1. Private-Pay Service

Hearts at Home Respite Services, LLC is a private-pay, non-medical respite care provider serving children and young adults ages 18 months through 25 years old. Our services are designed to provide temporary relief and support to parents, guardians, and caregivers by offering compassionate supervision, companionship, and assistance with activities of daily living in accordance with each client's individual needs.

All services provided by Hearts at Home Respite Services, LLC are offered on a private-pay basis only. Hearts at Home Respite Services, LLC does not currently participate in or bill any insurance companies, Medicaid, Medicare, waiver programs, managed care organizations, government agencies, or other third-party payers for services rendered.

By enrolling in services, the parent/guardian acknowledges and agrees that:

• All fees for services are the sole responsibility of the parent/guardian or financially responsible party.

• Payment is required regardless of whether reimbursement may be available through another source.

• Hearts at Home Respite Services, LLC makes no guarantee that any service provided will qualify for reimbursement through insurance, Medicaid waiver programs, flexible spending accounts (FSA), health savings accounts (HSA), grants, or other funding sources.

• The parent/guardian is responsible for verifying eligibility for any potential reimbursement independently.

• Failure to receive reimbursement from a third party does not relieve the parent/guardian of their financial obligation for services provided.

The parent/guardian agrees to pay all applicable service fees, late fees, cancellation fees, extended care fees, and any other charges outlined in the Client Service Agreement, Parent Handbook, or fee schedule. Payment policies, rates, and fees may be updated periodically, and families will be notified of any changes in advance.

Payment for services must be made through approved payment methods and according to the payment schedule established by Hearts at Home Respite Services, LLC. Services may be suspended, canceled, or denied if payments become delinquent or outstanding balances remain unpaid.

Hearts at Home Respite Services, LLC reserves the right to require payment before services are rendered and may decline future bookings until all outstanding balances have been satisfied.

The parent/guardian understands that enrollment in services constitutes acceptance of all financial responsibilities associated with receiving private-pay respite care services and agrees to comply with all payment policies established by Hearts at Home Respite Services, LLC.

2. Intake Requirement Before Booking

To ensure the safety and well-being of every client, all parents/guardians must complete the intake and enrollment process before any services can be scheduled or provided by Hearts at Home Respite Services, LLC.

Prior to booking services, parents/guardians are required to:

• Complete and submit all required intake forms and enrollment documents
• Provide accurate and current medical, behavioral, emergency, and contact information.
• Sign all required policies, consents, waivers, and service agreements.
• Participate in an intake consultation, meet-and-greet, or assessment if requested.
• Provide any additional documentation necessary to support safe and appropriate care.

All information submitted will be reviewed to determine whether Hearts at Home Respite Services, LLC can safely and effectively meet the client's needs. Submission of intake paperwork does not guarantee approval for services.

Services cannot be scheduled, confirmed, or provided until all required forms have been completed, reviewed, and approved by Hearts at Home Respite Services, LLC.

Parents/guardians are responsible for notifying Hearts at Home Respite Services, LLC of any changes to medical information, emergency contacts, behavioral needs, or other information that may affect the client's care.

3. Payment Policy

The parent/guardian acknowledges and agrees that they are financially responsible for all fees associated with services provided by Hearts at Home Respite Services, LLC.

The parent/guardian agrees to:

• Pay all fees for scheduled respite care services, including any applicable late cancellation, late pick-up, or additional service fees.
• Maintain a valid payment method on file when required.
• Submit payment according to the current pricing schedule and payment terms established by Hearts at Home Respite Services, LLC.
• Ensure payment is received before services begin unless alternative payment arrangements have been approved in writing.

Any unpaid balances must be paid promptly. Hearts at Home Respite Services, LLC reserves the right to decline future bookings, suspend scheduled services, or terminate services for accounts with outstanding balances or repeated late payments.

4. Cancellation Policy

At Hearts at Home Respite Services, LLC, we understand that unexpected situations and schedule changes may occur. To ensure fairness to all families and staff, the following cancellation policy applies:

• Cancellations made 24 hours or more before the scheduled service start time will not incur a cancellation fee.

• Cancellations made with less than 24 hours' notice may be subject to a late cancellation fee.

• Clients who fail to cancel and do not arrive or make themselves available for services ("no-shows") may be charged up to the full amount of the scheduled service.

