Failure to Provide Equal Access to Rehab Services for Medicaid Resident
Summary
The facility failed to provide equal access to rehabilitation services for a resident with Medicaid as a payer source. Resident L, who had been admitted to the facility with the expectation of receiving therapy, reported that he had not received any range of motion exercises or therapy since his admission. Despite having a physician's order for physical therapy, the resident experienced a delay in receiving an evaluation and therapy services. The Director of Rehab indicated that she was unable to evaluate new admissions with Medicaid without the Administrator's permission, which contributed to the delay in Resident L's therapy evaluation and services. Resident L had significant medical conditions, including hemiplegia and hemiparesis following a cerebral infarction, which affected his left side. His admission Minimum Data Set assessment indicated he required assistance with personal hygiene, bathing, and transfers, and had impaired range of motion on his left side. A baseline care plan outlined the need for physical and occupational therapy to improve his functional status and minimize decline. However, the therapy services were not initiated until after the Administrator approved them, despite the resident's requests and the Director of Rehab's belief that he would benefit from therapy. The Administrator acknowledged that the facility did not offer a restorative program and that they did not receive reimbursement for therapy services for residents with Medicaid. This financial consideration appeared to influence the delay in providing therapy services to Resident L. The Administrator confirmed that Resident L had requested therapy and that his request was addressed in a written grievance. The facility's policy on specialized rehabilitation services indicated that such services are considered a facility service and should not be charged to Medicaid recipients, yet the delay in providing these services suggests a failure to adhere to this policy.
Penalty
Resources
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Surveyors found that after a change of ownership, the facility shifted toward a short‑term/post‑acute model while continuing to hold Medicaid certification, and began systematically planning discharges for LTC residents whose primary payor was Medicaid. The new admission agreement only allowed month‑to‑month or respite/short‑term stays, and the website omitted LTC services. The Administrator and DON acknowledged that discharge planning began on admission and that residents on former LTC wings were being moved to skilled care, while discharge logs showed that all residents sent to other nursing homes over a recent period were Medicaid. Multiple residents and their representatives reported being told that LTC residents, especially those on Medicaid, could not stay because the facility was now only rehabilitation or short‑term, that “long‑term don’t belong,” and that stable, non‑skilled residents were being transitioned out, leading to fear and distress among remaining Medicaid LTC residents.
The facility did not ensure that all residents were treated equally in matters of transfer, discharge, and service provision, regardless of their payment source.
The facility did not provide equal treatment to all residents in matters of transfer, discharge, and services, with differences noted based on payment source.
A resident who transitioned from Medicare to private pay was not provided with consistent discharge planning or assistance with alternative placement, despite being assessed as appropriate for a lower level of care. The facility did not document an active discharge plan for several months, failed to communicate effectively with the POA, and staff threatened to contact APS when the POA attempted to arrange a transfer. Leadership acknowledged a lack of proactive discharge planning and indicated the resident would remain until funds were depleted, without evidence of equal access to services regardless of payor source.
Two residents did not receive necessary services due to their insurance status. A resident with a dental abscess did not receive timely dental care because she was awaiting medical assistance approval. Another resident, requiring therapy services, was not provided with these services as her insurance paperwork was pending. The facility's failure to provide these services was confirmed by the nursing home administrator.
Discriminatory Discharge Practices Targeting Medicaid LTC Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure residents were treated equally regarding transfer, discharge, and provision of services regardless of Medicaid payment source, and failure to ensure Medicaid residents were not being discharged because of their payor status. A Change of Ownership (CHOW) application dated 07/23/2025 indicated the new owner requested Medicaid certification and a letter to residents and families stated there would be no disruption in care. However, the new, undated admission agreement under the new facility name only offered month‑to‑month or respite/short‑term stay options, and the facility website listed skilled nursing, rehabilitation, activities, and social services but did not list LTC services. The Administrator stated facility practices had not changed but acknowledged they discharged “all kinds of residents,” started discharge planning on admission, and that acceptance and retention of LTC Medicaid residents “depended” on the resident. Interviews and records showed a pattern of targeting Medicaid LTC residents for discharge or transfer. The DON reported that social services sought residents willing to transfer to other SNFs to increase availability to provide services to the community and that residents on the East wings, previously LTC, were being placed on skilled care. Census review showed a high proportion of Medicaid residents on the East wings, and discharge records from 01/01/2026 to 01/21/2026 showed nine residents discharged to other nursing homes, all of whom were Medicaid. An administrator and DNS from a receiving facility stated the discharging facility was referring Medicaid residents because they now only accepted Medicare residents, were making room for more skilled residents, and were trying to transition to skilled‑care‑only operations. Multiple residents and their representatives reported being told that LTC residents, particularly Medicaid‑funded residents, could not remain. One resident’s representative stated they were told the facility was no longer doing LTC, only rehabilitation, and another emergency contact reported being told that the LTC side of the building “had to be discharged.” Several residents and POAs, all with Medicaid as primary payor source, reported being informed that the facility was becoming a short‑term/post‑acute or rehabilitation facility and that LTC residents “don’t belong,” could not stay, or would be transitioned because they were stable and did not need skilled care. A Nursing Facility Case Manager stated the new ownership wanted to run the facility like a rehabilitation place, fill beds, and discharge residents as soon as possible. Residents and representatives described fear and upset as LTC residents were approached about transfers without written notices, and staff interviews confirmed an active process of discharge planning for “everyone” and transitioning stable, non‑skilled residents out of the facility, many of whom were Medicaid LTC residents.
