Fill and Sign the Medicaid Hospital Services Agreement Aetna Better Health Form

Agreement Between Hospital and Nurse Staffing Agency Agreement made on the _________________________________ (date), between __________________________________________________ (Name of Nurse Staffing Agency), a corporation organized and existing under the laws of the state of __________________________, with its principal office located at _________________ ___________________________________________________________________________________________________________ (street address, city, county, state, zip code), referred to herein as NSA, and _______________________________________________ (Name of Hospital), a corporation organized and existing under the laws of the state of ______________________________, with its principal office located at _____________ __________________________________________________________________________________________________ (street address, city, county, state, zip code), referred to herein as Hospital. Whereas, Hospital wishes to contract with NSA for the services of NSA in providing registered nurses (RN), licensed practical nurses (LPN) and nursing assistants (NA) to Hospital; and Whereas, NSA is ready, willing, and able to provide such services as may be required by Hospital. Now, therefore, for and in consideration of the mutual covenants contained in this agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. ServicesA. NSA understands and agrees that services to be provided Hospital under and pursuant to this Agreement shall be so provided on a day-to-day, as-needed, basis and that Hospital in its sole discretion shall determine its need, if any, for services or the continuation of services as may be provided by NSA under and pursuant to this Agreement. B. NSA agrees to provide services upon the written request of Hospital and further agrees that the cost of such services shall not exceed the limitation of the cost set forth by Hospital’s request. C. When requesting services, Hospital shall specify the nursing classifications required (e.g., RN, LPN and/or NA); the applicable hourly or daily price for each specified nursing classification; the maxi
Day time frame which the nursing service will be maintained; the duration of the services; the maximum number or units of such nursing service requested; and, if the nurse has an obligation to the employer, the nurse's name and address, as well as the nature of the hospital's obligation. D. NSA shall furnish to hospital on reasonable notice of its next scheduled date of service and within 24 hours of such date, reasonable accommodation to provide RNS, lpns and na at the hospital site during non-operating hours at a price established as set forth in hospital's request for NSA to provide the services. E. Nsa shall not be required to provide services to which hospital is entitled under this article if NSA and the patient are in a mutually agreed upon alternative service arrangement which includes, but is not limited to, a nurse staffing agency arrangement which includes but is not limited to, an agreement that all nurses assigned to hospital will be registered nurses by NSA (nsp) or a registered nurse staffing agency arrangement (RNN). F. Nsa will be paid by hospital the difference between the time spent on-site assisting the patient, and the time expended in providing the services specified above. G. Hospital will not be responsible for any or all of these additional costs of providing hospital service. H. Nothing contained in this agreement shall be construed to authorize nor shall be required to the hospital to use a specific or unreasonable number of hospital nurses. I. Hospital shall provide the nurse staffing agency and the NSW with an electronic database, where nurses and the client agency (client) will be able to obtain the status of all nurses and other health service workers as well as the status of all employees (as the case may be) assigned or assigned positions as described above. J. Hospital and nurse staffing agency agreement, as well as other relevant documents such as the written notification which the hospital has sent to the nurse staffing agency, the client and hospital (if any), including, without limitations, the letter from each respective employer to the other employer, shall all be posted conspicuously on the premises and accessible to all employees, clients and representatives of the agencies or any person on-site at the time the agreement is performed. K. If the employee or agency requests that the services of the NSW, lpns or na be performed by another nurse or agency other than the one designated by NSA or the registered nurse staffing agency, the nurse staffing agency shall make reasonable efforts to accommodate the request, but the agency and NSW shall be responsible