By entering into this agreement, the Client
knowingly and voluntarily consents to receive the
private care management services further described on
Schedule A attached hereto and incorporated herein by
this reference(“Services”) on the terms and conditions
set forth in this Agreement. All Services provided shall
include case management services provided by MHD.
Services materially varying from the Services listed on
Schedule A are not included in the rate set forth therein
and MHD is not obligated to provide such additional
services except under a separate written agreement
between Client and MHD. MHD will make every effort
to fulfill the additional services requested but does not
guarantee uninterrupted service to the Client for such
Medical Home Detox is an alcohol and drug home detox treatment program offering private 24-hour, 7-day-a-week on-site expert home detox nurse supervision anywhere and anytime.
This unique treatment model focuses on the client and meets the client wherever he or she lives. We are licensed medical experts in the field of detox medications, and we will work to ensure you have a comfortable complications free detox.
MHD’s Private Home Detox is an in-home alternative to inpatient alcohol or drug detoxiﬁcation methods. Safe, Comfortable, Private, Convenient, Competent.
In addition to the Services, in the event of
a medical emergency whereby there is an inability or
impracticality to obtain Client’s consent or Client’s
emergency contact’s express consent, Client hereby
knowingly consents to such further services that Client’s
providers deem necessary.
Consent to Treat
Client hereby authorizes Providers to
render care and services as prescribed by Client’s
physician(s) to the extent required. It is Client’s
responsibility to ensure that Client is fully informed by
Client’s physician as to the benefits, possible
discomforts, and potential side effects prior to
performance of any medical treatment. Client further
authorizes (i)MHD to communicate with Client’s
physician(s)and other healthcare providers regarding
Client’s care and ii) Providers engaged pursuant to this
Agreement to communicate with Client’s physician.
As full consideration for MHD’s
agreement to provide the Services to Client the Client
agrees to MHD the rates set forth on Schedule A
(“Compensation”). The parties acknowledge and agree
that the Compensation is consistent with fair market
value in an arms length transaction. Invoices remitted
by MHD will include an itemized list of the Services
provided and the rates of pay for such Services
Client shall pay all fees, costs, and
expenses related to the Services in advance as set forth
herein. MHD will accept payment in cash, wire
transfer, check, or credit card. Client acknowledges and
agrees none of the Services provided by MHD shall be
subject to payment or reimbursement by Medicare or
any other third party payor and that all Services are
private pay only.
Payment Terms: For Detoxification Services
Payment for medical detoxification Services are due and payable in full prior to the start of treatment. Payment for detoxification services are non-refundable unless treatment is discontinued by the detoxification physician in writing. If the Client ends
treatment for any other reason or is otherwise non-
compliant with the treatment plan, or involves him or
herself in any form of harassment directed toward the staff
no refund from MHD shall be due or paid. After treatment
is complete, MHD will remit a final invoice, which will
reflect all additional expenses related to medications,
supplies, phlebotomy services, IV vitamin therapy, and
travel. Such amount will automatically be charge to the
credit card on file with MHD, if any, or shall otherwise be
paid in full by Client within forty-eight(48) hours receipt of
Payment Terms: Insurance Coverage
Client and the Guarantor (defined below), if any, acknowledge that MHD has not made any representations whatsoever that any fees paid under this Agreement are covered by the Client’s health insurance or other third party payment plans applicable to the Client. This agreement acknowledges Client’s
understanding that Medicare cannot be billed for any
Services provided hereunder. Client agrees not to bill
medicare or attempt medicare reimbursement for any such
Payment Terms: Interest Charges, Collection Costs
Invoices not paid within 7 days from the date of the invoice are considered past due and will be subject to a finance charge of 12% per annum, or the maximum interest rate allowed by applicable
law, whichever is lower. Should any balance be referred
for collection, Client agrees to pay all reasonable costs of
collection including attorney’s fees, court costs, and
Expenses: Reimbursable Expenses
Client, or Guarantor, if any, shall reimburse MHD for all out-of-pocket expenses incurred on behalf of Client, including but not limited to prescription medications, medical supplies required as part of the Services; and food purchases.
Expenses: Travel Expenses
If air travel is required for or during
treatment of Client , Client is responsible for all travel
expenses including but not limited to any fees for changing
flights if necessary, ground transportation, baggage fees,
taxis, ride sharing fees, parking fees, tolls, the provider’s hourly rate during travel, and hotel accommodations, if necessary.
Expenses: Other Expenses
If 24hr care is provided, then Client must also provide acceptable accommodations in the Client’s home such as a private room, and foods for the length of Client’s care or treatment.
If a party other than Client, is the financially responsible party for the Services (“Guarantor”) such party will be required to execute a
written Financial Guaranty
This agreement shall remain in force and effect from the Effective Date through the date of termination or discharge from treatment in accordance with the Services. Subject to sections 5.1 and 5.2 either party may terminate the Agreement upon twenty-four (24)hours’ prior written notice to the other party. If Client terminates this Agreement or otherwise cancels a scheduled service with less than 24hrs notice, Client will be charged the full rate for 12hrs of service. Notwithstanding the foregoing, Medical Home Detox reserves the right to terminate this Agreement immediately upon notification of abusive
behavior to, or harassment of, Providers or for other
Client agrees to maintain homeowners
insurance, medical insurance, and any additional coverage
necessary to provide adequate coverage for Client. Client
further agrees to provide automobile insurance if Client
desires Providers to drive a Client-owned automobile. In
such case Client shall notify Client’s automobile insurance
that such Providerwill be driving Client’s automobile.
