[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-282924-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-282924-en":127},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","attachment-d-personal-care-and-nursing-services-agreement","Attachment D - Personal Care and Nursing Services Agreement","","Attachment D sets out an agreement structure for local social services districts to obtain personal care services and selected nursing supervision for Medicaid recipients in adult homes. It defines the provider as an independent contractor, requires services to follow NYCRR and related statutory definitions, limits covered nursing activities, and sets authorization rules by district direction. The document also covers termination rights, notice periods, record transfers, contract validity terms, reimbursement rate principles, case management oversight, and employee training requirements under applicable regulations.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/attachment-d-personal-care-and-nursing-services-agreement/282924/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/attachment-d-personal-care-and-nursing-services-agreement/282924.png","ImageObject",442,249,{"name":42,"@type":43},"McQueen","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-01","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the provider’s relationship to the district under this agreement?","Question",{"text":63,"@type":64},"The provider is an independent contractor and agrees not to represent themselves as a state officer or employee, including avoiding claims tied to state employment benefits.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Which personal care and nursing services are covered, and what limits apply?",{"text":68,"@type":64},"Personal care services and related nursing supervision must follow the listed NYCRR definitions for Medicaid recipients. Nursing services are limited to sterile dressing changes and related sterile dressing administration tasks plus subcutaneous and/or intramuscular injections.",{"name":70,"@type":61,"acceptedAnswer":71},"How can the district terminate services, and what happens to records?",{"text":72,"@type":64},"The district may terminate agreements or requests for services at its discretion by notifying the provider and related parties. For non-emergency terminations, the district provides thirty (30) days notice, and the provider must promptly transfer records for affected recipients to the local district or subsequent provider designated by the district.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},282924,1790576216,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social Media",50,"social-media",{"id":110,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":111,"slug":112},17,40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":115,"show_sort_weight":116,"slug":117},18,"Letters",30,"letters",{"id":119,"doc_module":22,"doc_module_name":25,"category_name":120,"show_sort_weight":121,"slug":122},21,"Paper Templates",5,"papers-templates",{"id":124,"doc_module":22,"doc_module_name":25,"category_name":125,"show_sort_weight":4,"slug":126},158,"General","general-158",{"code":4,"msg":82,"data":128},{"doc_id":79,"user_id":129,"nickname":42,"user_avatar":130,"doc_module":22,"category_id":110,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":136,"language":137,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":12,"update_tm":141,"read_time":30},5909890329169,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Attachment D  \nWHEREAS, Local Social Services Districts are authorized pursuant to Sections 365-a (2) (d) and 367-p of the New York State Social Services Law and Title 18 of the Code of Rules and Regulations and/or other applicable regulations to provide personal care services and nursing services to persons eligible to receive such services; and  \nWHEREAS, the District is desirous of obtaining personal care services and selected nursing services to be rendered to recipients of medical assistance in adult homes for which reimbursement is available pursuant to Title XIX of the Federal Social Security Act and applicable state law and which are eligible for reimbursement thereto,  \nNOW, THEREFORE, the parties signing and executing this instrument do, in consideration of the above, covenant and agree as follows:  \n1. The relationship of the provider to the district shall be that of independent contractor . The provider, in accordance with his status as an independent contractor, covenants and agrees that he will conduct himself in accordance with such status, that he will neither hold himself out as, nor claim to be an officer or employee of the State by reason thereof and that he will not by reason thereof, make any claim, demand or application to or for any right or privilege applicable to an officer or employee of the State, including, but not limited to, Workmen's Compensation coverage or retirement membership or credits.  \n-2-  \n2. The provider(s) agree(s) to provide personal care services and related nursing supervision, as defined in regulations set forth at NYCRR 505.14 to recipients of medical assistance (Medicaid), as defined in Title 11 of Article 5 of the New York State Social Services Law and/or Title XIX of the Federal Social Security Act, if requested to provide said services by asocial services district pursuant to the order(s) and/or prescription(s) of a physician in accordance with a plan of treatment to be supervised by a registered nurse employed by the provider and subject to the conditions set forth in 18 NYCRR 505.14 or superseding regulations, provided, however, that Medicaid reimbursement under this contract for such services shall not include reimbursement for Level I Personal Care Services as defined in 18 NYCRR 505 .14(a)(6)(I) .  \n3. The provider(s) agree(s) to provide nursing services to recipients of medical assistance (Medicaid) as defined in Title II of Article 5 of the New York State Social Services Law and/or Title XIX of the Federal Social Security Act, if requested to provide said services by a social services district pursuant to the order(s) and/or prescription(s) of a physician in accordance with a plan of treatment subject to the conditions provided for in the regulations set forth in Title 18 of the New York Code of Rules and Regulations, provided, however, that such nursing services shall be limited to sterile dressing changes and to subcutaneous and/or intramuscular injections and all other related nursing tasks associated with the administration of sterile dressing changes and subcutaneous and/or intramuscular injections.  \n-3-  \n4. The personal care services and nursing services will be rendered as authorized by the district at the locations specified by the district during the term of this agreement and should be provided for particular recipients only as long as authorized, pursuant to the district's direction as to frequency, type, and amount .  \n5. The district shall not be obligated to utilize the services of the provider(s), and the district or the New York State Department of Health shall, in its discretion be authorized to terminate any agreement or request for services to be rendered to any or all recipient(s) upon notification to the provider(s), its agent(s) or employee(s) . The cessation of services to a particular recipient shall not render this entire agreement void or voidable. Except for emergencies, the district shall give the provider thirty (30) days notice of an int","cbCaier19V8W3KcL","https://ap.wps.com/l/cbCaier19V8W3KcL","pdf",24547,9,"English","# Attachment D\n## Independent contractor relationship\n## Scope of covered services and regulatory limits\n## Service authorization and provider obligations\n## Termination, notice, and records transfer\n## Contract duration and voidability\n## Reimbursement rates and consent to changes\n## Case management oversight and monitoring\n## Provider and employee training requirements","[{\"question\":\"What is the provider’s relationship to the district under this agreement?\",\"answer\":\"The provider is an independent contractor and agrees not to represent themselves as a state officer or employee, including avoiding claims tied to state employment benefits.\"},{\"question\":\"Which personal care and nursing services are covered, and what limits apply?\",\"answer\":\"Personal care services and related nursing supervision must follow the listed NYCRR definitions for Medicaid recipients. Nursing services are limited to sterile dressing changes and related sterile dressing administration tasks plus subcutaneous and/or intramuscular injections.\"},{\"question\":\"How can the district terminate services, and what happens to records?\",\"answer\":\"The district may terminate agreements or requests for services at its discretion by notifying the provider and related parties. For non-emergency terminations, the district provides thirty (30) days notice, and the provider must promptly transfer records for affected recipients to the local district or subsequent provider designated by the district.\"}]","Attachment D - Personal Care and Nursing Services Agreement | PDF",1789585318]