• Repeated late cancellations or no-shows may result in restrictions on future bookings or discontinuation of services.

Hearts at Home Respite Services, LLC reserves the right to waive cancellation fees in cases of emergencies or unforeseen circumstances at its discretion.

Provider Cancellation
While Hearts at Home Respite Services, LLC strives to provide reliable and consistent services, there may be occasions when services must be canceled due to circumstances beyond our control, including illness, family emergencies, severe weather, unsafe travel conditions, staff emergencies, or other unforeseen events.

If Hearts at Home Respite Services, LLC must cancel a scheduled service, every reasonable effort will be made to provide advance notice to the parent/guardian as soon as possible. When appropriate and mutually agreeable, efforts will be made to reschedule the canceled service to another date and time.

Parents/guardians will not be charged for any services canceled by Hearts at Home Respite Services, LLC. However, Hearts at Home Respite Services, LLC cannot guarantee the availability of replacement staff or immediate rescheduling.

The safety of clients, families, and staff will always remain the highest priority when determining whether services should be canceled or postponed.

5. Late Pick-Up and Extended Care Policy
At Hearts at Home Respite Services, LLC, we understand that unexpected delays and emergencies can occur. However, parents/guardians are responsible for returning at the agreed-upon end time of services to ensure the safety, well-being, and scheduling needs of all clients and staff.

Scheduled Service End Time
Services are provided only during the hours reserved and confirmed at the time of booking. Parents/guardians are expected to arrive promptly at the scheduled end time to assume responsibility for their child or young adult.

Grace Period
A one-time grace period of up to 10 minutes may be provided after the scheduled service end time. The grace period is intended for unforeseen circumstances and should not be relied upon as an extension of regularly scheduled services.

Late Pick-Up Fees
If a parent/guardian arrives later than the 10-minute grace period, additional charges will be assessed for extended care. Extended care begins immediately after the grace period expires.

Late Pick-Up Fees:

• 11–30 minutes late: $15 fee
• 31–60 minutes late: $30 fee.
• More than 60 minutes late: $50 fee plus applicable hourly service rate.
• Any additional time beyond one hour may be billed at the provider's current hourly respite rate in addition to late fees.

All late pick-up fees will be charged to the payment method on file and must be paid before future services can be scheduled.

Failure to Communicate Delays
Parents/guardians are expected to notify Hearts at Home Respite Services as soon as possible if they anticipate being late. Failure to communicate delays may result in additional fees and may be documented as a policy violation.

Emergency Situations
In the event of an emergency that prevents a parent/guardian from returning on time, Hearts at Home Respite Services will make reasonable efforts to continue supervision of the client until a parent, guardian, or authorized emergency contact can be reached. Extended care fees may still apply unless otherwise determined by management.

Required Availability During Services
Parents/guardians must remain reachable at all times while services are being provided. This includes:

• Maintaining an active and working phone number.
• Keeping mobile phones turned on and able to receive calls or text messages.
• Responding promptly to communications regarding their child.
• Providing at least two emergency contacts who can be reached if the parent/guardian is unavailable.

Failure to remain reachable during service hours may be considered a safety concern and may result in suspension or termination of services.

Repeated Late Pick-Ups
Repeated late pick-ups place an undue burden on staff and may affect the scheduling of other families. The following actions may occur:

• First occurrence: Verbal reminder of policy.
• Second occurrence: Written warning.
• Third occurrence: Review of continued eligibility for services.
• Continued violations: Suspension, restriction of booking privileges, or termination of services at the discretion of Hearts at Home Respite Services.

Abandonment and Emergency Contact Procedures

If a parent/guardian cannot be reached within a reasonable period after the scheduled service end time and all listed emergency contacts have been contacted without success, Hearts at Home Respite Services reserves the right to take any actions necessary to ensure the safety and welfare of the client, including contacting local authorities or child protective services when legally required.

6. Parent/Guardian Responsibilities
To help ensure the safety, well-being, and success of services, the parent/guardian agrees to actively participate in and support the care process by fulfilling the following responsibilities:

The parent/guardian agrees to:

• Provide complete, accurate, and up-to-date information regarding the client's medical history, behavioral needs, communication abilities, routines, preferences, and support requirements.

