Policy Manual sample

MDT Home Health Care Agency, Inc. CONTRACT/AGREEMENT with Another Licensed Provider This contract/Agreement is made in good faith between MDT Home Health Care Agency, Inc. (the first party) and another licensed provider, namely, __________________________________________________________ (a Licensed Pool Services (offering nursing, social services), Licensed Therapy Staffing Company (Physical, Occupational, Speech Therapist) or other licensed provider (the second party)) In this Contract/Agreement, both parties agree as follows: (i) Whenever applicable (contingency/emergency situations), MDT Home Health Care Agency, Inc., (the first party) shall refer a patient to the second party. The timeframe for placement of contract staff and contingency staff is 1 day (24 hours) (ii) The second party shall render such professional services to the patient as are necessary and requested, and is required to adhere to applicable Agency’s policies and procedures. Every contracted staff from the second party shall submit to MDT Home Health Care Agency, Inc. a complete application package, and must be Oriented in our office about our Policy and Procedures, Job Description, and Professional responsibilities, as part of our application process. (iii) In every case, MDT Home Health Care Agency, Inc., shall be responsible for billing the Medicare/Medicaid/Insurance for such services. Patients are accepted for care only by our Agency who is responsible for patient's care. Both parties will comply with all Medicare Conditions of Participation. (iv) MDT Home Health Care Agency, Inc., shall make remunerations to the second party based on an agreed fee _______________. The bills and related documentation must be dropped in our office every week. (v) The services requested for are named above. The second party must show evidence of education, training, qualifications, identification, licensure or certification of personnel designated to provide care, and services. (vi) All services provided by the second party shall conform with and be within the scope and limitations set forth in our plan of treatment. The second party has responsibilities for participation in developing plans of care, and participate in Performance Improvement activities as applicable, such participate in the Agency QAPI Program, activities to reach our services goals, receive and inform patients concerns, and suggest ways to improve our services. Maintain coordination of care, communication with all disciplines involved in patient’s care and patient’s physician. (vii) These services may be altered only upon the specific orders of MDT Home Health Care Agency, Inc., which will be in response to the orders of or a change made by the patient's Physician who ordered the plan of treatment. The second party is responsible for Therapy Care Plan & Services guidelines compliance included re-assessment after 30 days of the first therapy visit as required/applicable, also assess frequency/scheduling of visits, and periodic patient evaluation. (viii) A staff of our Agency shall make a yearly supervisory/consultatory visit to the second party to assess the progress made by the second party in providing the requested services. (ix) All clinical notes, patient observation charts and other relevant pertinent clinical notes made in reference to the patient by the second party, shall be recorded in our Agency's records in order to facilitate the planning and evaluation of the patient care process. These Home Health Agency Agreements G-4