Common use of Private Pay Residents Clause in Contracts

Private Pay Residents. The items and services included in our daily rate of ______ which include basic room, board and general nursing care as required by the Resident's medical condition are listed in Exhibit 2. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You agree to make timely payments. You understand and agree that the Resident will be charged separately for additional items and services which the Resident or you (or the Resident's physician, with the Resident's or your approval) request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident may be charged is at Exhibit 2. If the Resident, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 2, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's physician with the Resident's or your approval) have requested them, and the Resident has received and been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor billed for the service. You understand and agree that you are responsible for paying the Facility for items and services provided to the Resident during any period of time in which the Resident is or was a resident of the Facility and during which the Resident has not been determined eligible for Medical Assistance. If you do not pay the amount owed us after receiving Facility bills and we hire a collection agency or attorney because of your breach of this Agreement, you agree to pay their fees, expenses and court costs with your own funds. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's income and assets available to pay the cost of the Resident's care. Once Medical Assistance determines the income and assets available to pay for the Resident's care, you agree to use such income and assets to pay the Facility's bills.3 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the Resident.) You agree to notify the Facility promptly if the Resident has insufficient income, funds, or assets to meet the Resident's financial obligations to the Facility and you agree to apply for Medical Assistance benefits in a timely manner and to cooperate fully in the Medical Assistance eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the court to order you to do so. If you are no longer able to pay for the Resident's care at the Facility and the Resident is not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the Resident for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's departure. If there is any dispute about whether the Resident should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Resident, you may want to find out now if the Resident is "medically eligible" for nursing home payment by Medicaid. (This is not, however, the same as applying for Medical Assistance benefits.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]

Private Pay Residents. The items and services included in our daily rate of ______ which $ include basic room, board and general nursing care as required by the Resident's your medical condition and are listed in Exhibit 21. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You , and you (or youragent) agree to make timely paymentspayment. You understand and agree that the Resident will be charged separately for additional items and services which the Resident you or you (or the Resident's your physician, with the Resident's or your approval) , request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy chargespharmacycharges, laboratory charges and additional services laboratorychargesandadditionalservices such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident you may be charged is at Exhibit 21. If the Residentyou (or your physician, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 21, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's your physician with the Resident's or your approval) have requested them, and the Resident has you have received and have been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that statementthat briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor payer billed for the service. You understand and agree that you (or your agent) are responsible for paying the Facility for items and services provided to the Resident you during any period of time in which the Resident is you are or was were a resident of the Facility and during which the Resident has you have not been determined eligible for Medical Assistance. If you (or your agent) do not pay the amount owed you owe us after receiving Facility bills bills, and we hire a collection agency or attorney because of your breach of this Agreementattorney, you agree to pay for their fees, expenses and court costs with your own fundscosts. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's your income and assets available to pay the cost of the Resident's your care. Once Medical Assistance determines the income and assets available to pay for the Resident's your care, you agree to use such income and assets to pay the Facility's bills.3 bills.1 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the ResidentAssistance.) You agree to notify the Facility promptly if the Resident has you have insufficient income, fundsfunds or assets, or assets to meet the Resident's your financial obligations to the Facility and you agree promptly to apply for Medical Assistance benefits in a timely manner and benefits. You agree to cooperate fully in the applying for Medical Assistance and in the eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the a court to order you to do so. If you are no longer able to pay for the Resident's your care at the Facility and the Resident is you are not eligible for eligiblefor Medical Assistance, you and the Resident will youwill be notified of the Facility's intention to discharge the Resident for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's departure. If there is any dispute about whether the Resident should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Resident, you may want to find out now if the Resident is "medically eligible" for nursing home payment by Medicaid. (This is not, however, the same as applying for Medical Assistance benefits.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]notified