• Promptly notify Hearts at Home Respite Services, LLC of any changes to the client's medical conditions, medications, allergies, behaviors, emergency contacts, custody arrangements, or other information that may affect service delivery.

• Provide all necessary supplies needed during the service period, including but not limited to diapers, wipes, medications, snacks, meals, drinks, comfort items, adaptive equipment, communication devices, and other personal care items.

• Ensure that medications are properly labeled and accompanied by written instructions and authorization forms when applicable.
  Remain available and reachable by phone at all times during scheduled service hours and respond promptly to calls, texts, or emergency communications.

• Provide and maintain a safe, clean, and appropriate environment for service delivery that is free from known hazards or unsafe conditions.

• Inform Hearts at Home Respite Services, LLC of any safety concerns, triggers, behavioral risks, or special supervision needs before services begin.

Failure to provide accurate information, maintain communication, supply necessary items, or disclose important medical, behavioral, or safety-related information may result in delayed services, service suspension, or termination of services at the discretion of Hearts at Home Respite Services, LLC.

7. Non-Medical Services

Non-Medical Services
The parent/guardian acknowledges and understands that Hearts at Home Respite Services, LLC is a private-pay, non-medical respite care provider that offers supervision, companionship, support, and assistance with daily activities for children and young adults ages 18 months through 25 years old.

The parent/guardian further understands that Hearts at Home Respite Services, LLC:

• Is not a medical facility, healthcare provider, or home health agency.
• Does not provide nursing services, skilled medical care, or personal healthcare services.
• Does not provide medical treatment, physical therapy, occupational therapy, speech therapy, behavioral therapy, counseling, or other clinical interventions.
• Does not diagnose medical, developmental, behavioral, or mental health conditions.
• Does not prescribe, adjust, or make decisions regarding medications or medical treatment plans.
• Will only assist with medications when authorized through a separate written agreement and when permitted by applicable laws and company policies.

Parents/guardians remain responsible for all medical decisions, treatment plans, physician recommendations, and healthcare needs of their child or young adult.

In the event of a medical emergency, illness, injury, or other situation requiring immediate medical attention, Hearts at Home Respite Services, LLC staff may contact emergency services (911), administer basic first aid within the scope of their training, and notify the parent/guardian and emergency contacts as soon as possible.

8. Safety and Behavior Expectations
The safety, health, and well-being of all clients, families, and staff are the highest priorities of Hearts at Home Respite Services, LLC. To provide safe and effective services, parents/guardians must fully disclose information that may affect the client's care, supervision, or safety.

The parent/guardian agrees to:

• Provide accurate and complete information regarding the client's behavioral, emotional, developmental, medical, and safety-related needs.

• Inform Hearts at Home Respite Services, LLC of any history of aggression, self-injurious behavior, elopement/wandering, property destruction, seizures, allergies, sensory concerns, or other significant behaviors or medical conditions.

• Notify staff immediately of any changes in the client's health, behavior, medications, or support needs.

• Ensure the client is healthy enough to participate in services and does not have a contagious illness or condition that could place others at risk

• Maintain current emergency contact information and ensure emergency contacts are available if needed.
  Work collaboratively with staff to support the client's safety and success during services.

Hearts at Home Respite Services, LLC reserves the right to refuse, suspend, or discontinue services if critical information has not been disclosed or if a client's medical, behavioral, or safety needs exceed the scope of services provided. Services may also be terminated if a situation presents a significant safety risk to the client, staff, or others that cannot be safely managed.

9. Illness Policy
To protect the health and safety of all clients, families, and staff, Hearts at Home Respite Services, LLC reserves the right to postpone, reschedule, or cancel services when a client is ill or has symptoms that may be contagious.

Services may not be provided if a client has any of the following:

• Fever
• Vomiting
• Diarrhea
• Contagious illness or infection
• Unexplained rash
• Persistent cough or other symptoms of illness
• Any condition that may place staff, other clients, or community members at risk

Parents/guardians are responsible for notifying Hearts at Home Respite Services, LLC as soon as possible if their child becomes ill before a scheduled service. Failure to disclose an illness may result in service interruption or cancellation.

If a client becomes ill during services, the parent/guardian may be contacted and required to arrange for immediate pick-up or supervision. Emergency contacts may also be contacted if the parent/guardian cannot be reached.

