Use this free hospice nursing home contract template to create a legally binding agreement between a nursing home and hospice. Outline the arrangement of the hospice offering their services to nursing home residents and set out the responsibilities of each party throughout the term of this agreement.
THIS SERVICES AGREEMENT (“Agreement”) is entered into as of (Enter Date) (the “Effective Date”) by and between [HospiceRepresentative.FirstName] [HospiceRepresentative.LastName] located at (Enter Hospice Name) (“Hospice”) and [FacilityRepresentative.FirstName] [FacilityRepresentative.LastName] located at (Enter Facility Name) (“Facility”).
Facility is a nursing facility and is certified to participate in Medicare and/or Medicaid as a provider of skilled nursing facility services and/or nursing facility services to its residents (“Residents”).
From time to time, Residents may elect to receive hospice services.Facility desires to arrange for the provision of hospice services to Residents through an agreement with one or more Medicare-certified hospices.
Hospice is a Medicare-certified hospice. Facility is located within the Hospice’s service area.The parties have determined to enter into this Agreement so that Residents electing to receive hospice services have the option to receive such services from Hospice.
The parties hereto agree as follows:
1. Hospice shall be solely responsible for determining a Resident’s eligibility for admission to, and discharge from, hospice care in accordance with applicable law and shall process such admissions and discharges as well as all Resident elections of hospice care and revocations of elections of hospice care as applicable.
2. Hospice shall be solely responsible for initially certifying and recertifying, as necessary, the Resident’s terminal illness in accordance with applicable law.
3. Hospice shall be solely responsible for conducting initial and comprehensive assessments upon a Resident’s election of hospice care as provided in 42 C.F.R. §418.54 and for designating an interdisciplinary group as provided in 42 C.F.R. §418.56.
4. Hospice shall be responsible for determining and modifying, as necessary, the appropriate hospice care plan as specified in 42 C.F.R. 418.112(d). Such a hospice plan of care shall encompass all issues related to the terminal illness and related conditions. Hospice shall communicate with the Resident, family members, Facility staff, and the attending physician to develop and update the content of the hospice care plan.
5. Hospice shall determine the appropriate course of hospice care for Residents who are under Hospice care, including any determination to change the level of services provided to such Residents.
6. With respect to Residents who are under Hospice’s care, Hospice shall be responsible for providing the following in accordance with applicable law: medical direction and management; nursing; counseling (including spiritual, dietary, and bereavement); social work; medical supplies, durable medical equipment, and drugs necessary for the palliation of pain and symptoms associated with the terminal illness and related conditions; and all other hospice services that are necessary for the care of the Resident’s terminal illness and related conditions in accordance with the hospice plan of care and applicable law, including but not limited to hospice aide, volunteer, and homemaker services; physical therapy, occupational therapy, and speech-language pathology services; transportation (including by ambulance) if necessary; 24-hour continuous care services when necessary to achieve palliation or management of acute medical symptoms during a crisis; and short-term inpatient care.
To the extent that Facility will provide any of the foregoing hospice items or services on behalf of Hospice under arrangement with Hospice, the parties shall enter into a separate written agreement, which may be in the form of an addendum to this Agreement, addressing the provision of and payment for such items or services.
7. Hospice shall designate an interdisciplinary group member who shall be responsible for coordinating with the Facility the provision of hospice services to each Resident under Hospice’s care and communicating with the Facility and other healthcare providers participating in the provision of care for the Resident’s terminal illness and related conditions, and other conditions, for ensuring the quality of care for the
8. Hospice shall deliver hospice services to each Resident under Hospice’s care in a timely manner.
9. Hospice shall provide services to Residents who are under Hospice care at the same level and to the same extent as those services would be provided if the Resident were in his or her own home. Hospice shall designate an interdisciplinary group member who shall be responsible for coordinating with the Facility the provision of hospice services to each Resident under Hospice’s care and communicating with the Facility and other healthcare providers participating in the provision of care for the Resident’s terminal illness and related conditions, and other conditions, for ensuring the quality of care for the Resident and family. Hospice shall notify Facility promptly of any change in the designated interdisciplinary group member.
10. Hospice shall ensure that the hospice interdisciplinary group communicates with the Facility medical director, the Resident’s attending physician, and other physicians participating in the provision of care to the Resident as needed to coordinate the hospice care of the Resident with the medical care provided by other physicians.
11. Hospice shall provide the Facility with the following information immediately upon the information becoming available to Hospice: (i) the most recent hospice plan of care specific to each Resident under Hospice’s care; (ii) each Resident’s hospice election form; (iii) physician certification and recertification of the terminal illness specific to each Resident under Hospice’s care; (iv) names and contact information for Hospice personnel involved in hospice care of each Resident; (v) instructions on how to access Hospice’s 24-hour on-call system; (vi) hospice medication information specific to each Resident; and (vii) Hospice physician and attending physician (if any) orders specific to each Resident.
12. Hospice shall report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source and misappropriation of Resident property by anyone unrelated to the hospice, to the Facility administrator immediately upon becoming aware of such alleged violation.
13. Upon execution of this Agreement, Hospice shall assure that Facility staff furnishing care to Residents who are under Hospice care are educated in the hospice philosophy, including policies and procedures regarding methods of comfort, pain control, symptom management, as well as principles about death and dying, individual responses to death, patient rights, appropriate forms, and applicable record keeping requirements.
14. Hospice shall, at the request of the Facility, provide bereavement counseling to those Facility staff directly involved in caring for Residents who are under Hospice’s care and who desire to receive such bereavement counseling.
1. Facility shall be solely responsible for admitting and discharging Residents to the Facility as appropriate in accordance with Facility’s policies and procedures.
2. Facility shall maintain responsibility for care planning for any Resident conditions unrelated to the Resident’s terminal illness.
3. Facility shall immediately notify Hospice about the following: a significant change in the Resident’s physical, mental, social, or emotional status; clinical complications that suggest a need to alter the plan of care; a potential need to transfer the Resident from the Facility for any condition; the Resident’s death.
4. Facility shall furnish 24-hour room and board care to Residents who are under Hospice care.
5. Facility shall meet the Resident’s personal care and nursing needs in accordance with the Hospice representative and ensure that the level of care provided is appropriately based on the individual Resident’s needs.
6. When Facility personnel are directed by Hospice to administer prescribed therapies to Residents who are under Hospice care, including those therapies determined appropriate by Hospice and delineated in the hospice plan of care, Facility personnel shall administer the therapies in accordance with applicable law and Facility policies and procedures.
7. Facility shall report all alleged violations involving mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source and misappropriation of Resident property by Hospice personnel, to the Hospice administrator immediately upon becoming aware of such alleged violation.
8. Facility shall designate a member of the Facility’s interdisciplinary team who is responsible for working with the Hospice to coordinate care provided by the Facility staff and Hospice staff to any Resident under the Hospice’s care. Such interdisciplinary team member shall be responsible for the following:
(i) collaborating with Hospice and coordinating Facility staff participating in the hospice care planning process for those Residents who are under Hospice’s care;
(ii) communicating with Hospice and other healthcare providers participating in the provision of care for the terminal illness, related conditions, and other conditions, to ensure quality of care for the Resident and family;
(iii) ensuring that Facility communicates with the Hospice medical director, the Resident’s attending physician, and other practitioners participating gin the provision of care to the Resident as needed to coordinate the hospice care with the medical care provided by other physicians;
(iv) obtaining the following information from Hospice: