Effective Date:
04/04/2017 to Current
Rule Type:
Current Rules & Regulations
Reference Number:
048.0053.10.04042017
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CHAPTER 10
Standards for Convalescent Leave
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 Wyo. Stat. Ann. §§ 25-10-101 through
-
127 and the Wyoming Administrative Procedure Act at Wyo. Stat. Ann. §§ 16-3-101
through -115
.
Section 2. Purpose
and Applicability.
(a) These rules have been adopted to establish and implement the procedures and corresponding responsibilities for releasing a patient on convalescent status pursuant to Wyo. Stat. Ann. §
25-10-127.
(b) The Department may issue manuals
or
bulletins to interpret the provisions of th
ese
rule
s, which
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.
Section 3.
Conditions Necessary for Convalescent Leave.
(a) Convalescent Leave may be utilized
by the State Hospital or designated hospitals
when:
(
i
) The patient
:
(A) Was
previously involuntarily hospitalized and demonstrated an inability to follow past discharge plans
,
or has demonstrated a history of noncompliance with outpatient
treatment
;
(
B
)
W
ill need additional assistance and support to adequately comply with the required plan of treatment on an outpatient or nonhospital basis; or
(
C
)
W
ill 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.
(
ii
)
W
hen the treating medical provider, after consultation with the treatment team and appropriate parties, believes it is in the best medical interest of the patient.
(
b
)
Wyoming State Hospital patients who have active or pending criminal charges may not be placed on convalescent leave.
Section 4.
Process to Initiate Convalescent Leave.
(
a
) Request for Convalescent Leave.
(
i
) Treatment team. Members of the patient's treatment team and any
designated gatekeeper
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. If the patient's treatment team is located at a designated hospital, the treatment team shall consult with the Wyoming State Hospital on all convalescent leave orders and treatment plans.
(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, gatekeeper, and community treatment provider. A member of the treatment team shall document this process.
(iii)
Wyoming State Hospital or designated hospital staff shall assist patients
being released
on convalescent leave
in applying for Medicaid and securing Social Security benefits, if applicable
.
(b) Convalescent Leave Plan.
(
i
)
Using
input from the patient and all appropriate parties,
the treatment team shall develop
a written Convalescent Leave Plan.
(ii) The Convalescent Leave Plan shall include:
(A) The roles and responsibilities of the patient and
other
appropriate parties and any areas for which the
treating facility,
Wyoming State Hospital
,
or designated 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
them,
and how they will be paid;
(C) Provisions for quarterly reports from the community treatment provider, or
any designated gatekeeper
, to the Department 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 or gatekeeper responsible for 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,
any designated gatekeeper
, and other appropriate parties for signature
. Signature shall constitute
acknowledg
ment of the plan,
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
initial
report to the court, or a separate report to the court outlining additional information may be drafted and submitted by the treating medical provider.
(v)
The treatment team shall provide c
opies of the signed Convalescent Leave plan to the patient and the appropriate parties in a manner to ensure receipt of the copy prior to the
beginning of convalescent leave
.
(
c
)
Notice
for Convalescent Leave.
(
i
) The
Wyoming State Hospital or designated hospital
will file
all
notices
for Convalescent Leave
with the Court, and provide notice to the county attorney office that initiated involuntary hospitalization proceedings, any designated gatekeeper, and other interested parties. Notice shall consist of a
copy of the
notice for convalescent leave along with copies of the initial commitment documents, the signed Convalescent Leave Plan, and any other relevant information or documents, including any separate reports or documents in support of the Convalescent Leave.
(
ii
) The Wyoming State Hospital shall develop and utilize uniform forms for Convalescent Leave Plans.
Section 5.
Return to Involuntary Hospitalization from Convalescent Leave.
(a) If
the hospital reasonably believes that it is in the best interest of the patient
, the patient shall be returned to the
hospital from which the patient was given convalescent leave
. The
hospital from which the patient was given convalescent leave
may
return the patient to its care,
subject to notice and hearing as provided by Wyo. Stat. Ann. §
§
25-10-116 and 127
.
