Medicaid Attendant Care Contract

Non-Public Entity OHCDS Services to be Subcontracted by

Organized Health Care Delivery System Services or !nde"endent #iving
Home and Community $ased Services %e&uest or Pro"osal
A' Consumer(Em"loyer)s Name* +++++++++++++++++++++++++++++++++++++++++++++++
$' Attendant(Em"loyee)s Name* +++++++++++++++++++++++++++++++++++++++++++++++
C' Date o Contract* +++++++++++++++++++++++++++++++++++++++++++++++++++++++++
A,,ENDAN, CA%E CON,%AC,
,his Attendant Care Contract (Contract) is made by Services or !nde"endent
#iving and the Attendant(Em"loyee identi-ed in line $ above .ho .ill be em"loyed
by the Consumer(Em"loyer identi-ed in line A above as o the Date o Contract
s"eci-ed in line C above'
1. Defnitions and responsibilities' !n order to ma/e this Contract more easily
understood0 certain terms are de-ned and various res"onsibilities are described
as ollo.s*
a1 ,he term Consumer/Employer means the individual identi-ed in #ine A
above .ho re&uires attendant care services in his(her home' Hereater0 the
Consumer(Em"loyer .ill be reerred to as Consumer' Consumer is the
em"loyer o the Attendant(Em"loyee and as such is res"onsible or directing0
managing0 scheduling 2.ithin the "arameters o authorized service hours10
and su"ervising the Attendant(Em"loyee' Consumer is res"onsible or
revie.ing all timesheets connected .ith Attendant(Em"loyee)s hours o
service or accuracy0 and Consumer is res"onsible or "rom"tly or.arding
the same to Services or !nde"endent #iving' Consumer0 through the -scal
intermediary0 .ill "ay the Attendant(Em"loyee or services authorized in
Consumer)s Plan o Care by this Contract'
b1 ,he term Attendant/Employee means the individual identi-ed in line $
above .ho0 as a "arty to this contract0 agrees to "rovide attendant care
services to Consumer' Hereater0 the Attendant(Em"loyee .ill be reerred to
as Attendant' Attendant shall have and maintain the &uali-cations0
credential0 certi-cations0 licenses0 and(or training necessary to "erorm the
attendant care services described and authorized in Consumer)s Plan o Care
beore rendering any attendant care services to Consumer' Attendant is not
entitled to be "aid until and unless he(she has met(maintained all
&uali-cations or rendering attendant care services' Attendant agrees that
he(she .ill acce"t as "ayment in ull or the services described and
authorized in Consumer)s Plan o Care the "ayments he(she receives
"ursuant to this Contract' He(she .ill not see/ additional su""lemental
3
"ayments rom Consumer or others acting on behal o Consumer nor .ill
he(she acce"t additional or su""lement "ayments rom Consumer or others
acting on behal o Consumer'
c1 ,he term attendant care services or attendant care means those
services that Consumer needs to have "rovided to him(her at home in order
to achieve inde"endent living .ithin the community' Attendant care services
may include0 but are not limited to hel"ing Consumer .ith eating0 dressing0
meal "re"aration0 toileting0 bathing0 grooming0 transerring0 and s"eci-c
health maintenance tas/s0 as .ell as some incidental house/ee"ing tas/s
that insure Consumer)s health and saety0 li/e grocery sho""ing and laundry'
,he attendant care services that Attendant .ill "erorm .ill be described and
authorized in the Consumer)s Plan o Care' A co"y o the "ertinent "arts o
the Plan o Care .ill be "rovided to Attendant'
d1 ,he term Services or !ndependent "ivin# means the agency signing
this Contract' Hereater0 Services or !nde"endent #iving .ill be reerred to
as $ni%ue !n&'ome 'ealt( Care) ""C' !t is recognized as a vendor o
Consumer Directed Services and enrolled as an Organized Health Care
Delivery System .ith the De"artment o Health and Senior Services0 Division
o Senior and Disability Services' $ni%ue !n&'ome 'ealt( Care) ""C is
authorized to "rovide administrative su""ort to Consumer' $ni%ue !n&'ome
'ealt( Care) ""C is authorized to enter into "ayroll service contracts .ith
"ayroll service com"anies to "rovide -scal intermediary services as set orth
belo.'