Private Pay Residents. The items and services included in our daily rate of ______ which $ include basic room, board and general nursing care as required by the Resident's your medical condition and are listed in Exhibit 21. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You , and you (or your agent) agree to make timely paymentspayment. You understand and agree that the Resident will be charged separately for additional items and services which the Resident you or you (or the Resident's your physician, with the Resident's or your approval) , request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident you may be charged is at Exhibit 21. If the Residentyou (or your physician, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 21, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's your physician with the Resident's or your approval) have requested them, and the Resident has you have received and have been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor payer billed for the service. You understand and agree that you (or your agent) are responsible for paying the Facility for items and services provided to the Resident you during any period of time in which the Resident is you are or was were a resident of the Facility and during which the Resident has you have not been determined eligible for Medical Assistance. If you (or your agent) do not pay the amount owed you owe us after receiving Facility bills bills, and we hire a collection agency or attorney because of your breach of this Agreementattorney, you agree to pay for their fees, expenses and court costs with your own fundscosts. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's your income and assets available to pay the cost of the Resident's your care. Once Medical Assistance determines the income and assets available to pay for the Resident's your care, you agree to use such income and assets to pay the Facility's bills.3 bills.1 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the ResidentAssistance.) You agree to notify the Facility promptly if the Resident has you have insufficient income, fundsfunds or assets, or assets to meet the Resident's your financial obligations to the Facility and you agree promptly to apply for Medical Assistance benefits in a timely manner and benefits. You agree to cooperate fully in the applying for Medical Assistance and in the eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the a court to order you to do so. If you are no longer able to pay for the Resident's your care at the Facility and the Resident is you are not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the Resident for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's departure. If there is any dispute about whether the Resident should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Resident, you may want to find out now if the Resident is "medically eligible" for nursing home payment by Medicaid. (This is not, however, the same as applying for Medical Assistance benefits.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]notified

Private Pay Residents. The items and services included in our the monthly or daily rate of ______ which $ include basic room, board board, and general nursing care as required by the Resident's your medical condition and are listed in Exhibit 2Appendix 1. Payment for items and services that are included in the monthly or daily rate is payable one month in advance and due on the first of each month. You , and you (or your agent) agree to make timely paymentspayment. You understand and agree that the Resident will be charged separately for additional items and services which the Resident you or you (or the Resident's your physician, with the Resident's or your approval) , request and which are not included in our the Corporation's monthly or daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services services, and newspapers. A list of many of the ordinary items and services for which the Resident you may be charged is at Exhibit 2Appendix 1. If the Residentyou (or your physician, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 2Appendix 1, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's your physician with the Resident's or your approval) have requested them, and the Resident has you have received and have been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us the Corporation for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor billed for the service. You understand and agree that you (or your agent) are responsible for paying the Facility Corporation for items and services provided to the Resident you during any period of time in which the Resident is you are or was were a resident of the Facility and during which the Resident has not been determined eligible for Medical AssistanceFacility. If you (or your agent) do not pay the amount owed us you owe the Corporation after receiving Facility bills bills, and we hire the Corporation hires a collection agency or attorney because of your breach of this Agreementattorney, you agree to pay for their fees, expenses and court costs with your own fundscosts. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's income and assets available to pay the cost of the Resident's care. Once Medical Assistance determines the income and assets available to pay for the Resident's care, you agree to use such income and assets to pay the Facility's bills.3 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the Resident.) You agree to notify the Facility Corporation promptly if the Resident has you have insufficient income, funds, or assets assets, to meet the Resident's your financial obligations to the Facility and you agree to apply for Medical Assistance benefits in a timely manner and to cooperate fully in the Medical Assistance eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the court to order you to do soCorporation. If you are no longer able to pay for the Resident's your care at the Facility and Facility, the Resident Corporation will determine whether it will provide financial assistance to help you pay for your care at the Facility. The Corporation is not eligible for Medical Assistance, you and the Resident will be notified obligated to provide financial assistance. The President of the Facility's intention Corporation has the sole and absolute discretion to discharge the Resident grant, deny or withdraw financial assistance. If you are discharged for non-payment. You , you agree to continue to pay the FacilityCorporation's prevailing daily or monthly charges until the date of your departure. See Section V of the ResidentCorporation's departureResidence and Care Agreement or Residence and Services Agreement for information on the Corporation's discretionary financial assistance program for residents that have exhausted their funds. If there is any dispute about whether the Resident you should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's your funds, the Facility Corporation will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Residentlater, you may want to find out now if the Resident is you are "medically eligible" for nursing home payment by Medicaid. (See Appendix 2B. This is not, however, the same as applying for Medical Assistance benefitsAssistance.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]

