{"ref":"PA-HH-PR-03","title":"Patient Agreement, Consent, and Disclosure of Charges","category":"Client rights","summary":"Sets out the written service agreement and consent each patient signs before care begins, the consent to release information outside the Agency that 28 Pa. Code §601.36(c) requires, the patient’s right to refuse, how the Agency tells each patient orally and in writing what Medicare, Medical Assistance or another payer is expected to cover and what the patient may have to pay, and the written notices given in advance of non-covered care or of reducing or ending care.","inShort":["Have the patient sign the agreement and consent (Form PA-HH-PR-03-A) before the first hands-on care.","Explain who is expected to pay and what the patient may owe, out loud and in writing, before care starts.","Ask before every treatment; if the patient refuses, explain the likely result, respect the decision, write it down and tell your supervisor the same day.","Do not send records outside the Agency without the patient’s written consent unless the law allows it.","Tell your supervisor at once if coverage changes or care may be cut back or ended, so the patient gets written notice in time."],"primaryCitation":"42 CFR §484.50(c)","citations":["28 Pa. Code §601.36(c)","28 Pa. Code §601.31(a)","55 Pa. Code §1249.52(a)(6)","62 P.S. §1407(a)(10)"],"federalCitations":["42 CFR §484.50(c)(4)","42 CFR §484.50(c)(7)","42 CFR §484.50(c)(8)","42 CFR §405.1200","42 CFR §405.1202","42 CFR §411.408(d)(2)","42 CFR §411.408(f)"],"surveyorAsks":["Show me the signed consent for this patient. Was it signed before the first hands-on care?","How was this patient told what Medicare would cover and what she would have to pay? Was it oral as well as written?"],"forms":[{"ref":"PA-HH-PR-03-A","title":"Home Health Services Agreement and Consent"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §484.50(c))","5. Verifying Coverage Before the First Visit","6. The Agreement and Consent","7. Consent During Care, Refusals, and Withdrawal","8. Explaining Payment and Charges","9. Changes in Payment Information","10. Advance Notices: Non-Covered Care, Reductions, and Terminations","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":"pa-hha","state":"Pennsylvania","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}