e1 ,he term fscal intermediary means a "ayroll service com"any0 under
contract .ith 4ni&ue !n-Home Health Care0 ##C0 retained to "erorm 5-scal
intermediary services6 7 those services that an em"loyer must generally
"erorm in connection .ith "aying his(her em"loyee' ,hese include
calculating the amount that an em"loyee is to be "aid0 .riting "ayroll chec/s
2or ma/ing direct de"osits10 .ithholding and "aying state and ederal income
ta8es to the a""ro"riate authorities0 .ithholding and "aying Social Security
29!CA1 and Medicare "ayments and(or em"loyer)s "ortion as is re&uired by
la. or regulation and "aying them to the a""ro"riate authorities0 and ma/ing
unem"loyment(.or/er)s com"ensation insurance "ayments0 as .ell as
.ithholding("aying those amounts as may be re&uired by la. or regulation
rom time-to-time' ,he -scal intermediary .ill "rovide Attendant .ith a
.ritten summary o all deductions and "ayments made' ,he -scal
intermediary .ill "re"are and "rovide Consumer and Attendant .ith end-o
year ta8 inormation and orms .ithin the time "rescribed by la.0 such as :-
;s0 so that Consumer and Attendant my com"ly .ith all ta8 -ling
re&uirements' ,he -scal intermediary .ill maintain co"ies o all records
re&uired by la. or regulation or ta8 and other "ur"oses0 and these shall be
;
the o<cial records documenting the em"loyer(em"loyee
2Consumer(Attendant1 relationshi"'
*. +urpose and bac,#round inormation. ,he "ur"ose o this Contract is to
allo. Consumers to intervie.0 hire0 direct0 manage0 schedule 2.ithin the
"arameters o authorized service hours10 su"ervise and discharge his(her
Attendant' $ni%ue !n&'ome 'ealt( Care) ""C is a vendor o Consumer
Directed Services and as such it is authorized by the Missouri De"artment o
Health and Senior Services to "rovide administrative su""ort or Consumer
Directed Services' $ni%ue !n&'ome 'ealt( Care) ""C may contract .ith
"ayroll service com"anies to act as a -scal intermediary' ,he -scal intermediary
.ill act as an agent or and "rovide "ayroll services or Consumer0 as e8"lained
herein'
Consumer .ill em"loy Attendant to .or/ in Consumer)s home0 at the direction
and under the su"ervision o Consumer0 to "rovide the attendant care services
described and authorized in Consumer)s Plan o Care' $ecause o the .or/
arrangement contem"lated in this contract0 Attendant is an em"loyee o
Consumer or "ur"oses o the 9ederal 9air #abor Standards Act0 and not an
inde"endent contractor' !t is0 thereore0 necessary that Consumer0 through the
-scal intermediary0 .ithhold and "ay all income ta8es re&uired by la.0 as .ell as
all other .ithholdings or "ayments that em"loyers generally ma/e in connection
.ith em"loyees in order to com"ly .ith a""licable la.s and regulations'
,he -scal intermediary .ill "erorm -scal intermediary services as described
above and "re"are and .rite "ayroll chec/s to Attendant on behal o Consumer'
-. .asis or payment. Attendant agrees to "erorm the attendant care services
described and authorized in Consumer)s Plan o Care at an initial rate o
=>'?@(hour0 .hich rate may be increased rom time-to-time .ith or .ithout
