Failure to Assist Resident with Medicaid Application
Summary
The facility failed to provide necessary assistance and written information to a resident's designated power of attorney (DPOA) on how to apply for and use Medicare and Medicaid benefits. This resulted in the resident not having Medicaid coverage in a timely manner, leading to significant out-of-pocket expenses. The resident, who was admitted with diagnoses including Parkinson's disease, congestive heart failure, and cognitive communication deficit, faced financial challenges when Medicare coverage ended. The DPOA reported not receiving an admission packet with pertinent insurance and Medicaid information, leading to a stressful financial situation. The facility attempted to discharge the resident home, despite the resident requiring two-person assistance for care, and demanded advance payment for continued stay. The DPOA had to fill out Medicaid paperwork multiple times without assistance, resulting in a $14,000 bill. The facility's business office manager provided a Medicaid application only after receiving a check for three days of private pay. The facility did not have a policy for readmitting residents after hospitalization and did not provide admission packets. The resident's Medicaid application was delayed, and there was a lack of follow-up when Medicare coverage ended. The facility's regional business office manager consultant confirmed that the facility should have assisted the DPOA in applying for Medicaid sooner and that the NOMNC was not properly handled.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
Missing Required Medicare and Medicaid Posting: A First Floor bulletin board had required posted information for residents and visitors, but it did not include written information on how to apply for Medicare and Medicaid benefits or how to receive refunds for previous payments covered by those programs. The omission was observed by surveyors and confirmed by the A/NHA.
A resident with severe cognitive impairment was admitted with Medicare A, but the admission agreement stated the facility did not participate in Medicaid even though staff later said the facility did accept Medicaid residents and assisted families with Medicaid applications. The resident’s guardian said she did not apply for Medicaid because of the contract language.
Late NOMNC Delivery. A resident’s NOMNC for ending Medicare-covered skilled services was signed only 1 day before services ended, and the NHA confirmed it was not provided within the required 48-hour advance timeframe.
A facility failed to display required written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid. Surveyors observed the missing information on the First Floor, Second Floor nursing unit, and Fourth Floor nursing unit, and the NHA confirmed the omission.
The facility failed to display written information on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid on two nursing units, including the [NAME] and Garden units. Surveyors observed the missing information, and the NHA later confirmed the deficiency.
Surveyors found that the facility did not display required written information in common posting areas, such as the lobby and hallways near nursing units, explaining how residents and their representatives can apply for and use Medicare and Medicaid benefits and obtain refunds for previous payments covered by those programs. During an interview, the NHA confirmed that this information was not posted anywhere in the building, resulting in noncompliance with state requirements for licensee responsibility and management.
Missing Required Medicare and Medicaid Posting
Penalty
Summary
The facility failed to display written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid in the area where postings are available on the First Floor. During an observation on 7/30/26 at 10:30 a.m., the First Floor bulletin board was noted to have required posted information that was conveniently located for residents and visitors, but it did not include the required Medicare and Medicaid application and refund information. This was confirmed during an interview on 7/30/26 at 11:40 a.m. by the Assistant Nursing Home Administrator, who acknowledged that the facility failed to display the required written information.
Admission Contract Misstated Medicaid Participation
Penalty
Summary
The facility failed to provide an admission contract that accurately reflected its Medicaid participation status for one resident who was reviewed for admission contract issues. The resident was admitted with Medicare A as the payer source, and the quarterly MDS showed a BIMS score of zero out of 15, indicating severe cognitive impairment. The resident’s guardian stated she was given a contract at admission that said the facility did not accept Medicaid as payment, and she had not attempted to apply for Medicaid because of that contract. Record review of the resident’s admission agreement showed language stating that the resident may be considered a Medicaid beneficiary under applicable state law, but also stated, “The Facility does NOT participate in the Medicaid program.” During interviews, the BOM stated the facility did complete Medicaid applications with residents and family members and said the facility participated in Medicaid even though the contract said otherwise. The ADON and Administrator also stated the facility accepted Medicaid residents and were not sure why the contract was different.
Late Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide the Notice of Medicare Non-Coverage (NOMNC) within the required 2-day advance timeframe for one resident. Review of the resident’s medical record showed a NOMNC stating that Medicare-covered skilled services were ending on May 14, 2026, and the notice was signed and dated by the resident on May 13, 2026 at 9:00 a.m., which was only 1 day before the end of Medicare-covered services. During an interview on June 12, 2025 at 12:05 p.m., the Nursing Home Administrator confirmed that the NOMNC was not provided within the required 48-hour timeframe.
Missing Medicare and Medicaid Posting Information
Penalty
Summary
The facility failed to display written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid in areas where postings were available, including the First Floor, Second Floor Nursing Unit, and Fourth Floor Nursing Unit. During observations on 4/7/26 from 12:51 p.m. through 1:10 p.m., surveyors found that the required information was not included on the postings in those locations. During an interview on 4/7/26 at 2:13 p.m., the Nursing Home Administrator confirmed that the facility had failed to display the required written information in the building.
Failure to Display Medicare and Medicaid Benefit Information
Penalty
Summary
The facility failed to display written information on how to apply for Medicare and Medicaid benefits and on receiving refunds for previous payments covered by Medicare and Medicaid on two of two nursing units, identified as the [NAME] and Garden nursing units. During observations on 3/4/25 at approximately 1:30 p.m., surveyors found that the required information was not included on either unit. During an interview on 3/6/26 at approximately 12:00 p.m., the Nursing Home Administrator confirmed that the facility failed to display the written information on applying for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid on both units.
Failure to Post Required Medicare/Medicaid Information for Residents
Penalty
Summary
The facility failed to display required written information for residents and/or their responsible persons on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. During observations on 2/11/26 at approximately 11:30 a.m., surveyors inspected the first-floor lobby and hallways in and around the nursing units, where postings are typically available, and found that information on applying for Medicare and Medicaid and obtaining refunds for prior payments covered by these programs was not posted. In a subsequent interview on 2/12/26 at 9:00 a.m., the Nursing Home Administrator confirmed that the facility had not displayed this required written information anywhere in the building. The deficiency was cited under 28 Pa. Code: 201.14(a) Responsibility of licensee and 28 Pa. Code: 201.18(e) Management.
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