Memorandum of Agreement Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) review medical services provided to Medicare beneficiaries, including hospital discharge appeals, termination of services appeals, and quality of care complaints.

Step by Step ProcessTo see a.Step 1: Determine if you need a new agreement and if so, what kind of agreement is appropriate.Ask your VC or Provost level administrative assistant to check the database to seeif UAF already has an existing agreement with the entity in question. If there is NOT an existing agreement, move on to Step 2.

If there IS an agreement:. Determine whether the proposed new activities fall under the existing agreement. Ifit does, make sure the existing agreement is still valid and not expired.

Department of Health and Human Services A Guide to Memorandum of Understanding Negotiation and Development Mary L. Johnson, M.S.W., and Linda M. Sterthous, M.P.A. Temple University, Institute on Aging, Mid-Atlantic Long Term Care Gerontology Center 1982PDF Version: (26 PDF pages)This report was prepared under contract #HEW-1 between the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Social Services Policy (now the Office of Disability, Aging and Long-Term Care Policy) and Mathematica Policy Research, Inc., and contract #HEW-1 with Temple University. Additional funding provided by the Administration on Aging and Health Care Financing Administration (now the Centers for Medicare and Medicaid Services). For additional information about this subject, you can visit the DALTCP home page at or contact the office at HHS/ASPE/DALTCP, Room 424E, H.H.

Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is:. The DALTCP Project Officer was Robert Clark.This monograph was developed through partial support of a grant to the Long Term Care Gerontology Center of Temple University by the Administration on Aging, Office of Human Development Services, Department of Health and Human Services, Grant #90-AL0011-01 and through partial support of Contract #HEW-1 to the Contractor for Technical Assistance and Training to Demonstration Projects in the National Channeling Demonstration Program, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, D.C. The grantees' opinions expressed in this document do not necessarily represent official policy of the Department of Health and Human Services.TABLE OF CONTENTS I.

General Guidelines B. Stages in the Process IV. General Comments B. Terms and Conditions of the MOU V.

Model 1: MOU for Direct Service B. Model 2: MOU with a Referring Agency C. Model 3: MOU for Transfer of AuthorityThis monograph was prepared for the agencies participating in the National Long Term Care Channeling Demonstration Program. It has been adapted for use by other case management agencies and disseminated by the Mid-Atlantic Long Term Care Gerontology Center at Temple University.Mary L. Johnson and Linda M.

Sterthous are members of the staff of the Technical Assistance Contractor to the National Long Term Care Channeling Demonstration Program, Division of Technical Assistance and Training, Mid-Atlantic Long Term Care Gerontology Center, Temple University, Philadelphia, Pennsylvania.Mid-Atlantic Long Term Care Gerontology CenterEvan Sorber, Executive DirectorDivision of Public Policy and Information DisseminationTechnical Assistance MonographsElias S. Cohen, Editor-in-ChiefLinda Staroscik, Managing EditorCaring for the elderly in a community setting has become an extremely complex task. The needs of the elderly population are varied, and the service providers attempting to meet these needs represent a diverse group of agencies, organizations, and institutions.

Providers may be public, non-profit, or proprietary. They may receive reimbursement for services from a variety of social service, aging, or health funding streams. These include Area Agencies on Aging, Base Service Units of Mental Health Agencies, agencies funded by Title XX of the Social Security Act, and home care agencies reimbursed through Titles XVIII (Medicare) and XIX (Medicaid) of the Social Security Act.Case management or coordinating agencies have been established in many locales, partly in response to the complexity of the service system which provides community care to the elderly. These agencies have the Herculean task of creating order and organization in this system. The Memorandum of Understanding is a tool which can be quite effective in achieving this end.Through the use of the Memorandum of Understanding (MOU), agreements between coordinating or case management agencies and the agencies providing direct service can be formalized. The MOU can be tailored to the specific needs of each agency, whether the agency provides case management services, direct services, or some combination of both.The MOU is an important device in organizing community care systems for the elderly since it can be used to stipulate client flow and other issues related to efficient service delivery in advance of operation.

This paper discusses the process an agency should follow to develop interagency MOU's and presents examples of MOU's which can be used as models.Case management agencies must develop working relationships with a variety of other agencies in their communities and states. These relationships will vary depending on the needs of the case management agency and the willingness and capability of community agencies to become involved in the case management effort.

Many interagency relationships can be based simply on the informal understandings of executives or workers in each of the agencies. Other relationships, however, are important or complicated enough to require formalization through the development of MOU's, or as they are sometimes referred to, Memoranda of Agreement or MOA's.

An MOU is a formalized statement of the mutual expectations of two agencies. Although not a legally binding document, an MOU represents a signed commitment on the part of two or more parties to conduct interagency business in a specified manner.An MOU can be a useful tool for case management agencies which have as their major function, coordination of services for clients from a number of community providers. Procedurally, this task could be a nightmare for case managers unless specific elements, especially client flow, are clearly described in advance of operation.