Private Pay Residents. The items and services included in our daily rate of _$_____ which include basic room, board and general nursing care as required by the Resident's your medical condition and are listed in Exhibit 21. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You , and you (or your agent) agree to make timely paymentspayment. You understand and agree that the Resident will be charged separately for additional items and services which the Resident you or you (or the Resident's your physician, with the Resident's or your approval) , request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident you may be charged is at Exhibit 21. If the Residentyou (or your physician, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 21, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's your physician with the Resident's or your approval) have requested them, and the Resident has you have received and have been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor payer billed for the service. You understand and agree that you (or your agent) are responsible for paying the Facility for items and services provided to the Resident you during any period of time in which the Resident is you are or was were a resident of the Facility and during which the Resident has you have not been determined eligible for Medical Assistance. If you (or your agent) do not pay the amount owed you owe us after receiving Facility bills bills, and we hire a collection agency or attorney because of your breach of this Agreementattorney, you agree to pay for their fees, expenses and court costs with your own fundscosts. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's your income and assets available to pay the cost of the Resident's your care. Once Medical Assistance determines the income and assets available to pay for the Resident's your care, you agree to use such income and assets to pay the Facility's bills.3 bills.1 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the ResidentAssistance.) You agree to notify the Facility promptly if the Resident has you have insufficient income, fundsfunds or assets, or assets to meet the Resident's your financial obligations to the Facility and you agree promptly to apply for Medical Assistance benefits in a timely manner and benefits. You agree to cooperate fully in the applying for Medical Assistance and in the eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the a court to order you to do so. If you are no longer able to pay for the Resident's your care at the Facility and the Resident is you are not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the Resident you for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's your departure. If there is any dispute about whether the Resident you should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's your funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Residentlater, you may want to find out now if the Resident is you are "medically eligible" for nursing home payment by Medicaid. (See Exhibit 2B. This is not, however, the same as applying for Medical Assistance benefitsAssistance.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]

Private Pay Residents. The items and services included in our daily rate of _$_____ which include basic room, board and general nursing care as required by the Resident's your medical condition and are listed in Exhibit 21. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You , and you (or your agent) agree to make timely paymentspayment. You understand and agree that the Resident will be charged separately for additional items and services which the Resident you or you (or the Resident's your physician, with the Resident's or your approval) , request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident you may be charged is at Exhibit 21. If the Residentyou (or your physician, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 21, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's your physician with the Resident's or your approval) have requested them, and the Resident has you have received and have been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor payer billed for the service. You understand and agree that you (or your agent) are responsible for paying the Facility for items and services provided to the Resident you during any period of time in which the Resident is you are or was were a resident of the Facility and during which the Resident has you have not been determined eligible for Medical Assistance. If you (or your agent) do not pay the amount owed you owe us after receiving Facility bills bills, and we hire a collection agency or attorney because of your breach of this Agreementattorney, you agree to pay for their fees, expenses and court costs with your own fundscosts. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's your income and assets available to pay the cost of the Resident's your care. Once Medical Assistance determines the income and assets available to pay for the Resident's your care, you agree to use such income and assets to pay the Facility's bills.3 bills.1 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the ResidentAssistance.) You agree to notify the Facility promptly if the Resident has you have insufficient income, fundsfunds or assets, or assets to meet the Resident's your financial obligations to the Facility and you agree promptly to apply for Medical Assistance benefits in a timely manner and benefits. You agree to cooperate fully in the applying for Medical Assistance and in the eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the a court to order you to do so. If you are no longer able to pay for the Resident's your care at the Facility and the Resident is you are not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the Resident you for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's your departure. If there is any dispute about whether the Resident you should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's your funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Residentlater, you may want to find out now if the Resident is you are "medically eligible" for nursing home payment by MedicaidMedicaid (see Exhibit 2B). (This is not, however, the same as applying for Medical Assistance benefitsAssistance.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]

