Client / Staff Agreement

We enter into this agreement to provide Homecare services for the Consumer.

Consumer (or Responsible Party) Roles and Responsibilities

As a Consumer using Bella Mente Inc. as my Homecare provider, I, or my Responsible Party (if applicable), agree to the following responsibilities:

1. Accept responsibility for my health and safety; meaning I will find staff or supports that ensure my health and safety needs are met. I ensure that I have adequate backup staff or support in case a regularly scheduled PCA is unable to fulfill their duties as scheduled.

2. Develop and revise, as needed, a Consumer Care Plan that details my health, safety and care needs and schedule based on my physician's orders and public health nurse assessment.

3. Recruit, interview and hire my own staff. Before working any shifts, ALL of my staff must pass a criminal background check, facilitated by Bella Mente to ensure they have no prior criminal record that disqualifies them from being employed as a Caregiver.

4. As a joint employer with Bella Mente, enter into a written agreement with each of my caregiver before I receive their services. No caregiver will start services without a valid service agreement on file with Company. Verify with your QP that service agreement is active. caregiver WILL NOT BE PAID BY COMPANY for unauthorized work. caregiver Payment responsibility will fall on the client when this policy is violated.

5. Schedule my staff and provide ongoing supervision and evaluation of my staff.

6. Provide information, orientation and training to my PCA staff including safety and emergency procedures in their applicable service/working environment.

7. Provide and maintain my personal emergency contact information and any advance directives (if applicable), to my staff for my own safety. I will also recommend to my staff that they provide their emergency contact information to utilize in the event of emergency while on the job.

8. Manage the use of my allocated hours/units to ensure I do not use more than allocated in my Service Authorization (SA). I will monitor my use of flexible units, and if I run out of units before my services authorization expires I understand my care services will be suspended until the new SA starts or I will personally pay for my continued care. CLIENT IS RESPONSIBLE FOR THIS MONITORING.

9. Abide by Department of Labor regulations and Bella Mente policies regarding overtime.

10. Monitor, ensure accuracy and verify time worked by my caregivers. Sign verified time cards for my staff. Submit time sheets to Bella Mente as outlined in the company policies and procedures.

11. Notify Bella Mente of my in-patient treatment or hospitalization dates throughout our service agreement.

12. Notify the county public health nurse, waiver service coordinator or otherwise appropriate individual when it is time for a reassessment of my need for Homecare services or if there is a change in condition or change in the level of services that I need. 

13. As joint employers, I will notify Bella Mente prior to terminating any caregivers and inform them of the effective date. I will notify Bella Mente if assistance is needed in terminating an employee.

14. Contact the Bella Mente Program Manager in the event of a billing or payment complaint.

15. Notify Bella Mente in writing if I want to terminate this agreement at any time.

16. Comply with Bella Mente company policies and procedures.

Provider Roles and Responsibilities
As your Homecare provider, Bella Mente agrees to perform the following:

1. 1. Enroll and meet all standards as a PCA Provider and 245D License holder with the Minnesota Department of Human Services, including passing a criminal Background Study (BGS).

2. As a joint employer with the Consumer or Responsible Party, enter into a written agreement with each caregiver the Consumer chooses to hire before services are provided to the Consumer.

3. Obtain releases, request and secure background checks according to the State of MN human services licensing act for all caregivers referred by Consumer or Responsible Party.

4. Bill the Department of Human Services or appropriate health care plan for personal care assistant services rendered.

5. Pay the caregivers at the rate determined by the Consumer as provided on the Bella Mente Pricing Schedule.

6. Issue paychecks, withhold and remit all applicable state and federal taxes from caregiver's paychecks.

7. Arrange for and pay the employers share of payroll taxes, unemployment insurance, workers compensation insurance and liability insurance for all staff.

8. Keep records of the hours worked by caregivers as submitted by the Consumer or Responsible Party.

9. Assist Consumer in terminating caregiverss, if requested to do so by the consumer.

10. Assess an administrative fee for the provision of Homecare services. (Refer to the Pricing Schedules for current Administrative Fees.)

11. Ensure arms length transactions and confirm Bella Mente is not related to the Consumer orcaregiver.

Caregiver Responsibilities

As a Caregiver employed by the Consumer and Bella Mente, I agree to the following responsibilities:

1. Enter into a written agreement with the Consumer and Bella Mente, as joint employers, before providing services
to the consumer.

2. Complete all required forms and provide necessary information to Bella Mente, including criminal background study release and my Individual PCA Provider ID number prior to providing services to the Consumer.