Client agrees that at any time this Agreement is in effect and for a period of twelve (12) months from expiration or termination of this Agreement Client shall not directly or indirectly for Client or any other individual or business entity solicit, recruit, or hire a
Provider engaged by Medical Home Detox hereunder to
provide services of the nature provided hereunder. Client
will not directly or indirectly solicit, recruit, or induce any
of Medical Home Detox’s employees or the Providers to
terminate their employment with Medical Home Detox or
other agreement with Medical Home Detox. The parties
hereto agree that if a breech of this Section (10) were to
occur it would be difficult to ascertain MHD’s actual
damages. Based upon what is presently known the parties
agree that the sum of twenty-five thousand ($25,000) is a
reasonable estimate of the damages that would accrue if a
breach of this section ocurred in the future, and that the
amount of damages is fair and reasonable and would not
act as a penalty to the breaching party.
Client acknowledges and agrees that Providers are not authorized to accept, use have custody of cash, credit cards, debit cards, checks, or other valuables belonging to the Client without written authorization in advance from Client or Guarantor, if any
This Agreement will be construed in accord with and any dispute or controversy arising from any breach or asserted breach of thaw Agreement will be governed by the laws of the state of Utah.
No Act Contrary To Law
Nothing herein shall be construed so as to require the commission of any act contrary to law and wherever there is any applicable statute, law, ordinance, or regulation which is inconsistent with this Agreement , such statute, law, ordinance, or regulation shall prevail, and, in such event, the provision herein in conflict automatically shall be curtailed, limited, or eliminated to the extent necessary to bring it within legal limitations.
Dispute Resolution: Mediation/Arbitration
The parties will endeavor to resolve any dispute arising out of or relating to the Agreement by mediation Unless the parties agree
otherwise the mediator will be selected from the JAMS
Panel of Neutrals. Any controversy or claim arising out of
or relating to the Agreement , including breach,
termination, or validity thereof which remains unresolved
thirty(30) days after the appointment of a nediator will bw
finally resolved by arbitration in accordance with the JAMS
Rules for Arbitration then currently in effect, by one(1)
independent and impartial arbitrator who will be selected
by agreement of the parties, but if the parties cannot agree ,
will be designated by JAMS; provided, however, that the
same person may not serve both as the mediator and
arbitrator. Judgement upon the award rendered by the
arbitrator may be entered by any court having jurisdiction
thereof. The place of arbitration will be Salt lake City,
Dispute Resolution: Attorney’s Fees
If either party initiates arbitration to interpret or enforce this Agreement, or to recover damages for breach of this Agreement, the prevailing party will be entitled to recover costs of suit or arbitration and to recover its reasonable attorney fees.
Miscellaneous: Entire Agreement
This Agreement represents the
entire agreement between the parties and supersedes
any prior agreements, written or oral, respecting the
subject matter herein. This Agreement may only be
modified or amended in writing executed by all of the
Miscellaneous: Assignment of Agreement
Neither this Agreement nor any duties or obligations under this Agreement may be assigned by either party without the prior written consent of the other party
If any provision of this Agreement is held by a court of competent jurisdiction to be invalid, void, or unenforceable, the remaining provisions will nevertheless continue in full force and effect
Miscellaneous: Survival of Obligations
The termination of this Agreement will not release or discharge either party from any obligation, debt, or liability which will have previously accrued and remains to be performed by such party upon the date of termination or which , by its terms, is to be
performed after the date of termination
Any waiver of any term and condition here of
must be in writing and signed by the party against whom it
is sought to be asserted. No consent or waiver, expressed
or implied, by any party to any breach or default by the
other in the performance by the other of their obligation
hereunder will be deemed or construed to be a consent or
waiver to or consent to any other breach or default of this
Miscellaneous: Counterparts; Construction
This Agreement may be
executed in counterparts, each of which will be deemed an
original but all of which together will constitute one and
kbCKS the same instrument. The parties may deliver
executed signature pages to this Agreement by facsimile,
email, or other electronic transmission. The parties have
participated jointly in the negotiation and drafting of this
Agreement and the agreement will be construed as if
drafted jointly by the parties and no presumption or burden
of proof will arise favoring or disfavoring any party by
virtue of authoring any of the provisions of this Agreement.
Miscellaneous: Discounts, Kickback Policy
Our policy does NOT permit discounts OR kickbacks and is in full compliance with stark law kickbacks. Medical Home Detox is committed to conducting its business transactions and practices in compliance with the Anti-Kickback Statute and analogous state laws. All Medical Home Detox employees and contractors present and future shall comply with the requirements of the Anti-Kickback Statute as well as all related Medical Home Detox company policies and procedures. This means that Medical Home Detox employees and contractors shall not give, receive, solicit or help arrange anything of value as part of the process of obtaining or making referrals in violation of the Anti-Kickback Statute or state law.
Medical Home Detox employees and contractors shall report suspected violations of the Anti-Kickback Statute and/or related company policies and procedures consistent with Medical Home Detox Compliance Policies and the Medical Home Detox Code of Conduct.
In addition, Medical Home Detox employees and contractors may direct any questions regarding the Anti-Kickback Statute and related Medical Home Detox company policies and procedures to the Compliance Officer or the Administrator.
No Scholarship Policy/ Referral Policy
Medical Home Retox is not a rehabilitation treatment center therefore, we do not offer or accept scholarships for our treatment. We also do not refer patients to a specific rehabilitation center. We only inform patients of rehabilitation centers within a reasonable distance within their location.
Detox Staffing and Supervision Policy
All in-home detox programs are run by a certified nurse and are under the supervision of a licensed doctor.