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Tip Sheets
Nursing Home Admission Contracts: What do I need to know?
If you move into a nursing home, you will be asked to sign an admission contract, sometimes called an admission agreement. The document's language is determined by federal and state law.
This tip sheet is designed to inform you of these laws and your rights under these laws. It is also a guide on what to look for before signing an admission contract with a facility.
What is an Admission Contract?
The admission contract is a written, legal consumer contract.
It must be written according to the plain language law. This means that the contract must be in black type, using at least 10-point size lettering, and written in language that is easily understood by the lay person. In addition, oral agreements to the contract will not be legal unless they are also in writing. To emphasize that point, the following notice, in bold print, must be included in the admission contract:
Notice to applicants for admission. Read your admission contract. Oral statements or comments made by the facility or you or your representative are not part of your admission contract unless they are also in writing. Do not rely on oral statements or comments that are not included in the written admission contract.
Complete, unsigned copies of the contract must be made available to you immediately upon request. Whenever possible, obtain a copy of the contract and read it carefully ahead of time.
Admission to a nursing home is often a difficult and confusing time, but it is very important to take the time to understand this document. Once you or your legal representative has signed it, you are bound to it (unless it violates a contract law). The home must provide you with a signed copy for your records.
What should I look for in an Admission Contract?
Waivers of Liability
Your admission contract cannot include a waiver of facility liability for the health, safety or personal property of a resident. Nor can it include a provision that is deceptive, unlawful or unenforceable, or imply a lesser standard of care or responsibility than is required by law. Facility staff may try to discourage you from bringing jewelry or other valuables into the home, or they may try to insist you keep such items locked in a central storage area at the facility. You are not required to comply with this, although it is wise to be cautious with valuables. A facility cannot waive its liability if staff is negligent in handling your belongings.
Consent to Treatment
Your admission contract must contain a statement informing you of your right to refuse treatment and it cannot require you to give a blanket consent to all treatment ordered by a physician. It may ask you to consent to routine nursing care or emergency care.
Residents Signature and Financial Responsibility
The facility's representative must make reasonable efforts to explain the contents of the admission contract to you and obtain your signature.
You, the resident, must sign the admission contract.
There are only two exceptions to this:
- the court has judged you to be legally incompetent, and your guardian or conservator may sign; or,
- you cannot sign or understand the contract because of a medical condition, and the admitting physician documents the reasons why the nursing home may ask another person to sign the admission contract on your behalf.
Medical Assistance and Public Benefits
The admission contract must tell you if the nursing home participates in Medicare, Medical Assistance, and Veterans Administration programs. If the nursing home's participation in any of these programs is limited, you must be told what the limitations are and how this may affect you during your stay at the facility.
Admission contracts must also have specific statements about how Medical Assistance (MA) payments are handled, including all of the following:
- A nursing home that participates in the MA program must state in its contract that it will not require you, your family members, or anyone representing you to pay privately for any services that will be covered by the MA program. It must also state that the facility will submit a MA claim for payment, and reimburse any amount paid by you or your family if it is later covered by MA.
- An admission contract cannot require you to pay privately for any period of time in order for you to enter the nursing home.
- A nursing home that participates in the MA program cannot charge any resident (including private paying residents) for the day of discharge from the facility or subsequent days. However, a nursing home may continue to ask for advance notice if you plan to move out of the facility. Some nursing homes may try to charge "penalty fees" for failure to give the required advance notice. In addition, some facilities may charge a "storage fee" if any of your belongings remain at the home after you leave. All charges, including penalties and storage fees, must be clearly explained to you in the admission contract. If you are billed for such a charge and want to question it, contact an attorney or the local ombudsman program.
- If the facility charges have not been paid for 30 days and no other person has agreed to apply for MA for you, the nursing home can petition the court to appoint a representative to apply for MA on your behalf.
What if I disagree with an item in the contract?
As with any contract, you have the right to review the admission contract before signing it. If you disagree with any of the terms, talk to the facility representative - negotiation may be possible.
If the facility will not negotiate, you may wish to document this in a letter to the administrator. You can also make a note of your contention in the margin of the contract and initial it. Should you dispute any term at a later time, the letter or note may be helpful to you.
What else do I need to know?
Bill of Rights
You will receive a copy and explanation of the Bill of Rights. The admission contract must contain a written acknowledgment that you have been informed of them. Keep your copy for future reference, noting the phone numbers and addresses for the Office of Health Facility Complaints and the ombudsman program.
Preparation for Medical Assistance
Some people enter a nursing home as private pay residents without having had a permission screening. In this case, the nursing home is required to notify you and your spouse in writing about certain MA facts. The notice must let you know that you and your spouse may retain certain resources if you apply for MA, and what those resources are (such as liquid assets, homestead property, etc.). If you have been screened, the preadmission screening team is responsible for giving you this information.
Medicare
Medicare pays for very little nursing home care, but may be helpful for short-term stays following a hospitalization. You must be informed that the federal Medicare hospital insurance benefits program may help cover some of your care costs. You and your family must also be informed of the appeal process if denied Medicare coverage.
Bed Hold
If you are hospitalized or absent from the facility and ask that your bed be held for you, you can be charged for these days. But if the facility accepts MA payments, it cannot charge you more than 79% of your current daily rate.
The nursing home will hold your bed for 18 hospital days and 36 personal leave days per year. They are not required to hold your bed beyond this number of days without full payment. But if you want to move back, they must offer you the next available bed that opens up.
A representative of the nursing home must discuss the "bed hold" policy with you and explain what the charges will be. You must receive this information in writing at the time you move in and every time you utilize your leave days.
Case Mix
At the time you enter the nursing home, you may be assigned a "temporary" daily rate until the assessment for your case mix level can be processed at the Health Department. Once the assessment is finalized you will receive a letter stating the case mix level and rate. This letter also gives information about how to appeal if you disagree with the case mix level.
New case mix assessments will be done at least twice a year and you will be notified each time of the results. Not all admission contracts state clearly that your initial case mix assessment is only temporary. If you are not sure, clarify this with the facility.
Retroactive Billing
The Department of Human Services sets the rates for most nursing homes; facilities often disagree with the established rate and file an appeal asking for an increase. When the appeal is settled (months or a year later), the facility will send you a "retroactive billing" if the rates were increased (or a refund if the rates were lowered).
The facility may not bill you retroactively unless you were notified in writing at the time the appeal was being filed. (For more information on nursing home fees and charges, see Consumer Tips to Nursing Home Charges.)
Remember: Before signing an admission contract, be sure all of your questions are answered. You are signing a legal document and your signature means you are accepting the conditions of the contract. If your questions are not answered to your satisfaction, contact an attorney or your local Ombudsman.
Where can I get more information or assistance?
- Your local Long Term Care Ombudsman Program (LINK). Office of Ombudsman for Older Minnesotans, 121 E. 7th Place,
Suite 410, St. Paul, MN 55101, (651) 296-0382 or toll free 1-800-657-3591.
- Your local Legal Services office. Check your area telephone listings or call your local Ombudsman for assistance.
- Office of Attorney General - Medicaid Fraud Division, 1400 NCL Tower, 445 Minnesota Street, St. Paul, MN 55101 or call (651) 296-7575.
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