sample hospice travel contract

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Travel contract enables hospice patient to visit family

Ann Fischetti knows firsthand how fragile life can be. Just six months ago, the 81-year-old Eau Claire, Wisconsin, woman was feeling fine and eagerly awaiting the holidays. Now, Fischetti’s health has taken a turn for the worse, and her prognosis is not good.

But she’s determined to make the most of every remaining moment she has. Her recent trip to California is evidence of that.

Fischetti, a mother of five, grandmother and, now, great grandmother, discovered a large lump in her chest on Dec. 20, 2013. With relatives due to arrive any day and not wanting to worry anyone during their family doings, she waited until after the holidays to act on her revelation.

Her doctor ordered a mammogram and ultrasounds and, through those tests, Fischetti learned that she had advanced stage four lung cancer and a cancerous lump in her chest.

Despite undergoing radiation therapy, the tumor in her chest continued to grow, and she entered Mayo Clinic Health System’s Home Health & Hospice program in February.

Fischetti, who had an estimated six-month life expectancy, deeply wanted to visit family in California while she still felt well enough and, with the help of her daughter and hospice team, planned an unforgettable nine-day trip there.

“I wanted to say goodbye to my brother and his family, and I wanted to spend more time with my son,” she says.

Since cross-country travel isn’t typical for hospice patients, those who’ve pursued similar endeavors have generally been discharged from hospice care until they returned to the area. Fischetti’s request prompted a different course of action — a traveling contract.

“What appealed to her about hospice, in general, was to have someone to call if something would change and to avoid having to rush to the emergency room,” explains Billie Anderson, the social worker who helped facilitate Fischetti’s traveling contract arrangements. “This led to looking to see if we could help meet her goal of going on the trip and her goal also of having hospice there and potentially having us to co-manage her care from a distance.”

Home Health & Hospice worked quickly to identify a receiving hospice agency willing to support Fischetti, including after-hours care, if needed.

“It was such a comfort to know that if anything happened to me while I was out there, I did have hospice to lean on, and they were there for me. It gave me a feeling of security in case anything happened. It was just like somebody there to catch you if you stumbled,” Fischetti says.

She never needed care from the other hospice agency but appreciated the safety net the arrangement provided her. 

Kelly Sikkink, assistant administrator of Home Health & Hospice, applauds Fischetti for entering the hospice program early enough to take advantage of options like this and demonstrating how patients can live life to the fullest. She notes that her request has expedited the development of a traveling contract template for all affiliate Mayo hospice programs to use going forward.

“We’re hoping her story inspires other people to elect hospice care earlier so they can make the most of what time remains” Sikkink says.

Likewise, Fischetti has nothing but praise for the Mayo Clinic Health System hospice team.

“I can’t praise them enough,” she says. “They have just been awesome.”

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Hospice Form Contract Templates

Business Associate Agreement

$250.00    

General Inpatient Care

$250.00   

Inpatient Respite Care

Skilled Nursing Facility / Nursing Facility Resident

Medical Director

ENTIRE SET OF 6 CONTRACTS

Hospice Physician

Compliant contracts are an essential component of the Office of Inspector General's (OIG) recommendations for an effective compliance program. The hospice experts at Weatherbee Resources and Arent Fox, LLP , a healthcare law firm, have created 6 Hospice Form Contract templates that allow the hospice provider and/or its legal counsel to customize each contract to include any state, federal, accreditation, or best practice language. 

Click here to read disclaimer information and see an abbreviated sample contract (non-editable / non-printable)..

