Include these items in nursing home contracts

Agree on terms at the outset

While good communication will enhance the hospice/nursing home relationship, a good contract is the foundation. To avoid misunderstandings, the contract should be as specific as possible so that both sides have a clear picture of their responsibilities.

Below is an outline of the key elements of a contract that was developed by the Wisconsin Department of Health and Family Services. While not intended to be a cookie-cutter contract, it touches on most of the items that should be agreed upon in a hospice/nursing home contract.

1. Recitals

2. Definitions (particularized to individual needs and terminology)

  • Attending Physician
  • Care Manager
  • Covered Services
  • Facility
  • Hospice
  • Hospice Care
  • Hospice Medical Director
  • Hospice Services

— Routine Home Care

— Inpatient Respite Care

— Continuous Care

— Inpatient Acute Care

  • Informed Consent
  • Interdisciplinary Group
  • Non-covered Services
  • Nursing Home Medical Director
  • Patient Care Management
  • Plan of Care
  • Residential Hospice Patient
  • Respite Care
  • Room and Board Services
  • Other Pertinent Definitions as Identified by the Parties
  • Bed Hold

3. Eligible Residents (criteria)

  • Medicaid Eligible
  • Medicare Eligible
  • Medicaid/Medicare (dual eligibility)
  • Private Insurance or HMO
  • Private Pay
  • Other Pertinent Sections As Identified by the Parties

4. Coordination of Services

  • Admission Procedures (general process, written orders, authorizations)
  • Patient Care Management (decision process, delegation of responsibility)
  • Continuity of Care (transfers between levels of care, actions requiring patient notice)
  • Communication Process (detail the process generally and for emergencies)

— notification of MD (change of condition, death, etc.)

— notification of hospice

  • Interdisciplinary Team Meetings
  • Quality Assurance/Performance Improvement
  • Drugs and Pharmaceuticals
  • Medical Equipment and Medical Supplies
  • Transportation and Ambulance
  • Family Services and Bereavement Care
  • Other Pertinent Sections as Identified by the Parties

5. Hospice Duties, Responsibilities and Services

  • Hospice Services (general coverage under Routine Home Care), Access and Availability
  • Provision of Core Services
  • Compliance with Law (including licensure, staff qualifications)
  • Hospice Patient Care Management
  • Management of the Terminal Illness: Plan of Care
  • Medical Order: Responsibilities of Attending Physician
  • Medical Order Procedures
  • Documentation (clarification of respective duties, location of original medical record)
  • Confidentiality of Medical Record
  • Orientation and Education
  • Other Pertinent Sections as Identified by the Parties

6. Facility Duties, Responsibilities and Services

  • Facility Services (generally, room and board, specific services, plan of care, cooperation with hospice in identified areas, bedhold policy)
  • Compliance with Law (including licensure, staff qualifications)
  • Availability of Nursing Home Care (hours of care, adequate services, personnel)
  • Documentation (clarification of respective duties, location of original medical record)
  • Facility Staff Privileges: Hospice Medical Director
  • Access to Documents (medical/business records, federal record retention requirements for facility, subcontractors)
  • Orientation and Education
  • Other Pertinent Sections as Identified by the Parties

7. Financial Responsibility

  • Responsibility of the Hospice
  • Responsibility of the Facility
  • Reimbursement

— Medicaid Patients

— Medicare Patients

— Medicaid/Medicare Patients

— Private Pay/Insurance Patients

— Purchase of Services by the Hospice from the Facility

— Other Pertinent Sections as Identified by the Parties

8. Insurance and Indemnification

9. Joint Review of Hospice Services (quality, appropriateness)

10. Compliance with Government Regulations (caregiver background checks, nurse aide registry, corporate compliance, etc.)

11. Relationship Between the Parties

12. Conflict Resolution Process

13. Term of the Agreement (length, renewals)

14. Termination of the Agreement (for cause/without cause, events precipitating regulatory implications, resident transfers and single-case continuation agreements, resident notice timeframes)

15. Amendments to the Agreement

16. Notice Requirements (form, method, and delivery)

17. Miscellaneous (including non-discrimination policy)

18. Other Pertinent Sections as Identified by the Parties

19. Appendices (if desired, may include references to provider policies, clinical protocols and procedures)