notice to Attendant' Attendant .ill be "aid only or those services described and
authorized in Consumer)s Plan o Care and no others' Medicaid .ill "rovide
unds to the -scal intermediary to "ay Attendant or authorized attendant care
services actually "erormed or Consumer' Attendant is not "ermitted to oA-set
e8cess hours in one month against scheduled hours in another month0 even i
this is agreeable to Consumer' Attendant understands that he(she is not entitled
to nor .ill he(she receive as "art o his(her "ayment hereunder0 or other.ise0
any 5ringe6 bene-ts0 such as health insurance0 sic/ leave0 "aid "ersonal days0
"aid vacation0 "aid holidays0 and the li/e'
/. 0et(od o +ayment. $ni%ue !n&'ome 'ealt( Care ""C .ill "rovide
Consumer .ith documents authorizing "ayment or the services described and
authorized in Consumer)s Plan o Care' ,he document .ill set orth the
ma8imum number o hours to be .or/ed during a s"eci-c time "eriodB and the
a""licable time "eriod or "erormance o the attendant care services' $ni%ue
C
!n&'ome 'ealt( Care ""C .ill also "rovide Consumer .ith timesheets to
record Consumer)s name0 Attendant)s name0 dates and times o services
delivered0 ty"es o activities "erormed at each visit0 Attendant)s signature or
each visit and Consumer)s signature veriying service delivery or each visit'
Payroll .ill be "rocess bi-.ee/ly' At the end o each "ayroll "eriod0 Consumer .ill
revie. and a""rove the com"leted timesheet and or.ard the same to $ni%ue
in&'ome 'ealt( Care) ""C. ,imesheets must be received by $ni%ue in&
'ome 'ealt( Care) ""C .ithin three 2C1 calendar days o the end o a "ayroll
"eriod in order to be included in the ne8t "ayroll' ! $ni%ue !n&'ome 'ealt(
Care) ""C does not receive the timesheets .ithin the "rescribed time0 then
"ayment .ill not be "rocess until ne8t "ayroll0 and Attendant)s "ayment .ill be
delayed'
!t is important t(at Consumer and Attendant accurately record and
report services and (ours. 1alsifcation or misrepresentation on any
times(eets constitutes raud. +ayments made on be(al o Consumer
as a result o inaccurate times(eets 2ill be recouped rom Attendant
and/or Consumer. Any incidents o apparent raud may be reported to
0edicaid and/or ot(er appropriate aut(orities.
3. Conditions and understandin# o Contract. ,he &uality0 a""ro"riateness
and timeliness o the attendant care services rendered and reimbursed through
this contract are subDect to evaluation0 through ins"ection or other means0 by
$ni%ue in&'ome 'ealt( Care) ""C' !n addition0 or so long as Medicaid unds
are used0 in .hole or in "art0 to "ay Attendant0 the Missouri De"artment o Social
Services and the 4'S' De"artment o Health and Human Services0 and(or
it)s(their designee2s10 have the right to evaluate0 through ins"ection or other
means0 the attendant care services rendered and reimbursed0 hereunder'
Attendant understands and agrees that he(she is not an em"loyee o $ni%ue
in&'ome 'ealt( Care) ""C and Attendant .ill not re"resent to anyone that
he(she is an em"loyee o $ni%ue in&'ome 'ealt( Care) ""C.