The Business Associate Agreement (BAA) is a legal document between a healthcare provider and a contractor/vendor (e.g., pharmacy provider, medical equipment supplier, etc.) intended to communicate the parties' obligation to safeguard Protected Health Information (PHI). This legal contract satisfies Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations when the contractor/vendor has access to a hospice's PHI. This contract creates a bond of liability between the parties who create, transmit, or receive information and/or documentation that contains PHI.​

General Inpatient Care Contract

General Inpatient (GIP) care and services are available to hospice patients for short-term acute or chronic pain management or other symptom crisis, provided in an inpatient facility when a patient's care cannot be managed in an alternate setting. The Centers for Medicare and Medicaid Services (CMS) has long expressed concerns about possible misuse of GIP such as: care being billed for but not provided, long lengths of stay, and beneficiaries receiving care unnecessarily. Therefore, it is vital that General Inpatient Care contracts are written in a manner compliant with state and federal regulations and contain each parties' individual and collective responsibilities related to patient care in order to avoid the risk of noncompliant practices and negative payment implications.​

Inpatient Respite Care Contract

CMS defines respite care as, "... short-term inpatient care provided to the individual only when necessary to relieve the family members or the person caring for the individual at home." Weatherbee's Inpatient Respite Care contract aligns the hospice's Respite Care policies with Respite facility's procedures to ensure both parties meet the Respite needs of the patient/family, while ensuring mutual adherence to the patient's palliative Plan of Care established by the hospice.​

Skilled Nursing Facility / Nursing Facility Resident Contract

A Skilled Nursing Facility (SNF) or Nursing Facility (NF) provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists, and audiologists to hospice patients, based on the needs identified in the patient's Plan of Care. Skilled nursing facilities provide round-the-clock assistance with patients' care needs and activities of daily living. There are numerous federal regulations and OIG recommendations regarding what hospices, SNFs, and NFs must do to demonstrate compliance and receive payment from Medicare and/or Medicaid programs. Weatherbee's SNF/NF contract includes the parties' individual and collective responsibilities related to patient care while ensuring compliance with state and federal regulations.​

Medical Director and Hospice Physician Contracts   (2 separate contracts)

The Hospice Medical Director and Physician member(s) of the interdisciplinary group (Hospice Physician), in conjunction with the patient's attending physician, are responsible for the palliation and management of the needs of the hospice patient. Weatherbee's contracts for the Medical Director and Hospice Physician outline the administrative and patient care responsibilities of the physician as well as other compliance-specific elements designed to promote the highest quality of patient care.​

When purchased individually or as a full set, each contract is an electronic, downloadable product. An email will be sent to the purchaser with instructions for downloading and accessing the contract(s). The contracts are drafted in Microsoft® Office Word format, which can be edited and/or customized to meet the unique needs of a hospice provider.

Hcn members receive a 10% discount only if the six (6) contracts are purchased as a set. call (866) 969-7124 to verify hcn membership and order., purchasers of this hospice form contract are permitted to use the contractual language contained herein for one location only; pricing is available for hospices with multiple locations. no part of this contract may be reproduced in any form or by any means, electronic of mechanical including photocopying, recording or by and information storage and retrieval system and shared with third parties, without prior written permission fo weatherbee resources and arent fox, llp. to license the hospice form contract template(s) for use at more than one location, please contact weatherbee resources at (866) 969-7124 or email [email protected].

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• Complying with the Vendor Contracting Requirements of the New CoPs
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Hospices often contract with professionals and other entities for a wide variety of services and supplies, ranging from therapy to durable medical equipment and supplies. The new Medicare Conditions of Participation (CoP) set forth certain minimum requirements for these arrangements in order to ensure that hospice care patients receive quality care, regardless of whether the services are provided by the hospices' own employees or under arrangements with contracted providers.

Before deciding to use a vendor to provide a particular hospice service, hospices must consider whether the CoPs allow the hospice to provide the service through a contracted entity or individual, rather than providing the service directly by its own employees. The CoPs require hospices to routinely provide nursing services, medical social services, and counseling services (including dietary counseling) directly by hospice employees. However, in limited circumstances, a hospice may qualify for a waiver that allows contracting for nursing services or dietary counseling services. Notably, in commentary to the new CoPs, the Centers for Medicare and Medicaid Services (CMS) stated that it also considers services such as music therapy, art therapy, and massage therapy to be "counseling services" which must be provided by hospice employees. Many hospices have questioned this position, and it is possible CMS may provide additional clarification.

