Billing. The caregiver will fill out an electronic timesheet daily. At the end of the caregiver's work shifts (Monday to Sunday), you or the patient will be expected to sign the timesheet as acceptance of the hours service delivered. Please sign it promptly so the caregiver can be paid promptly. After the start of services, invoices will be sent weekly after completion of each service period. Any questions regarding timesheets or your invoice should be directed to our office.
Payment and Overdue Accounts. Fees for services rendered are payable upon receipt of invoice. Payment may be made by check, money order or credit card. It is Brockton Home Health Care Agency, LLC's policy not to accept checks endorsed over to the agency. All payments must be remitted to the address noted above; direct care workers are not permitted to accept payment. An account is considered overdue if not paid within··5 days of the billing date. Interest will be charged on account balances which remain unpaid for 5 days or more after the same becomes due at the rate of 10% per month until paid. We reserve the right to discontinue providing services until the account is paid in full, including any additional charges and accrued interest. A $25.00 returned check fee will be charged. Checks are to be made payable to Brockton Home Health Care Agency.
Cancellations. Cancellations may be made up to 24 hours in advance of a scheduled visit without charge. We reserve the right to charge for a scheduled visit if insufficient notice is not given. In the event that a referred caregiver fails to arrive at the care •recipient's home, we will make every effort to find a replacement as quickly as possible. If a replacement is not found or if the caregiver alters the predetermined weekly schedule in some way, we will adjust the amount that you are billed accordingly.
Termination. Either "Patient" or "Agency" may terminate this agreement upon two (2) calendar-week's written notice to the other party. If either party terminates this Agreement, all fees due at time of termination will be due and payable by you immediately. We will immediately refund any prepaid fees. Exception to the two-week notice provision would include:
1. When care needs undergo a change, which necessitates transfer to a higher level of care.
2. When there is documented non-compliance of the Care Plan or Service Agreement (including, non-payment of justified charges).
3. When the activities or circumstances in the home or living facility jeopardize the welfare and safety of the home health aide.
Patient or patient' s representative shall have the right to appeal the discharge decision during the two-week notice period and will be notified of this in the discharge statement. The Appeal panel will be led by the Director of Nursing, Administrator and include both the Supervisor and Caregiver. The panel will review the patient file with the patient or Patient's 's representative. The Director of Brockton Home Health Care make the final decision.
Governing Law. The laws of the States Massachusetts shall govern this agreement.
Agency's Responsibilities. Brockton Home Health Care Agency, LLC responsibilities are outlined on the enclosed "Rights and Responsibilities" form.
Patient’s Responsibilities. Your responsibilities are outlined on the enclosed “Rights and Responsibilities" form. You will be required to sign it.
Light Housekeeping Defined: The Nurse employee is not required to provide e a general housekeeping service.
Transportation. (none)
Private/Direct Hiring. The overriding business relationship is strictly between you and Brockton Home health Care Agency, LLC and by agreeing to this proposal you are confirming to us that you will abstain from making or accepting any offers whereby any of the caregivers/employees we have referred to you would provide services other than as sanctioned by Brockton Home health Care Agency, LLC (whether you still have an ongoing relationship with Brockton Home health Care Agency, LLC, or not) for a period of one year after the date of the final fee that you pay to us. If you violate this provision, you will immediately pay Brockton Home Health Care Agency, LLC e a sum of $10,000 for each affected individual employee.
Insurances. We will maintain worker 's compensation insurance coverage for any and all referred caregivers, and they will be bonded. In good faith, you agree to maintain homeowner 's insurance, medical insurance and/or other coverage as may be necessary to provide protection for the care recipient.
Severe/Bad Weather. In severe weather, we may determine it is not safe for our Home Care Workers to travel and provide services to your home that day and may have to cancel that day's service. When this occurs, we will notify you and reschedule. We appreciate your understanding regarding this matter.
Supplies and Equipment. You are responsible for supplying all supplies (i.e. cleaning, personal care etc. including latex gloves needed for the safe execution of any kind of personal care) and equipment which may be necessary in the provision of services. Extra charges will apply if the Agency provides the supplies and/or equipment.
Your signature and /or your representative' s signature below indicate that you and/or your representative have read, understand and are in agreement with the terms and conditions of this Service Agreement.