Unequal Treatment in Transfers, Discharges, and Services Based on Payment Source
Penalty
Summary
The facility failed to treat all residents equally regarding transfer, discharge, and the provision of services, regardless of their payment source. This deficiency indicates that some residents may have experienced differences in how they were transferred, discharged, or received services based on their payment method. The report specifically notes the lack of equal treatment but does not provide further details about individual residents or specific incidents.
Failure to Ensure Equal Treatment Regardless of Payment Source
Penalty
Summary
The facility failed to treat all residents equally regarding transfer, discharge, and the provision of services, regardless of their payment source. This deficiency indicates that some residents may have experienced differences in how they were transferred, discharged, or received services based on their payment method. The report specifically notes the lack of equal treatment but does not provide further details about individual residents or specific incidents.
Failure to Ensure Equal Access and Discharge Planning Regardless of Payment Source
Penalty
Summary
The facility failed to ensure equal access to services and assistance with alternative placement for a resident whose payor source changed from Medicare Part A to private pay. The resident was admitted for skilled nursing services and, after Medicare coverage ended, continued to reside at the facility as a private pay resident. Assessments indicated that the resident no longer met the medical eligibility for nursing home level of care and was appropriate for a lower level of care, such as assisted living. Despite this, there was no active discharge plan documented in the clinical record for several months, and the facility did not provide evidence of consistent discharge planning or assistance with alternative placement. Documentation showed that the resident and their POA were informed about the need to move to a lower level of care, and a bed was available at an assisted living facility, but the resident refused to move. The resident's cognitive status declined over time, as indicated by BIMS scores, but the facility continued to allow the resident to remain without a documented discharge plan. The POA reported that the facility staff threatened to contact Adult Protective Services (APS) if attempts were made to move the resident, and staff confirmed that APS was contacted due to concerns about the resident's mental health and threats of self-harm during discussions about transfer. Interviews with facility leadership revealed a lack of communication with the POA regarding discharge planning and an absence of proactive steps to prepare for the resident's discharge, despite the resident being assessed as appropriate for a lower level of care months earlier. The facility indicated that if the resident's funds were depleted, they would be considered "days awaiting placement" pending Mainecare, and would need to accept an available assisted living facility within a certain distance. However, there was no evidence that the facility had actively assisted with alternative placement or ensured equal access to services regardless of payment source.
Failure to Provide Services Due to Insurance Status
Penalty
Summary
The facility failed to provide necessary services to residents without discrimination based on their payment source, affecting two residents. Resident R45, who was admitted with conditions including high blood pressure and a dental abscess, did not receive timely dental services due to her insurance status being pending. Despite having a physician's order for a dental consult and being on antibiotic therapy, the resident was not seen by a dentist because she was awaiting medical assistance approval. The facility's clerk and business office manager confirmed that the resident was not scheduled for a dental appointment due to her insurance status. Similarly, Resident R87, admitted with high blood pressure, heart failure, and diabetes, was not provided with ordered therapy services. The resident had physician's orders for physical, occupational, and speech therapy evaluations and treatments, but these services were not initiated because her insurance paperwork was still being processed. Interviews with the rehabilitation manager and business office manager revealed that the resident was only screened for therapy services and not started on them due to the lack of an established payer source. The nursing home administrator confirmed the facility's failure to provide the required services for both residents, acknowledging that Resident R45 did not receive dental services and Resident R87 did not receive therapy services as ordered. The facility's actions were in violation of regulations requiring equal treatment of residents regardless of their payment source, as outlined in 28 Pa Code: 201.18(e)(1) Management.
Plan Of Correction
Dental appointment was made immediately for R45. R87 was immediately evaluated by therapy. Therapy was started for R87. Education will be conducted on equal access to quality care to Medical Records, Social Services, and Therapy Manager by DON or designee on or before 2/11/2025. Audits will be conducted by DON or designee on prompt services such as dental care and therapy weekly x 4 weeks and monthly x 1 month. Audit results will be reviewed through the monthly QAPI process/meeting.
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