If the CoPs permit the service to be provided under contract, the hospice must ensure that the language of its vendor agreement contains the basic elements required by the CoPs. At a minimum, a hospice's contracts with its vendors who provide hospice services must include provisions requiring that all services provided be (1) authorized by the hospice, (2) furnished in a safe and effective manner by qualified personnel, and (3) delivered in accordance with the patient's plan of care. The revised CoPs also state, "Hospice contracts must require that all contracted entities obtain criminal background checks on contracted employees who have direct patient contact or access to patient records." Although there is some debate about how far this requirement extends, CMS's commentary to the CoPs suggests that it would encompass traditional vendor relationships, such as durable medical equipment suppliers and pharmacies.

In addition to these specific requirements that must be contained in the written contract, the CoPs set forth a number of obligations that touch on hospices' relationships with their vendors. Although hospices are not specifically required to address these general obligations in their contracts, they may find it helpful to do so in many cases so that the parties have a clear understanding of their mutual obligations and the hospice can help demonstrate compliance to surveyors. Examples of these requirements include:

Professional Management Responsibility (42 C.F.R. § 418.100(e) . The hospice must retain administrative and financial management and oversight of staff and services for all arranged services, to ensure the provision of quality care.

QAPI (42 C.F.R. § 418.58) . The hospice's quality assessment and performance improvement program (QAPI) must involve all hospice services, including those services furnished under contract.

Training, Assessment, and Education (42 C.F.R. §§ 418.100(g); 418.60(c) . The hospice must provide orientation about the hospice philosophy to all contracted staff who have patient and family contact. In addition, the hospice must assess the skills and competence of all individuals furnishing care and, as necessary, provide in-service training and education programs where required. The hospice must have written policies and procedures describing methods of assessment of competency. Finally, the hospice must provide infection control education to contracted providers.

Patient Grievances (42 C.F.R. § 418.52(b)(1) . Hospice patients have the right to voice grievances regarding treatment or care that is (or fails to be) furnished and the lack of respect for property by anyone who is furnishing services on behalf of the hospice. To ensure that the hospice becomes aware of patient grievances, vendor agreements may require the vendor's personnel to report grievances to the hospice.

Caregiver Misconduct (42 C.F.R. § 418.52(b)(4) . The hospice must ensure that all alleged violations involving mistreatment, neglect or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property by anyone furnishing services on behalf of the hospice, are reported immediately by hospice employees and contracted staff to the hospice administrator.

The CoPs also contain requirements that must be addressed for specific types of vendors. For example, the new CoPs only permit hospices to contract for durable medical equipment (DME) services with a DME supplier that meets the Medicare DMEPOS Supplier Quality and Accreditation Standards at 42 C.F.R. § 424.57. CMS has created a limited exception for hospices that contracted with an unaccredited DME provider prior to December 2, 2008, if the hospice obtains a letter from the vendor stating that it has applied for accreditation and expects to be accredited by September 30, 2009. Other specific requirements and qualifications apply to services such as physical therapy, occupational therapy, speech language pathology, home health and homemaker services, and pharmacy services.

Reinhart's Hospice and Palliative Care Practice Group has developed the Hospice Vendor Contracting Toolkit to help hospices develop vendor contracts that are compliant with the revised CoPs. In addition to the nine sample vendor contracts included in the Toolkit , covering services such as therapy and pharmacy, the Toolkit contains a "Vendor Contracting Checklist" that can help hospices evaluate the compliance of their current contracts with the revised CoPs.

