{"ref":"OH-HC-ADM-02","title":"Client Service Agreement and Disclosure of Charges","category":"Service delivery","summary":"Requires a written Client Service Agreement, signed before services begin, that sets out the services, schedule, charges and payment terms, how either side may change or end services, how to complain and how to claim for loss or damage; explains how the agreement works for clients whose services Medicaid pays for, who are never billed for covered services; and sets how the agreement is changed, renewed and kept.","inShort":["Every client signs a service agreement before the first service. Explain it in plain words and in the client's language.","Private-pay clients also sign the statement of charges. Never charge anything that is not in it.","Never ask a Medicaid client or family to pay for a covered service, or for a missed or cancelled visit.","If a Medicaid client wants more hours, tell your supervisor. The case manager decides what is authorized.","Any change to services, schedule or charges is agreed and written down before it starts."],"primaryCitation":"OAC 5160-1-17.2(C)","citations":["OAC 5160-1-17.2(C)","OAC 173-39-02(B)(11)(c)","OAC 173-39-02(A)(5)(b)","OAC 5160-45-03(B)","OAC 5160-44-31(A), (B)(8)(a)"],"federalCitations":[],"surveyorAsks":["Show me the signed service agreement for this client. When was it signed compared with the first visit?","How does a private-pay client learn what the services will cost before they start?"],"forms":[{"ref":"OH-HC-ADM-02-A","title":"Client Service Agreement"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (OAC 5160-1-17.2(C))","5. What the Agreement Contains","6. Giving and Explaining the Agreement","7. Clients Whose Services Medicaid Pays For","8. Private-Pay and Insured Clients","9. Changing the Agreement","10. Ending the Agreement","11. Responsibilities","12. Records and Compliance Monitoring","13. Staff Training","14. References","15. Related Policies and Forms","16. Approval","17. Revision History"],"version":"1.0","sample":false,"pack":"oh-hca","state":"Ohio","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}