Policy Manual sample

MDT Home Health Care Agency, Inc. SERVICES AGREEMENT WITH OTHER HEALTH CARE FACILITIES This contract/Agreement is made in good faith between MDT Home Health Care Agency, Inc. (the first party) and another health care facility, namely, __________________________________________________________ (Assisted Living Facilities (ALF), Adult Family Home Care (AFHC), Nursing Home(staffing)) (the second party) In this Contract/Agreement, both parties agree as follows: (1) MDT Home Health Care Agency, Inc. shall render professional and para-professional services to the second party’s patient as are necessary and requested/authorized by the patient’s physician. (2) 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, after review of the Patient’s contract with the ALF, AFHC. ______________________________________________________________________ Service to be provided (3) MDT Home Health Care Agency, Inc., shall make no remunerations to the second party. (4) The services requested for are named above (2). The second party must show evidence of licensure, and certification of personnel designated to provide care, and services to their patients (if applicable). (5) All services provided by MDT Home Health Care Agency, Inc. 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 (QAPI) activities as applicable to reach our services goals, receive and inform patients concerns, and suggest ways to improve our services. (6) 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. (7) A staff of our Agency shall make a supervisory/consultatory visit to the second party to assess the progress made by the requested services. (8) This agreement is legally binding. (9) This contract/agreement shall be in effect from the date both parties sign the contract and end the date the patient is discharged from our Agency. (10) This contract/agreement is subject to review by our Agency at any time and at any frequency as may be necessary based on charges in patient care plan as may be ordered by the patient's physician. (11) The Agency’s employee/contract shall ad here to all applicable policies and personnel requirements of MDT Home Health Care Agency, Inc. (12) Our Agency has full responsibility over all contracted services, and ensure overall quality of care provided by our staff. (13) Our Agency has full responsibility to retain and maintain all clinical records of patients served by this Contract. (14) The Patient’s information will be use only for the purposes for which it was engaged by the service provided, will safeguard the information from misuse, and will help the Agency comply with some of the Agency’s duties under the HIPAA Privacy Rule. We may disclose protected health information only to an entity/individual in our role as associated only to help us carry out its health care functions – not for the associate’s independent use or purposes, except as needed for the proper management and administration of the business associate. All records information will maintained “CONFIDENTIAL” Home Health Agency Agreements G-8