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Metallurgicheskii Zavod Electrostal AO (Russia)

In 1993 "Elektrostal" was transformed into an open joint stock company. The factory occupies a leading position among the manufacturers of high quality steel. The plant is a producer of high-temperature nickel alloys in a wide variety. It has a unique set of metallurgical equipment: open induction and arc furnaces, furnace steel processing unit, vacuum induction, vacuum- arc furnaces and others. The factory has implemented and certified quality management system ISO 9000, received international certificates for all products. Elektrostal today is a major supplier in Russia starting blanks for the production of blades, discs and rolls for gas turbine engines. Among them are companies in the aerospace industry, defense plants, and energy complex, automotive, mechanical engineering and instrument-making plants.

Headquarters Ulitsa Zheleznodorozhnaya, 1 Elektrostal; Moscow Oblast; Postal Code: 144002

Contact Details: Purchase the Metallurgicheskii Zavod Electrostal AO report to view the information.

Website: http://elsteel.ru

EMIS company profiles are part of a larger information service which combines company, industry and country data and analysis for over 145 emerging markets.

To view more information, Request a demonstration of the EMIS service

Claudia Looi

Touring the Top 10 Moscow Metro Stations

By Claudia Looi 2 Comments

Komsomolskaya metro station looks like a museum. It has vaulted ceilings and baroque decor.

Hidden underground, in the heart of Moscow, are historical and architectural treasures of Russia. These are Soviet-era creations – the metro stations of Moscow.

Our guide Maria introduced these elaborate metro stations as “the palaces for the people.” Built between 1937 and 1955, each station holds its own history and stories. Stalin had the idea of building beautiful underground spaces that the masses could enjoy. They would look like museums, art centers, concert halls, palaces and churches. Each would have a different theme. None would be alike.

The two-hour private tour was with a former Intourist tour guide named Maria. Maria lived in Moscow all her life and through the communist era of 60s to 90s. She has been a tour guide for more than 30 years. Being in her 60s, she moved rather quickly for her age. We traveled and crammed with Maria and other Muscovites on the metro to visit 10 different metro stations.

Arrow showing the direction of metro line 1 and 2

Moscow subways are very clean

To Maria, every street, metro and building told a story. I couldn’t keep up with her stories. I don’t remember most of what she said because I was just thrilled being in Moscow.   Added to that, she spilled out so many Russian words and names, which to one who can’t read Cyrillic, sounded so foreign and could be easily forgotten.

The metro tour was the first part of our all day tour of Moscow with Maria. Here are the stations we visited:

1. Komsomolskaya Metro Station  is the most beautiful of them all. Painted yellow and decorated with chandeliers, gold leaves and semi precious stones, the station looks like a stately museum. And possibly decorated like a palace. I saw Komsomolskaya first, before the rest of the stations upon arrival in Moscow by train from St. Petersburg.

2. Revolution Square Metro Station (Ploshchad Revolyutsii) has marble arches and 72 bronze sculptures designed by Alexey Dushkin. The marble arches are flanked by the bronze sculptures. If you look closely you will see passersby touching the bronze dog's nose. Legend has it that good luck comes to those who touch the dog's nose.

Touch the dog's nose for good luck. At the Revolution Square station

Revolution Square Metro Station

3. Arbatskaya Metro Station served as a shelter during the Soviet-era. It is one of the largest and the deepest metro stations in Moscow.

Arbatskaya Metro Station

4. Biblioteka Imeni Lenina Metro Station was built in 1935 and named after the Russian State Library. It is located near the library and has a big mosaic portrait of Lenin and yellow ceramic tiles on the track walls.

Lenin's portrait at the Biblioteka Imeni Lenina Metro Station

5. Kievskaya Metro Station was one of the first to be completed in Moscow. Named after the capital city of Ukraine by Kiev-born, Nikita Khruschev, Stalin's successor.

Kievskaya Metro Station

6. Novoslobodskaya Metro Station  was built in 1952. It has 32 stained glass murals with brass borders.

Novoslobodskaya metro station

7. Kurskaya Metro Station was one of the first few to be built in Moscow in 1938. It has ceiling panels and artwork showing Soviet leadership, Soviet lifestyle and political power. It has a dome with patriotic slogans decorated with red stars representing the Soviet's World War II Hall of Fame. Kurskaya Metro Station is a must-visit station in Moscow.