3. Complete and pass a criminal Background Study with the BCA submitted through Bella Mente, before working any shifts, a requirement of eligibility to be a personal care assistant.

4. Obtain and maintain an active Individual PCA Provider ID number from the Minnesota Department of Human Services. I agree to complete and submit updated registration forms to Bella Mente any time my personal information (legal name, residential address, phone #, etc.) changes.

5. Obtain training from the Consumer (or Responsible Party), to ensure I can satisfactorily perform all responsibilities in the Consumer's Care Plan. Training includes: proper use of equipment, review of care plan, medication procedures, safe transfers, emergency information form and procedures, and any other forms. I agree
to communicate with the Consumer (or Responsible Party) directly, regarding any health or training concerns.

6. Provide and maintain my personal emergency contact information to the Consumer (or Responsible Party) for my own safety while on the job.

7. Work at scheduled times as determined by the Consumer, notifying the Consumer of changes as early as possible to arrange for backup assistance. NEVER work over 40 hours a week unless permission in writing from the company is obtained. You will not be paid for unauthorized work hours over 40 a week.

8. Provide Homecare services to the Consumer as specified in their plan of care, following written and verbal directions from the Consumer. Communicate respectfully and directly to the Consumer regarding services. Understand Caregiver will NOT be paid for timesheets deemed fraudulent by the Company or Client.

9. Assist with Activities of Daily Living (ADLs) and Health Related Functions (HRFs) as directed, being observant and staying alert to ongoing instructions by the Consumer. Support the Consumer when they participate in community activities, relationships and involvement with others.

10. Inform the Consumer about all visible bodily changes that may need medical attention.

11. While working within the Consumer's home, maintain respect as a professional and focus on job related activities. Perform duties in an ethical matter, preserving and respecting the rights and dignity of the Consumer. Keep the Consumer's personal life as confidential, respect their personal property and adhere to Bella Mente data privacy policies.

12. Be present when working with the Consumer in their service environment, and leave only when the shift is completed.

13. Follow safety and emergency procedures in my applicable service/working environment and work to identify my safety needs and along with those of the Consumer.

14. Accurately document time worked for Consumer by promptly completing and signing time sheets. Submit time sheets to Bella Mente as outlined in the company policies and procedures.

15. Understand that the Consumer's PCA services payment source and authorization is subject to change. If the authorization for services or payment source should stop, services may be suspended or discontinued immediately. The Consumer will be notified by Bella Mente staff and will notify me that services have stopped. No time sheets shall be submitted until services are re-authorized and Bella Mente informs the Consumer that my employment has been re-instated. I also understand that I cannot provide any services when the Consumer is receiving any type of in-patient treatment, in-patient hospitalization or nursing home.

16. Agree to monitor total hours worked with all agencies/consumers actively employed with. PCAs cannot work more than 16 hours in a 24 hour period with a maximum of 275 hours per month. This is not per Consumer or per Agency, if you work for multiple Consumers or Agencies your totals cannot exceed these limits. PCAs who are found to have violated this policy will be required to reimburse wages paid or have future wages garnished due to exceeding the maximums allowed.

17. Report any service/working environment related injuries or accidents to the Consumer (or Responsible Party) AND Bella Mente Administrative Office within 24 hours of the incident, as outlined in the company policies and procedures.

18. Update Bella Mente staff anytime my status changes (name, address, phone #, tax exemptions, etc

19. Read, understand and comply with current Bella Mente Policies & Procedures. Bella Mente will publish any changes to the Policies & Procedures which are available on our web site.

 

Grievance Procedure

Bella Mente asks that if any PCA has any concerns they shall bring them up to their manager, the Consumer. Consumers are encouraged to address issues directly with their PCA. If the PCA/Consumer is unable to resolve the issue, they may bring the issue to the Bella Mente Program Manager. Bella Mente is committed to providing a timely response to concerns brought forward.

Regulatory Compliance

Both parties are responsible for complying with all rules and regulations related to PCA Choice. This includes, but is not limited to: State Vulnerable Adults Act, Data Privacy, PCA regulations, and Department of Labor Laws.

Cancellation and Amendments

Employees may resign their employment with the Consumer and Ability Care Partners, as joint employers, at any time for any or no reason, and the Consumer and Bella Mente reserve the same right regarding discontinuation of signed individual's employment. Any party may choose to cancel or amend this agreement at any time.

WE, THE BELOW SIGNED, HAVE READ AND UNDERSTAND THIS ENTIRE AGREEMENT.

These rates remain in effect until further notice and supercede any previously published rates.