The MOU serves as the vehicle for establishing the requirements of the agreement. SAMPLE 2 This Memorandum of Understanding is made on by and between and. Review of this Memorandum shall be made on or before , at which time this Agreement may be extended, modified or terminated.Name the Parties in the Agreement.

Be very clear about who is entering the agreement. The names of the persons with authority to enter the agreement could be included at the beginning of the MOU, but definitely are included as authorized persons delegated by the parties to sign the acceptance of the understanding. You might also include the name of the umbrella or sponsoring agency, and names of any persons who have responsibility for implementing the MOU.

SAMPLE 1This Memorandum of Understanding is designed to reflect the understandings between (your agency) (a case management agency coordinating services for the elderly) (an Area Agency on Aging) (a private non-profit orginization) (or some other similar general description) hereinafter (a shortened name) and (a social service agency) (a community hospital) hereinafter (a shortened name).Describe a Common Objective for Entering the MOU. This description provides some framework for the specifics of the MOU. You could develop specific goals and objectives which would provide the basis for monitoring the MOU or evaluating its effectiveness. SAMPLE 1 and , the parties to this Memorandum have the following common objectives:. To assure delivery of the right service at the right time to the right client;. To assure the application of service in strict accord with prescriptions prepared pursuant to careful, systematic assessment of the client;. To assure notice by the respective parties to each other of any changes in the client's circumstances in order to permit swift and proper response by the parties to such changes;.

Etc. SAMPLE 2 and , the parties to this memorandum of understanding have the common overall objectives of providing effective and efficient services to their elderly clients, of preventing unnecessary institutionalization, and of evaluating service impact.Describe the Expertise of Each Party. This description will establish the mutual respect for entering the agreement. This can be done with a bit of flare to make the other party feel good. Make the other party feel that his/her agency has something you need or want, and make sure he/she knows you have something to offer. You might include the scope of responsibility and/or program operational goals of each party.Describe the Clients Appropriate for your Service.

This inclusion is applicable only for MOU's involving services to or referral of clients. It can be written in general terms at the beginning of the MOU or can be outlined in greater specificity in a separate section. Eligibility requirements and determinations could be included. SAMPLE 2 Clients appropriate for services furnished by the parties to this memorandum are the frail elderly 65 and over.Describe the Understanding Between the Parties Including the Service to be Provided. This is the major portion of the MOU and its contents will depend on what has been negotiated. As mentioned earlier, it could specify a service, the number of service slots to be reserved, a referral process, a communication item.

State the nature, scope, amount, and duration of service where appropriate. SAMPLE 3 The ( provider) agrees to designate 15 slots per month for home delivered meals to case management clients.Describe Who Will Pay For Service and How Payments Will Be Made. An explanation of the fee payment arrangements may be necessary in some instances.

For example, if agency A transfers authority to you to authorize services for which Agency A will pay, and you are developing an MOU with Provider Agency B, you will want to specify the arrangement for payment of the services to Agency B by Agency A. SAMPLE 1Where (Agency B) furnishes services (of xyz dimension, i.e., describing what A will pay for) and for which charges are made, (Agency B) will bill (Agency A) directly. (Agency A)'s agreement to cover such charges is attached herewith as Appendix A and is a part of this Memorandum of Understanding.Describe the Referral Process. This description is an appropriate inclusion when client services will be provided by either party. A clearly delineated referral process can save case managers time and will formalize the practice. SAMPLE 2Hospital social workers from Hospital X will refer appropriate clients to the case management agency.

Following intake by the case management agency, the hospital social worker will be notified in writing regarding the client's eligibility for case management services. Intake will occur within days of the referral, and notice to the hospital regarding eligibility will occur within days of the assessment.Describe the Communication Process. As noted in the preceeding paragraph, referral processes can be handled separately in the MOU, particularly if that is the major understanding being negotiated. However, many other forms of communication processes might be the subject of the relationship between the parties. Some examples are regular or timely meetings between agency directors or parties, case conferences between workers, paper flow, correspondence, reports, service orders, and/or the naming of persons involved in the communication process.

SAMPLE 2Case manager(s) and provider agency workers shall meet biweekly to review special problem cases, coordinate schedules, evaluate closed cases, and assess caseloads. Precise times shall be set by the parties to their mutual convience.Describe Reporting/Recordkeeping Requirements. These requirements can be handled in general terms in the instrument, but the provider should be fully aware of any reporting or recordkeeping needs for or about case management agency clients. Other reporting might relate to your management needs. SAMPLE 1( Provider) shall safeguard the use of and access to information regarding individuals or families to which the case management agency is providing or arranging for services.