Attendant understands and agrees that he(she is not an em"loyee o the State o
Missouri or any de"artment0 unit0 agency0 or subdivision thereo' Attendant .ill
not re"resent to anyone that he(she is an em"loyee o the State o Missouri or
any de"artment0 unit0 agency0 or subdivision thereo'
Attendant understands and agrees that "ursuant to this Contract0 he(she is
em"loyed solely by the Consumer'
Attendant understands and agrees that this Contract is non-e8clusive' Consumer
may enter into one or more Attendant Care Contracts .ith other attendants'
Consumer may terminate this Contract .ith Attendant and such termination .ill
have no eAect on other non-terminated contracts .hich .ill remain in ull orce
E
and eAect' Similarly0 Attendant may enter into one or more Attendant Care
contracts .ith other consumers' ,ermination o one or more o such other
Attendant Care Contract2s1 .ith other consumer2s1 does not automatically
terminate this Contract'
Attendant understands and agrees that this Contract does not guarantee him(her
any s"eci-c number o hours o .or/ or any hours at all'
Attendant understands that he(she may not act as consumer)s "ersonal
re"resentative in matters regarding -nancial0 and(or budgetary decision ma/ing'
Attendant understands and agrees that he(she may not act as consumer)s
"ersonal re"resentative in matters regarding medical treatment unless0 and i
Attendant is designated as authority in Consumer)s Durable Po.er o Attorney
or Healthcare document and is acting .ithin the sco"e o his(her legal authority'
4. "iability or 2or, related in5ury/illness. Attendant understands and agrees
that Attendant and(or Consumer is(are solely res"onsible or any inDuries or
illness Attendant sustains .hile "roviding attendant care services and(or acting
.ithin the sco"e o his(her em"loyment0 and that neither $ni%ue in&'ome
'ealt( Care) ""C nor the State o Missouri has any liability or such inDuries or
illnesses'
6. 0andated 7eporter. Attendant agrees and understands that he(she is
re&uired by la. to re"ort sus"ected abuse0 neglect0 or e8"loitation as
determined under Sections FF@'@@0 ?F?'3GG0 ;@G'H3;0 ;@G'H3?0 and 3HG'@>@
%SM to 0issouri 7esponse System) 1&899&-:*&9*19.
8. Direction and supervision o Consumer' Attendant understands and agrees
that he(she .ill "erorm the attendant care services s"eci-ed in Consumer Plan
o Care in Consumer)s home under the direction and su"ervision o Consumer0 in
a manner reasonably satisactory to Consumer0 on such dates and at such times
as agreed u"on by the Attendant and ConsumerB Ho.ever0 the service times
shall not e8ceed the number o hours authorized or service'
:. ;ermination or cause. Attendant understands and agrees that consumer may
establish reasonable standards or em"loyment and "erormance and may
discharge Attendant or violation or the same' Attendant understands that
Consumer may discharge Attendant or cause .ith or .ithout "rior notices to
Attendant' Consumer)s discharge o Attendant or cause is a termination o the
Contract or cause'
19. ;ermination by Attendant. Attendant may terminate this Contract0 .ith or
.ithout cause u"on seven 2>1 days .ritten notice to Consumer and $ni%ue in&
'ome 'ealt( Care) ""C o (is/(er intention.
?
11. Contract term' ! this contract has not been "reviously terminated0 it shall
terminate one year rom the Date o Contract s"eci-ed in line C above0 or it shall
be rene.ed as set orth herein' On or beore the end o Contract term0 $ni%ue
in&'ome 'ealt( Care) ""C .ill rene. this Attendant Care Contract' ! $ni%ue
in&'ome 'ealt( Care) ""C determines that Attendant is em"loyed Consumer
at the end o the Contract term and the terms o this contract are met0 then this
Contract shall automatically rene. or a consecutive one-year term unless
Consumer has inormed 4ni&ue in&'ome 'ealt( Care) ""C that he(she no
longer .ishes to em"loy Attendant or Attendant has inormed $ni%ue in&'ome
'ealt( Care) ""C that he(she no longer .ishes to .or/ or consumer' ,his
Contract may be rene.ed or successive consecutive one-year terms i the terms
o this Contract are met0 Attendant continues to be em"loyed by Consumer and
neither Consumer nor Attendant have told $ni%ue in&'ome 'ealt( Care) ""C
that he(she .ishes to discontinue the em"loyment relationshi"' !0 at the time o
revie.0 $ni%ue in&'ome 'ealt( Care) ""C determines that Attendant is not
"resently .or/ing or Consumer0 but is li/ely to be re-em"loyed in the immediate
uture0 then $ni%ue in&'ome 'ealt( Care) ""C0 in its sole discretion0 may
rene. this Contract or a one-year terms commencing .ith the date o re-
em"loyment' !t may be rene.ed again or successive consecutive one-year
terms u"on the conditions set or in this "aragra"h and in this Contract'
1*. Confdentiality. Attendant understands that Consumer is entitled to have
his(her "ersonal and health care inormation treated .ith con-dentiality'
Attendant agrees to "rotect and maintain Consumer)s con-dentiality' 4nder no
circumstances .ill Attendant discuss or disclose Consumer)s "ersonal or health
care inormation .ithout legal authorization to do so' Consumer)s right to
con-dential treatment o "ersonal and health care inormation survives the
termination o this Contract'
1-. <on&discrimination. ,he "arties to this Contract agree that they and each
o them .ill rerain rom discrimination on the basis o race0 religion0 nationality0
se80 age0 amilial status0 color0 disability0 or any other basis not "ermitted by la.'