Private Pay Residents. The items and services included in our daily rate of ______ which include basic room, board and general nursing care as required by the Resident's medical condition are listed in Exhibit 2. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You agree to make timely payments. You understand and agree that the Resident will be charged separately for additional items and services which the Resident or you (or the Resident's physician, with the Resident's or your approval) request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident may be charged is at Exhibit 2. If the Resident, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 2, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's physician with the Resident's or your approval) have requested them, and the Resident has received and been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor billed for the service. You understand and agree that you are responsible for paying the Facility for items and services provided to the Resident during any period of time in which the Resident is or was a resident of the Facility and during which the Resident has not been determined eligible for Medical Assistance. If you do not pay the amount owed us after receiving Facility bills and we hire a collection agency or attorney because of your breach of this Agreement, you agree to pay their fees, expenses and court costs with your own funds. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's income and assets available to pay the cost of the Resident's care. Once Medical Assistance determines the income and assets available to pay for the Resident's care, you agree to use such income and assets to pay the Facility's bills.3 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the Resident.) You agree to notify the Facility promptly if the Resident has insufficient income, funds, or assets to meet the Resident's financial obligations to the Facility and you agree to apply for Medical Assistance benefits in a timely manner and to cooperate fully in the Medical Assistance eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the court to order you to do so. If you are no longer able to pay for the Resident's care at the Facility and the Resident is not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the 3 If you do not request a determination by Medical Assistance, or if payment is not made with the income and assets determined to be available for the Resident's care, the Facility may ask the court to order you to obtain the determination or to make payment. If you are willfully or grossly negligent in not paying the amount determined by Medical Assistance to be available for the Resident's care, you may have to pay a civil money penalty of at least that amount with your own money. Resident for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's departure. If there is any dispute about whether the Resident should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Resident, you may want to find out now if the Resident is "medically eligible" for nursing home payment by Medicaid. (This is not, however, the same as applying for Medical Assistance benefits.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]

Private Pay Residents. The items and services included in our daily rate of ______ which include basic room, board and general nursing care as required by the Resident's medical condition are listed in Exhibit 2. Payment for items and services that are included in the daily rate is payable one month in advance and due on the first of each month. You agree to make timely payments. You understand and agree that the Resident will be charged separately for separatelyfor additional items and services which the whichthe Resident or you (or the Resident's physician, with the Resident's or your approval) request and which are not included in our daily rates such as special nursing care, special equipment, pharmacy charges, laboratory charges and additional services such as telephone expenses, clothing, beauty and beautyand xxxxxx services and newspapers. A list of many of the ordinary items and services for which the Resident may be charged is at Exhibit 2. If the Resident, or you, or the Resident's physician (with the Resident's or your approval) request items or services other than those listed in Exhibit 2, you will be notified of the cost. Payment for these additional items and services is due within thirty (30) days after the Resident or you (or the Resident's physician with the Resident's or your approval) have requested them, and the Resident has received and been billed for them. Within ninety (90) days of receiving an item or service, or within thirty (30thirty(30) days of payment, you or the Resident have the right to ask us for an itemized statement that briefly but clearly describes each item and service, the amount charged for it, and the identity of the payor billed for the service. You understand and agree that you are responsible for paying the Facility for items and services provided to the Resident during any period of time in which the Resident is or was a resident of the Facility and during which the Resident has not been determined eligible for Medical Assistance. If you do not pay the amount owed us after receiving Facility bills and we hire a collection agency or attorney because of your breach of this Agreement, you agree to pay their fees, expenses and court costs with your own funds. If you do not pay what is owed the Facility, you agree to apply to Medical Assistance for a determination of the Resident's income and assets available to pay the cost of the Resident's care. Once Medical Assistance determines the income and assets available to pay for the Resident's care, you agree to use such income and assets to pay the Facility's bills.3 (Your request for this determination is not the same as applying for Medical Assistance on behalf of the Resident.) You agree to notify the Facility promptly if the Resident has insufficient income, funds, or assets to meet the Resident's financial obligations to the Facility and you agree to apply for Medical Assistance benefits in a timely manner and to cooperate fully in the Medical Assistance eligibility determination process. If you do not apply or cooperate fully in the process, the Facility may ask the court to order you to do so. If you are no longer able to pay for the Resident's care at the Facility and the Resident is not eligible for Medical Assistance, you and the Resident will be notified of the Facility's intention to discharge the 3 If you do not request a determination by Medical Assistance, or if payment is not made with the income and assets determined to be available for the Resident's care, the Facility may ask the court to order you to obtain the determination or to make payment. If you are willfully or grossly negligent in not paying the amount determined by Medical Assistance to be available for the Resident's care, youmay have to pay a civil money penalty of at least that amount with your own money. Resident for non-payment. You agree to continue to pay the Facility's prevailing daily charges until the date of the Resident's departure. If there is any dispute about whether the Resident should be discharged, the notice and other requirements in Section 4.F. apply. If transfer or discharge becomes necessary because you or someone else abused the Resident's funds, the Facility will request that the Attorney General investigate which may result in prosecution. If you believe that you may need to apply for Medical Assistance later for the Resident, you may want to find out now if the Resident is "medically eligible" for nursing home payment by Medicaid. (This is not, however, the same as applying for Medical Assistance benefits.) See Exhibit 3B. [The Exhibit is written in terms of the Resident.]