10.07.22.09

.09 Residential Agreement.

A. Patients admitted to the hospice house or their representatives shall sign, before or at the time of admission, a patient agreement that:

(1) Is a clear and complete statement of commitments agreed to by the parties and the services provided in the hospice house;

(2) Is accurate, legible, and communicated in a language understandable to patient and family; and

(3) Conforms to all applicable federal, State, and local laws and requirements.

B. The residential agreement shall include, at a minimum:

(1) The services to be provided by the hospice house;

(2) An explanation of the hospice houseís complaint or grievance procedure;

(3) Procedures to be followed in transferring the patient to another facility;

(4) The availability of secure storage of patientís belongings;

(5) The patientís and familyís rights and obligations concerning use of the hospice house, including common areas;

(6) Written plan and provisions for continued emergency preparedness services;

(7) An acknowledgement that the patient or the patientís representative has reviewed all hospice house rules, requirements, restrictions, or special conditions that the general hospice program will impose on the patient; and

(8) Admission and discharge policies and procedures including:

(a) Those actions, circumstances or conditions which may result in the patientís discharge from the hospice house;

(b) The procedures which the hospice house shall follow if it intends to discharge a patient without the patientís agreement, thereby terminating the residential agreement; and

(c) The procedures which the patient shall follow if the patient wishes to terminate the residential agreement.

C. The residential agreement shall include financial provisions, which include at a minimum:

(1) Rate structure and payment provisions covering:

(a) All rates to be charged to the patient, including but not limited to any non-service related charges; and

(b) Payment arrangements and fees, if known, for third-party services not covered by the residential agreement, but arranged for by either the patient, patientís representative, or the hospice house; and

(2) Obligations of the hospice house and the patient, or the patientís representative, as to:

(a) Handling the finances of the patient;

(b) Arranging and contracting for services not covered by the patient agreement;

(c) Disposition of the patientís property upon discharge or death of the patient;

(d) Identification of the persons responsible for payment of all fees and charges and a clear indication of whether the personís responsibility is or is not limited to the extent of the patientís funds;

(e) Fair and reasonable billing, payment, and credit policies;

(f) The procedures the hospice house will follow in the event the patient or representative can no longer pay for services provided for in the patient agreement or for services or care needed by the patient; and

(g) Terms governing the refund of any prepaid fees or charges in the event of a patientís discharge from the hospice house or termination of the patient agreement.

D. The hospice house shall maintain the patient agreement in the patientís record.