1/. 0iscellaneous provision. ,he Contract shall be inter"reted in accordance
.ith and governed by the la.s o the State o Missouri' ,he "lace o contract is
the county .here $ni%ue in&'ome 'ealt( Care) ""C has it)s "rinci"al o<ces'
,he invalidity or unenorceability o any "ortion or "rovision o this Contract shall
not eAect0 im"air or render unenorceable any other "ortion or "rovision' !t is
intended that each "rovision herein that is invalid or unenorceable as .ritten0
be valid and enorceable to the ullest e8tent "ossible'
4nder no circumstances may Attendant assign his(her obligation0 duties0 or
rights "ursuant to or connected .ith this Contract to any other "erson or entity'
F
All understanding0 agreement0 oAers0 re"resentations and(or .ritings made by
the "arties to this Contract "rior to the Date o Contract s"eci-ed in line C above
are hereby merged in this contract and are o no orce and eAect unless
s"eci-cally set orth in this contract'
,he ca"tions in this Contract are or convenience only to be construed as
substantive "arts o this Contract'
,his Contract may not be modi-ed e8ce"t by a .riting signed and dated by both
"arties' ,he Contract may be rene.ed "ursuant to "aragra"h 3@ above .ithout
an additional .riting and Attendant)s com"ensations or services may be
increased rom time-to-time as authorized by la. or regulation .ithout notices or
a .riting signed by both "arties'
At the time o termination o this Contract0 .hether or cause0 end o term0 or
other.ise0 Attendant agrees to "rom"tly deliver to $ni%ue in&'ome 'ealt(
Care) ""C) any and all records0 materials0 directives0 memos0 or other
documents that "ertain to this Contract0 Consumer or $ni%ue in&'ome 'ealt(
Care) ""C) including but not limited to all originals and(or co"ies o Consumer)s
Plan o Care 2in .hole or in "art10 con-dential Consumer inormation0 medical
care direction and(or "hysician(medical care instructions0 com"leted or
incom"lete timesheets0 and the li/e0 e8ce"t that Attendant may retain
Attendant)s "ayroll records and ta8 inormation'
At the time o termination o this Contract0 .hether or cause0 end o term0 or
other.ise0
Attendant agrees to "rom"tly "rovide Consumer .ith current timesheet
inormation so that the last "ayroll or Attendant may be com"leted'
13. Si#natures. .= S!><!<> .E"?@) =?$ ACA<?@"ED>E =?$ 'ABE
7EAD ;'!S C?<;7AC;) =?$ ACCE+; !;) A<D A>7EE ;? !;S ;E70S.
Services or !nde"endent #iving*
$I* ++++++++++++++++++++++++++++++++++++++++++++++ 2sign1
++++++++++++++++++++++++++++++++++++++++++++++
2Print Name and ,itle1
A,,ENDAN,* ++++++++++++++++++++++++++++++++++++++++++++++ 2sign1
++++++++++++++++++++++++++++++++++++++++++++++
2Print Name1
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