Hearts at Home Respite Services, LLC reserves the right to determine whether a client is well enough to safely participate in services and may require services to be postponed until the client is symptom-free or no longer considered contagious.

10. Multiple Children Services & Payment Policy
Services for Families with Multiple Children
At Hearts at Home Respite Services, LLC, we understand that many families have more than one child who may require supervision and support. To ensure the safety, quality, and individualized attention of all children in our care, the following policy applies to families requesting services for multiple children.

Eligibility
Services may be provided for multiple children within the same household, subject to staffing availability, child needs, and safety considerations.

Individual Intake Requirement
Each child receiving services must have:

• A completed Intake Packet
• Emergency Contact Information
• Medical Information Form
• Required Consent Forms
• Service Agreement signed by the parent/guardian

No child may receive services until all required documentation has been completed and approved.

Assessment of Care Needs
Hearts at Home Respite Services, LLC reserves the right to determine whether one caregiver can safely supervise multiple children based on:

• Age of each child
• Developmental level
• Behavioral support needs
• Medical needs
• Safety concerns
• Overall supervision requirements

Additional staff may be required if the level of care exceeds what one caregiver can safely provide.

Multiple Child Payment Policy
Base Service Rate
The standard hourly rate covers care for one child.

Additional Child Fee
An additional fee of $7 will be charged for each additional child receiving services during the same service period.

Example:

Child 1: Full hourly rate
Child 2: Additional child fee
Child 3: Additional child fee
Current rates will be provided before services are scheduled.

Higher Support Needs
Additional fees may apply if one or more children require:

Intensive supervision
Significant behavioral support
Frequent redirection
Specialized care routines
Additional staffing for safety
Parents/guardians will be informed of any additional fees before services are confirmed.

Staffing Requirements
If Hearts at Home Respite Services, LLC determines that more than one caregiver is necessary to safely support the children, the parent/guardian will be responsible for the cost of additional staff.

Payment Responsibility
The parent/guardian is responsible for payment for all children receiving services, regardless of whether one or multiple children are being supervised.

Payment is due according to the payment terms outlined in the Service Agreement.

No Sibling Discounts
To ensure fair compensation for caregivers and maintain quality care standards, sibling discounts are not guaranteed and are offered solely at the discretion of Hearts at Home Respite Services, LLC.

Schedule Changes
Adding additional children after a service has been booked may result in:

• A rate adjustment
• Additional staffing requirements
• Service rescheduling if staffing is unavailable

Parents/guardians must notify Hearts at Home Respite Services, LLC of any changes before the scheduled service date.

11. Community Outing Services

Community-based respite services are billed at a higher rate than in-home services due to transportation, increased supervision requirements, and community participation support. Parents/guardians are responsible for all admission fees, meals, activity costs, and other expenses incurred during the outing for their child.

12. Release of Liability

The parent/guardian acknowledges that Hearts at Home Respite Services, LLC is committed to providing a safe, supportive, and supervised environment for all clients. While reasonable precautions, safety procedures, and appropriate supervision will be provided at all times, the parent/guardian understands that participation in respite care services involves inherent risks, including but not limited to accidental injuries, falls, illness, behavioral incidents, or other unforeseen events that may occur despite reasonable care and supervision.

By voluntarily enrolling the client in services, the parent/guardian accepts these inherent risks and agrees that Hearts at Home Respite Services, LLC cannot guarantee the prevention of all injuries, accidents, or unexpected circumstances.

To the fullest extent permitted by law, the parent/guardian agrees to release, waive, and hold harmless Hearts at Home Respite Services, LLC, its owners, employees, independent contractors, volunteers, agents, and representatives from any and all claims, liabilities, damages, losses, expenses, or causes of action arising from participation in services, except in cases involving gross negligence, reckless conduct, or willful misconduct by Hearts at Home Respite Services, LLC.

The parent/guardian further agrees to assume responsibility for any medical expenses, damages, or costs incurred as a result of injury, illness, or other incidents that may occur during participation in services, except where otherwise required by law.

By signing this agreement, the parent/guardian acknowledges that they have read, understood, and voluntarily agree to the terms of this Release of Liability and understand the risks associated with participation in respite care services.