Ceiling panel and artworks at Kurskaya Metro Station

8. Mayakovskaya Metro Station built in 1938. It was named after Russian poet Vladmir Mayakovsky. This is one of the most beautiful metro stations in the world with 34 mosaics painted by Alexander Deyneka.

Mayakovskaya station

One of the over 30 ceiling mosaics in Mayakovskaya metro station

9. Belorusskaya Metro Station is named after the people of Belarus. In the picture below, there are statues of 3 members of the Partisan Resistance in Belarus during World War II. The statues were sculpted by Sergei Orlov, S. Rabinovich and I. Slonim.

10. Teatralnaya Metro Station (Theatre Metro Station) is located near the Bolshoi Theatre.

Teatralnaya Metro Station decorated with porcelain figures .

Taking the metro's escalator at the end of the tour with Maria the tour guide.

Have you visited the Moscow Metro? Leave your comment below.

January 15, 2017 at 8:17 am

An excellent read! Thanks for much for sharing the Russian metro system with us. We're heading to Moscow in April and exploring the metro stations were on our list and after reading your post, I'm even more excited to go visit them. Thanks again 🙂

December 6, 2017 at 10:45 pm

Hi, do you remember which tour company you contacted for this tour?

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Russia establishes special site to fabricate fuel for China’s CFR-600

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A special production site to fabricate fuel for China’s CFR-600 fast reactor under construction has been established at Russia’s Mashinostroitelny Zavod (MSZ - Machine-Building Plant) in Elektrostal (Moscow region), part of Rosatom’s TVEL Fuel Company. 

As part of the project, MSZ had upgraded existing facilities fo the production of fuel for fast reactors, TVEL said on 3 March. Unique equipment has been created and installed, and dummy CFR-600 fuel assemblies have already been manufactured for testing.

The new production site was set up to service an export contract between TVEL and the Chinese company CNLY (part of China National Nuclear Corporation - CNNC) for the supply of uranium fuel for CFR-600 reactors. Construction of the first CFR-600 unit started in Xiapu County, in China's Fujian province in late 2017 followed by the second unit in December 2020. The contract is for the start-up fuel load, as well as refuelling for the first seven years. The start of deliveries is scheduled for 2023.

“The Russian nuclear industry has a unique 40 years of experience in operating fast reactors, as well as in the production of fuel for such facilities,” said TVEL President Natalya Nikipelova. “The Fuel Division of Rosatom is fulfilling its obligations within the framework of Russian-Chinese cooperation in the development of fast reactor technologies. These are unique projects when foreign design fuel is produced in Russia. Since 2010, the first Chinese fast neutron reactor CEFR has been operating on fuel manufactured at the Machine-Building Plant, and for the supply of CFR-600 fuel, a team of specialists from MSZ and TVEL has successfully completed a complex high-tech project to modernise production,” she explained.

A special feature of the new section is its versatility: this equipment will be used to produce fuel intended for both the Chinese CFR-600 and CEFR reactors and the Russian BN-600 reactor of the Beloyarsk NPP. In the near future, the production of standard products for the BN-600 will begin.

The contract for the supply of fuel for the CFR-600 was signed in December 2018 as part of a governmental agreement between Russia and China on cooperation in the construction and operation of a demonstration fast neutron reactor in China. This is part of a wider comprehensive programme of cooperation in the nuclear energy sector over the coming decades. This includes serial construction of the latest Russian NPP power units with generation 3+ VVER-1200 reactors at two sites in China (Tianwan and Xudabao NPPs). A package of intergovernmental documents and framework contracts for these projects was signed in 2018 during a meeting between Russian President Vladimir Putin and Chinese President Xi Jinping.

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