Failure to Notify Residents of Medicaid Eligibility Risk
Summary
The facility failed to notify residents or their representatives who receive Medicaid benefits when their account balances reached $200 less than the Social Security Income (SSI) resource limit. This deficiency was identified for three residents whose personal needs funds were managed by the facility. Specifically, Resident ID #10 had a balance of $4,370.42, Resident ID #16 had a balance of $4,549.22, and Resident ID #17 had a balance of $4,186.66. According to Title 210-Executive Office of Health and Human Services, Chapter 50-Medicaid Long-Term Services and Supports (LTSS), the facility is required to notify residents in writing when their balance approaches the SSI Medicaid eligibility resource limit of $4,000. During an interview, the Administrator was unable to provide evidence that these notifications were made, resulting in a failure to comply with the regulatory requirement.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident's funds were not dispersed to their representative within the required timeframe following the resident's death. Staff involved were unaware of the policy timeframe, and the facility did not provide evidence that the funds were refunded within thirty days as required by policy.
A resident with severe cognitive impairment and multiple medical conditions was discharged, but the facility did not transfer the resident's personal funds to the estate within the required 30-day period. The account remained open for nearly three months after discharge, contrary to facility policy.
A resident's personal funds were not refunded to their spouse within the required 30-day period following the resident's death. Despite multiple contacts and assistance from the Ombudsman, the refund check was delayed for several months, and facility staff confirmed the delay without providing a reason. The resident had multiple serious medical conditions at the time of death.
The facility did not notify two residents, one with cognitive impairment and one cognitively intact, when their personal fund balances were within $200 of the SSI resource limit for multiple months. Documentation and interviews confirmed that required notifications to the residents or their representatives were not made.
Several residents with facility-managed accounts had personal fund balances that exceeded the SSI resource limit, and routine, timely notices were not consistently provided or acted upon. Some residents received spend-down notices but did not reduce their balances, and in one instance, a notice was given to a resident instead of their legal guardian. The Administrator confirmed the issue was related to the county office not deducting required liabilities.
The facility did not refund resident funds within the required 30 days after discharge for two residents, including one with a court-appointed guardian and another who transferred to a different facility. In both cases, the facility delayed closing the resident fund accounts and issuing refunds, despite facility policy requiring timely disbursement.
Failure to Timely Disperse Resident Funds After Death
Penalty
Summary
The facility failed to ensure that a deceased resident's funds were dispersed to the resident's representative within the required timeframe. Review of the closed medical record showed the resident had been admitted and subsequently passed away. Interviews with the Business Office Manager and Corporate Accounts Receivable revealed that although a check was eventually issued for the resident's funds, both staff members were unaware of the specific timeframe for dispersing funds after a resident's death. The facility's policy requires that all funds be refunded to a resident's representative within thirty days of discharge, but there was no evidence that this was done in a timely manner for this resident. The deficiency was identified during a complaint investigation and affected one resident out of those reviewed for dispersed funds.
Delay in Disbursement of Resident Funds After Discharge
Penalty
Summary
The facility failed to disburse a resident's personal funds to the resident's estate within the required 30-day period following discharge, as mandated by facility policy. A review of records showed that a resident with diagnoses including congestive heart failure, hypertension, and dementia, who was severely cognitively impaired, was discharged from the facility. The resident's responsible party had previously authorized the management of personal funds. Despite this, the resident's account, which had a balance of $35.12, was not closed and the funds were not conveyed to the estate until nearly three months after discharge. This delay was confirmed by the facility administrator during an interview and was not in accordance with the facility's written policy on managing personal funds.
Failure to Timely Refund Resident Personal Funds After Death
Penalty
Summary
The facility failed to convey a resident's personal funds and provide a final accounting to the resident's representative within 30 days of the resident's death, as required by facility policy. Record review showed that the resident, who had diagnoses including Alzheimer's Disease, dementia, severe protein-calorie malnutrition, congestive heart failure, and type 2 diabetes mellitus with diabetic neuropathy, expired in the facility. The resident's spouse reported not receiving the refund check for the resident's personal funds until several months after the resident's death, despite contacting the Ombudsman for assistance. Interviews with the Business Office Manager and the Administrator confirmed that the refund check was not issued within the required 30-day timeframe, and no explanation was provided for the delay. The Ombudsman also confirmed being contacted by the resident's spouse and subsequently speaking with the Administrator, who stated they were working on the issue. Documentation showed that the refund check for $759.00 was eventually issued to the resident's spouse, but not in a timely manner as stipulated by facility policy.
Failure to Notify Residents of Personal Fund Balances Near SSI Resource Limit
Penalty
Summary
The facility failed to notify residents who received Medicaid benefits when their personal fund balances reached within $200 of the Social Security Income (SSI) resource limit, as required. For one resident with significant cognitive impairment and multiple complex medical diagnoses, records showed that their account balance was within $200 of the SSI resource limit for five consecutive months. There was no documented evidence that the resident or their representative was notified of this status during that period. The resident's care plan noted communication problems and cognitive deficits, further emphasizing the importance of proper notification. A second resident, who was cognitively intact and had a history of multiple chronic conditions, also had personal funds within $200 of the SSI resource limit for three months. Again, there was no documentation that the resident or their representative was notified. The Business Office Manager confirmed in an interview that notifications were not sent to either resident or their representatives during the relevant months.
Failure to Provide Timely Notices for Resident Fund Balances Exceeding SSI Limit
Penalty
Summary
The facility failed to provide routine and timely notices to residents when their personal fund balances exceeded the Supplemental Security Income (SSI) resource limit. Record review and interviews revealed that four residents had authorized the facility to manage their funds, but their account balances surpassed the allowable SSI limit. Despite receiving spend-down notices, the residents' funds continued to exceed the limit, and in one case, the notice was given to the resident instead of the legal guardian. Residents reported receiving notifications but did not take action to reduce their balances, and one resident was unsure of what was needed to spend down the funds. The Administrator confirmed that the affected residents' funds were over the SSI resource limit and attributed the issue to the county office not deducting the required liability from the residents' accounts. As a result, the facility did not ensure that residents or their representatives were properly notified or assisted in maintaining their funds below the SSI threshold, as required.
Failure to Timely Refund Resident Funds After Discharge
Penalty
Summary
The facility failed to refund resident funds within 30 days of discharge for two residents. For one resident with a court-appointed guardian and severe cognitive impairment, the facility issued an initial check to the guardian to close the resident fund account, but continued to receive and process deposits from Social Security and other sources after discharge. The facility did not notify Social Security of the resident's discharge until several months later, resulting in additional deposits and delayed closure of the account well beyond the required 30-day period. For another resident who was their own responsible party and had a daughter as power of attorney, the facility issued a check to the new nursing facility where the resident transferred, but this was also completed past the 30-day post-discharge requirement. Facility documentation, including the Resident Admission Agreement and Resident Fund Authorization, specified that funds should be disbursed within 30 days of discharge, but this policy was not followed in these cases.
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