Contractor Acknowledgement with Policies and Procedures

During therapy sessions and when providing direct services to recipients, therapists and analysts are strictly prohibited from using their personal cellphones or electronic devices for any purpose not directly associated with the CPT code or service being delivered.

The Company maintains a professional dress code policy. Approved attire, grooming standards, and safety-related restrictions on jewelry, piercings, and tattoo coverage apply during all service delivery.

As a contractor, I am required to submit daily progress notes that are completed, signed, and reviewed in compliance with documentation standards. Notes must be finalized within 48 hours of service delivery and accurately reflect the CPT code billed, behaviors observed, interventions implemented, and any deviations from the treatment plan. Only finalized, reviewed, signed, and complete documentation will be billed.

As a contractor of the Company, I acknowledge that I will not give or receive any money, reward, or other benefit exceeding ten dollars ($10) to or from the client, their parents, or any other person associated with the client. Violating this policy may result in disciplinary action, up to and including termination of the contract.

As a contractor of the Company, I acknowledge that I am not authorized to assist with the delivery, administration, or management of any medication. All medication-related matters must be handled directly by the client, their caregiver, or an authorized medical professional.

The Company prohibits contractors from transporting recipients or their relatives in personal vehicles. Transporting recipients is not an authorized contracted activity and is not reimbursable. Contractors are expressly prohibited from transporting recipients in their personal vehicles.

The Company strictly maintains the confidentiality of records. I am not authorized to disclose any information without prior written consent and explicit direction from the organization. Medical records may not be removed from the company unless a Release of Information form is completed and signed by the patient. I will comply fully with HIPAA regulations.

The Behavior Support Plan (BSP) outlines crisis procedures. As the provider / contractor, if I am unable to safely manage the behavior, I will immediately contact 911 and notify relevant parties. I will regularly review the updated crisis plan within each recipient's treatment plan.

Behavior analysis therapy services cannot be provided simultaneously with other services such as Personal Care Services, Speech Therapy, Occupational Therapy, or other services where the provider does not have direct engagement with the recipient. Exceptions may be granted by the Clinical Director when medical necessity is demonstrated.

As a contractor, I set my own schedule subject to these limits. I may work and bill a maximum of six consecutive days with one required rest day per week, a maximum of six hours daily per recipient, and a maximum of ten hours total per day across all clients (including clients from other organizations). A single recipient may receive a maximum of eight hours per day across all providers, and no provider or combination of providers may exceed 40 hours per week per client. Standard hours are 8:00 AM to 8:00 PM; sessions outside this window require Clinical Director pre-approval. I am expected to be available on MLK Jr. Day, Presidents' Day, Good Friday, Columbus Day, and Veterans Day unless otherwise approved, and I will not be required on New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, or Christmas Day unless agreed.

The Company is committed to a safe, drug-free work environment. I acknowledge that random and specific drug testing may be requested at any time.

The Company operates a zero-tolerance policy for any form of sexual harassment. Any person found to have sexually harassed another will face disciplinary action, up to and including termination of the contract agreement. I have received a full copy of this policy.

I attest that I have not been excluded from participating in the Medicare or Medicaid programs in any state, and I will immediately notify the agency if I ever become excluded. The Company will verify this information with the Office of Inspector General (OIG).

Under federal OSHA 29 CFR § 1910.1030, I have been informed that due to occupational exposure to blood or other infectious materials, I may be at risk of acquiring Hepatitis B. I have been given the opportunity to receive the Hepatitis B vaccine at no charge, and I retain the option to request vaccination at no charge at any time.

Ongoing supervision is required to maintain BACB credentialing. RBTs are expected to make themselves available for supervision sessions in coordination with their analyst. Analysts engaged as contractors are required to offer and provide supervision to assigned RBTs in accordance with BACB requirements and payer guidelines. RBTs out of compliance with supervision expectations will not be allowed to provide behavioral services.

I attest that I have received and thoroughly reviewed my job description for my position as an RBT, BCBA, or Administrative staff. I understand the assignments and responsibilities outlined and agree to adhere to them. I have been given the opportunity to ask questions and seek clarification.

I attest that I have received detailed information and instructions on reporting abuse, neglect, and exploitation of children and vulnerable adults under Chapter 415, Florida Statutes. I have been informed how to recognize physical, behavioral, and environmental indicators and how to report suspected abuse to the Florida Abuse Hotline at 1-800-962-2873 or 1-800-96-ABUSE, and how to report life-threatening emergencies to 911.

During my engagement with the Company and for one (1) year thereafter, I shall not (a) persuade any patient, client, vendor, referral source, or business partner of the Company to cease or reduce their business with the Company; (b) employ or attempt to employ any person who is or was employed by or in a consulting relationship with the Company within one (1) year prior to my termination; (c) remove any property belonging to or within the possession of the Company; or (d) provide any healthcare or related services to any patient I served on behalf of the Company. I agree that breach would cause irreparable damage entitling the Company to injunctive relief in addition to other legal remedies, that I will pay all costs and expenses incurred by the Company in enforcing this Agreement, and that any action under this Agreement may be determined by a judge without a jury.

I acknowledge that an electronic signature has the same legal force and effect as a handwritten signature. The signature below represents my official signature, and I commit to using this signature on all documents related to the service.

As a contractor, I understand that the Company does not provide tools or materials to contractors. I am required to use the Company's designated ABA practice management software. I acknowledge that the cost for access is $20.00 per month, deducted from my payment on the 30th of each month.

Analysts must provide 30 days' written notice to terminate their contract. RBTs must provide 15 days' written notice. Upon termination, I have 15 calendar days to submit any missing documentation and return all company property, including company ID and materials.

I am expected to actively participate in scheduled meetings and respond to written and phone communications within 6 hours as a condition for maintaining the contractual relationship. Failure to meet these expectations may result in corrective action, up to and including termination of the contract.

As a contractor, I am responsible for supplying my own therapy materials necessary for service provision and for the expenses of obtaining assessment tools (such as the Vineland and BASC) and any necessary assessment software (such as VB-MAPP). I must comply with specific payer requirements, which may vary by contract and funding source.

I am responsible for maintaining and updating my CAQH (Council for Affordable Quality Healthcare) profile as required by payers. Failure to keep CAQH information up to date may result in delayed credentialing, reimbursement issues, or contract suspension.

As a contractor, I understand that payment is contingent upon reimbursement received by the Company and that I will not be paid until funds are received from the funding source. Payments are disbursed on the 15th and 30th of each month and require my compliance with mandatory trainings, including required certifications, CPR training, HIPAA compliance, and other payer or agency trainings. I will maintain appropriate liability insurance if required by my role or payer contracts and adhere to ethical guidelines, HIPAA regulations, and professional conduct standards at all times.

As a provider, I am required to submit a written incident report for any significant event occurring during a session. All incident reports must comply with reporting requirements outlined by the agency and funding sources.