(b) Any member of the patient's treatment team, the patient,
any designated gatekeeper
, or other appropriate parties may request that the
hospital from which the patient was given convalescent leave
return the patient to its care to comply with the Convalescent Leave Plan. The
hospital
shall review requests under subsection (b) to determine whether
return from Convalescent Leave
pursuant to subsection (a)
is in the best interests of the patient
.
(c)
If the patient is not able or is unwilling to return to the hospital, or i
f the
hospital from which the patient was given convalescent leave
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.
(d)
The Wyoming State Hospital shall arrange t
ransportation for a patient returning to 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 Wyo. Stat. Ann. § 25-10-127.
(f) The
hospital
from which the patient was given convalescent leave
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 hospital
.
(g) Upon the patient's return to the
hospital from which the patient was given convalescent leave
, the patient shall be notified of his/her rights, including the right to contest his return to the hospital, the right to a hearing, and the right to counsel.
(h) If the patient is returned to the Wyoming State Hospital or designated hospital, the Convalescent Leave is revoked.
Section 6.
One Year Follow Up.
(a) Prior to the end of one (1) year on convalescent leave, and not less than annually thereafter, the patient's treatment team shall consult with the patient,
any designated gatekeeper
, and other appropriate parties to reconsider and reexamine the facts relating to the original 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 and
any designated
gatekeeper
,
in collaboration with the Wyoming State Hospital or designated hospital, shall submit a 14-81 form to the Court for the discharge of the patient, following the procedures set forth in
Wyo. Stat. Ann.
§ 25-10-116(b). With the participation of the patient, the patient's guardian, the patient's caregiver, the patient's family,
if applicable,
and the community treatment provider, the Wyoming State Hospital or designated hospital shall prepare a discharge plan.
(c) If
a
patient on Convalescent Leave is returned to the Wyoming State Hospital, designated hospital, or treatment provider and
later
re-
placed on Convalescent Leave status, the one year follow up shall be based on the date of the most recent Convalescent Leave.
Section 7.
Two Year Discharge Process.
(a) After two (2) years on Convalescent Leave, the community treatment provider, in collaboration with the Wyoming State Hospital or designated hospital, and
any designated gatekeeper
, shall submit a 14-81 form to the court, seeking the discharge of the patient, pursuant to Wyo. Stat. Ann. § 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 or designated 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 and
any designated gatekeeper.
(b) If the patient is returned from Convalescent Leave to the Wyoming State Hospital, designated hospital, or treatment provider and
re-
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.
Section 8.
Responsibilities of the Wyoming State Hospital
or Designated Hospital
While Patient is on Convalescent Leave.
(a) While the patient is on Convalescent Leave, the Wyoming State Hospital or designated hospital shall periodically review, with the community provider and
any designated gatekeeper
, 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 or designated hospital
shall provide
direct care or treatment of the patient while the patient is on Convalescent Leave
unless otherwise documented in the treatment plan
, although they
shall
be available for consultation with community treatment providers. This provision recognizes the patient's best interests in being placed in his or her local community, which may be a great distance from the Wyoming State Hospital
or designated hospital
.
bin
Section 9.
Implementation of Chapter.
(a) The order in which the provisions of this Chapter appear is not to be construed to mean that any provision is more or less important than any other provision.
(b) The text of this Chapter shall control the titles of its various provisions.
Section 10.
Superseding Effect.
When promulgated, this Chapter supersedes all prior rules or policy statements issued by the Department, including manuals or bulletins, which are inconsistent with this Chapter
8-3
.
Section 11.
Severability.
If any portion of this Chapter is found to be invalid or unenforceable, the remainder shall continue in full force and effect.
For questions regarding the content or application of a specific rule, please contact the agency responsible for the rule. A directory of
agencies
is also available online. For questions about the rulemaking process, please send your questions and comments to
Rules@wyo.gov
.