Home Care Standards Bureau
A+ Rating Application

Agency Information


Thank you for your interest in becoming an A+ Rated agency with the Home Care Standards Bureau. Please be sure to fill out the application in its entirety. Missing information may prolong the application process. If something is not required for your state, please use N/A to acknowledge the question.

The following information will be used for agency marketing material



Qualified Agency Personnel
For example: Gerontologist, Social Worker, Certified Senior Advisor(CSA), RN, etc
Agency Procedures

Background Checks

All caregivers are required to have undergone a 5-tiered background check that include:

The motor vehicle background check is not applicable if your agency and it's caregivers are not providing transportation to patients.
Agency agrees to ensure caregivers hired meet the following background history requirements:

Acknowledgement
Insurance
To become A+ Rated, your agency is required to carry insurance coverage at or above the following: Commercial General Liability - $1,000,000 Minimum bodily injury and property damage general or public liability coverage, and $2,000,000 bodily injury and property damage liability in the aggregate. Medical Payments as part of the General Liability Insurance Policy - $5,000 Minimum. Completed Operations or Products as part of the General Liability Insurance Policy - $1,000,000 Minimum Professional Liability - $250,000 Minimum incidental professional liability coverage for bodily injury and property.
Auto Liability - If vehicles are owned: $1,000,000 Minimum combined bodily injury and property damage coverage; if hired/non-owned $500,000 Minimum combined single limit. Does your agency carry the above coverage?
Workers Compensation Coverage - If required by the state where the operation is based, the company must comply with the state statutory limits and a minimum of $500,000 employers’ liability.
Name of Insurance Company and policy numbers. -OR-
If you have Certificates of Insurance readily available, please upload now. Liability Insurance

Education and Training

All caregivers employed and contracted by the agency are required to complete a minimum of twelve (12) courses of continuing education annually. HCSB will provide access to an educational program at no additional charge. Please agree by initialing one or more of the below boxes:
HCSB will provide access to an educational program at no additional charge.

Agency Complaint Procedure

Agencies are required to have a complaint resolution policy and maintain a log of complaints and outcomes.
Does your agency have a complaint resolution policy?
Does your agency have a log of outcomes?

Disclosure Questionnaire


Acknowledgement of Code of Ethics & Standards: Adherence to A+ Rating Terms

a. Permission to use the Home Care Standards (HCSB) A+ Rating is valid so long as my agency remains in good standing. If agency fails to comply with the A+ Rating requirements, I will immediately cease use of the A+ Rating mark. HCSB may publish on its website names of certain agencies that have used the A+ Rating in an unauthorized manner.
b. HCSB has the absolute and unrestricted right to revoke my HCSB A+ Rating, including any rights the agency may have to use the HCSB A+ Rating.
c. In consideration of the A+ Rating granted, neither the Home Care Standards Bureau - Regulatory Board (HCSB-RB), nor HCSB, its directors, officers, employees and others acting on its behalf, shall be liable for any actions taken or omitted, to be taken in any official capacity or in the scope of employment, except to the extent that such actions or omissions constitute willful misconduct or gross negligence, and I hereby release HCSB and HCSB-RB from any liability for such actions or omissions.
d. The agency will fulfill any ongoing compliance requirements by HCSB or HCSB-RB.
e. HCSB may suspend or revoke the A+ Rating for nonpayment.
f. The agency will comply with all rules and requirements of the HCSB-RB. If granted an A+ Rating, the agency will comply with all standards and requirements that the HCSB-RB may issue from time to time, including usage standards for the A+ Rating.
g. All caregivers employed and contracted by this agency have undergone background checks. The agency understands that these reports will be maintained and will be made available to HCSB for review at the onsite audit.
h. The agency will carry continued insurance meeting minimum HCSB standards. The agency understands that continuance of insurance coverage will be made available to HCSB for review at the annual audit.
i. All caregivers employed and contracted by agency must complete 12 courses of approved caregiver education annually or demonstrate competency by passing an exam that covers core education topics.
j. The agency agrees to both scheduled and unannounced on-site audits.
k. The agency agrees to maintain 90% of its caregivers as W2 employees.
l. The agency will maintain a policy regarding motor vehicle use and required licenses to transport clients.
m. The agency will maintain a complaint resolution policy and a log of complaints and outcomes consistent with this policy.
n. The agency will agree to complete any requested monthly disclosures verifying ongoing compliance or progress meeting outstanding compliance items. I understand and agree to follow the HCSB A+ Rating Terms and Code of Ethics & Standards

Application Disclosure and Payment Information

As the authorized representative of this agency applying for the A+ Rating and enrollment in the Home Care Standards Bureau (HCSB), it is important to note that any and all information will be reviewed, checked, and verified to match the application and the statements of the applicant.
If at any time the information represented to HCSB is found to be intentionally untruthful, materially false, concealing facts, or misleading, it will be considered an attempt by the agency to defraud the HCSB and will lead to the dismissal of the application process. If the company has already achieved the A+ Rating, the Board of Directors will determine if the privileges will be revoked or other steps taken to assist the agency to correct the wrong and able them to keep their rating.
Payment Details: Application Fee of $95.00 will be a one-time charge processed today.

Payment
At the time of A+ Rating Approval, your credit card will be charged the month to month subscription amount of $195.00 ($145 for Agencies who are first in their market). As soon as you've successfully completed this A+ Rating process and your payment is confirmed, your A+ rating will go into effect. Your agency will receive the marketing items for approval, and the link to your full landing page on HCSB's website.

Renewal
After that, we'll renew your monthly subscription automatically, unless you cancel. The price is locked in for the first 36 months.

Cancellation
If you choose to cancel the subscription of the A+ Rating process, you will need to submit a request to cancel in writing 30 days prior to your billing cycle.

IF MY AGENCY IS NO LONGER A+ RATED, I WILL NO LONGER USE ANY MATERIAL THAT HAS THE HCSB LOGO AND WILL NOT DISPLAY IN ANY MANNER THE A+ RATED CERTIFICATE AND WILL DESTROY ANY BROCHURES AND OTHER MARKETING MATERIALS THAT HAVE ANY REFERENCE TO THE HOME CARE STANDARDS BUREAU.

I acknowledge that I have read, fully understand, and agree to comply with the application process for enrollment and all requirements to be an HCSB A+ Rated agency. You agree your electronic signature is the legal equivalent of your manual signature on this agreement.

Credit Card Information

Card Billing Address (if different from agency address)

Information for Landing Page and Brochure

Legal Name of Agency for Landing Page and Brochure
Agency Address, City, State and Zip Code for Landing Page
Agency Phone Number for Landing Page and Brochure
Agency Website Address for Landing Page and Brochure
Agency Contact Name for Landing Page
Please attach your agency logo into the body of the email when you return your application, or if you have a url of the logo please include it below.
For assistance, contact Sheila Rodgers at info@hcsb.us or 855.374-9076, Monday through Friday, 8:00 a.m. to 3:00 p.m. I will send you the link to your landing page for your approval before I post it to HCSB’s website.