Service Agreements

This section sets out the standing under which this policy is issued, who owns it, who is bound by it, and how it is kept current. It is not itself a procedure. The obligations begin at Section 1.

This policy establishes how Sample Agency, LLC (the "Agency") makes a written agreement with each client before and as services begin, so that the client knows what services will be provided, how often and for how long, what they cost, how to raise questions or complaints, and what the client has authorized the Agency's staff to do.

This policy applies to every client and every service category the Agency provides (companion or sitter services and personal care services), for every payer, including Medicaid waiver participants (whose program documents add to, but do not replace, the service agreement).

For the purposes of this policy:

All services provided to a client are based on a written service agreement entered into with the client or the client's responsible party, if applicable, containing every item listed in Section 5. (111-8-65-.09(2)(a)) For new clients, the initial service agreement is completed not later than the second visit to the client's residence to provide services if the second visit occurs on a different day from the first visit, or not later than seven calendar days after services are initially provided in the residence, whichever is earlier. (111-8-65-.09(2)(b)) If the Agency is unable to complete the service agreement for good cause, it documents the reason in the client's file. (111-8-65-.09(2)(b)1)

The client file contains the current service agreement. (111-8-65-.09(4)(a)2) A client has the right to cancel any service agreement at any time. (111-8-65-.09(2)(c))

Form GA-HC-ADM-02-A contains each item below. The supervisor checks every item is complete before signing.

1. As the Agency's own standard, the supervisor completes the service agreement at the admission visit, before or at the first visit to provide services, whenever possible.
2. The supervisor explains each part of the agreement, the schedule of charges and the notice of rights to the client and responsible party, in the client's preferred language and with any aid the client needs (Policy GA-HC-CR-02), and answers questions.
3. The supervisor confirms who will sign for the client. If anyone other than the client signs, the basis of that person's authority is recorded on Form GA-HC-CR-03-A (Policy GA-HC-CR-03).
4. If the agreement is not completed at the first visit, the supervisor records the date services were initially provided in the residence and calculates the deadline: the second visit, if it occurs on a different day from the first visit, or seven calendar days after services were initially provided, whichever is earlier. (111-8-65-.09(2)(b)) The deadline is entered on the schedule and the supervisor completes the agreement by then.
5. If the agreement cannot be completed by the deadline for good cause, the supervisor writes the reason in the client's file, with the date and what is being done to complete it, and completes it as soon as the cause ends. (111-8-65-.09(2)(b)1) A lack of staff time is not good cause.
6. The client or responsible party receives a signed copy of the agreement and its attachments. The original is placed in the client file. (111-8-65-.09(4)(a)2)

Example: services first provided on Monday, March 1. The second visit is on Wednesday, March 3, which is earlier than seven calendar days after March 1 (March 8). The agreement must be completed by the visit on Wednesday, March 3.

1. The supervisor asks what the concern is and, where possible, resolves it, for example by correcting an error or explaining a term again.
2. If the client or responsible party still refuses to sign, the supervisor notes the refusal on the agreement with an explanation, and signs and dates it. (111-8-65-.09(2)(a)10)
3. The supervisor tells the Administrator, who decides whether services can safely continue. If the refusal is because the client does not want the services, the client's right to refuse is respected (Policy GA-HC-CR-01) and services end under Policy GA-HC-DC-01.

Subsequent revisions to the initial service agreement may be handled by the Agency noting in the client's record the specific changes in service (for example addition or deletion of service, changes in frequency, or duration, or charge for services) that will occur and that the change was discussed with and agreed to by the client and/or responsible party, as appropriate, who signed the initial agreement, prior to the change in services occurring. (111-8-65-.09(2)(b)2) Accordingly:

1. No change in services or charges takes effect until it has been discussed with, and agreed to by, the client or responsible party who signed the initial agreement.
2. The supervisor records the revision on the revision page of Form GA-HC-ADM-02-A, or in the client record, stating the specific change, the date it was discussed, who agreed, and the date it takes effect.
3. The supervisor updates the service plan to match (Policy GA-HC-SP-01), and gives the client an updated copy.
4. As the Agency's own standard, a new full service agreement is signed when the client changes service category (for example from companion or sitter tasks to personal care tasks), when the responsible party changes, when the payer changes, or when more than three revisions have been made since the last full agreement.
5. A change in charges is also handled under Policy GA-HC-BUS-01.

A client has the right to cancel any service agreement at any time and is only charged for services actually rendered prior to the time that the Agency is notified of the cancellation. The Agency may assess a reasonable charge for travel and staff time only if notice of the cancellation is not provided in time to cancel the service prior to the staff member arriving at the client's house to perform the service. (111-8-65-.09(2)(c)) Charges are handled under Policy GA-HC-BUS-01. Ending services is handled under Policy GA-HC-DC-01.

Accountability under this policy is allocated as follows.

The current service agreement, its attachments, all revisions, any record of good cause for delay, and superseded agreements are kept in the client file for at least five years from the date of last service provided (111-8-65-.09(4)(a)2; 111-8-65-.09(4)(b)1).

Each quarter, as the Agency's own standard, the Administrator reviews the agreements of all clients admitted in the quarter (or a sample of at least ten) for: all ten items present; completion within the time frame or documented good cause; signatures or a noted refusal; and revisions recorded and agreed before the change. Findings are reported to the quality improvement program under Policy GA-HC-QA-01.

Supervisors and office staff are trained on this policy before they prepare or sign service agreements, and at the annual refresher. Direct care staff are trained at orientation to provide only agreed services and to pass requests for change to the supervisor.

This policy implements the following authorities.

• Ga. Comp. R. & Regs. 111-8-65-.09(2), Service Agreements, including (2)(a)1 to 10, (2)(b)1 and 2, and (2)(c)
• Ga. Comp. R. & Regs. 111-8-65-.09(4)(a)2 and (4)(b)1, client records and retention
• Ga. Comp. R. & Regs. 111-8-65-.03(g), (r) and (s), definitions of home management, responsible party, and transport and escort services
• Ga. Comp. R. & Regs. 111-8-65-.12(2) and (4), notice of rights and the provider's telephone number

The following documents are read together with this policy.

This policy is adopted by the governing body of Sample Agency, LLC. The effective date, the person who approved it, and the date of approval are shown in the header block and recorded in the signature lines below.

Every version of this policy, the date it took effect, a summary of what changed, and who approved it is recorded below. Where a rule cited in Section 13 is amended, the amendment is recorded in this table and a new version of this policy is issued.