( Provider) shall not use or release any reports, data, or other information except with the approval of such applicant or person served and in accordance with the rules and regulations of and , and where applicable, state and federal laws and regulations. Such information shall be used only to assure proper administration, planning, coordination and monitoring of performance under this Agreement, and permit the transfer of client records to another agency for the purpose of continuing services, with appropriate release from the client or the client's guardian, and for research purposes.State Whether There Will be an Exchange of Representation on Advisory Boards. Providing opportunities for the other party In the MOU to serve on your Advisory Board or working sub-committees may serve as an incentive for developing closer relationships. Exchange can also be initiated through a joint audit process. SAMPLE 1We mutually agree not to use the name of the other in any public information without permission.Dealing with Problems.

Few MOU's are negotiated with the anticipation of problems, however, relationships sometimes change and disputes may arise. It is important to anticipate problems and attempt to structure the MOU negotiation to minimize conflicts. While procedures for resolution need not be specified in the MOU, it is advisable to have strategies in mind which might be employed if needed.Liability. The MOU is not a legal document.

The case management agency assumes liability for its actions and those actions of its employees or representatives. The provider or other party is liable for its actions and the actions of its employees or representatives. No statement regarding liability is necessary in an MOU. However it is advisable to consult an attorney if there are questions.Closing. The closing statement finalizes the agreement. Appropriate signatures and dates must be included. Each party retains a signed original.

SAMPLE 1 and hereby express agreement to all of the above and enter into a joint agreement until such time that either agency shall amend or revise said agreement in writing. Name, Title for (Provider Agency) Name, Title for (Case Management Agency)Date Date The following MOU's have been developed as models of the three basic types of agreements you will most likely need to negotiate.

The first is a model of an MOU with a provider of services to case management agency clients. The second is an MOU with a referring hospital. The third is an MOU specifying transfer of nursing home prescreening authority.These are not necessarily complete MOU's which should be carried to provider agencies in your community for negotiation.

Completeness will be dictated by the issues of concern between your agency and each agency with which you negotiate an agreement.These model MOD's should be helpful to you in devising appropriate wording and in selecting areas of probable concern. Model #1: MOU for Direct Service PERIOD OF AGREEMENTThis Memorandum of Understanding is between Case Management, Inc. And Home Nursing Services of Porter County. It is effective upon signing and shall remain in effect until termination by either party with 30 day written notice.PARTIESCase Management, Inc. (hereinafter CM) is a not for profit corporation funded by the Area Agency on Aging of Porter County. CM is engaged in undertaking, directly and through contracted services, the assessment of chronically ill and/or disabled elderly, care planning, arranging for services for them, and evaluating the impact of such services.

Home Nursing Services of Porter County (hereinafter HNS) is a home health agency providing professional nursing and supportive services to the sick, disabled, and elderly in their own homes. It, like CM, is organized on a not-for-profit basis.COMMON OBJECTIVECM and HNS have as a common objective the effective and efficient delivery of health and social services to elderly individuals and the prevention of unnecessary institutionalization. Both are interested in assisting clients over 65 years old with chronic physical, mental or emotional conditions who are unable to care for themselves without the help of others over an extended period of time.DISTRIBUTION OF FUNCTIONSIn view of the common objective, CM and HNS agree on the following distribution of functions: CM Inc. Will determine eligibility for case management services through an intake process, conduct a comprehensive needs assessment, provide case management services to include developing a comprehensive care plan, arranging for services, monitoring and reassessment. HNS of Porter County agrees to provide skilled nursing, speech therapy, physical therapy, occupational therapy, and homemaker-home health aide care to CM clients.

CM clients will receive priority attention over Home Nursing Services patients.BILLING & ELIGIBILITY DETERMINATIONHNS agrees to bill Blue Cross, Medicare, Medicaid or other third party payors for services provided to CM clients where such clients are covered by these programs. CM agrees to conduct eligibility determinations for all clients prior to referral and to certify as to their eligibility.REFERRAL PROCESSA case manager from CM will make a telephone request for initiation of services which will be followed by a written service order. A service order will be issued for each client. Each service order may contain requests for more than one service to be provided to the same client. Each service order will specify the amount and duration of service delivery.

Services will be expected to begin no later than 48 hours following receipt of a written service order unless the order proposes a subsequent initiation.COMMUNICATIONMonthly meetings will be held between the case management supervisor of CM and the director of community services of HNS to review implementation of this agreement and to establish policy directives as appropriate.REPORTING/ RECORDKEEPINGCM and HNS will maintain documentation of service orders and service provision by client and by service worker. HNS shall furnish a weekly report to CM of its case management clients served, added, or dropped. HNS personnel shall report changes in client status immediately to the CM case manager. CM shall notify HNS of changes in client status, client financial or provider eligibility or other matters in ways that will minimize HNS' exposure to financial liability.RESEARCHHNS agrees to cooperate with the research requests of CM. These requests may be for information about clients and occasional interviews. CM agrees to share results of its research with HNS.CONFIDENTIALITYHNS and CM each shall safeguard the use of and access to information regarding individuals or families, to which either agency is providing or arranging for service.

HNS and CM agree not to use or release any reports, data, or other information identifying applicants or persons, except with the approval of such applicant or person served and in accordance with the rules and regulations of and and where applicable, federal laws and regulations.