Failure to Provide Notice of Medicare Non-Coverage
Penalty
Summary
The facility failed to provide the required Notice of Medicare Non-Coverage (NOMNC) to a resident whose Medicare A coverage was ending. According to the review of clinical records and staff interviews, Resident 76's last covered day of Medicare A services was June 27, 2024, and the resident was discharged to home/self-care. Despite the planned discharge and the known end date of Medicare A coverage, there was no evidence that the facility provided the CMS-10123 form to Resident 76, which is necessary to inform the resident of the termination of services and their right to appeal. Interviews with the Nursing Home Administrator and the Director of Nursing confirmed that the facility had no documentation to show that the NOMNC was delivered to Resident 76. The facility also lacked evidence that Resident 76 had exhausted his available Medicare A covered days. The deficiency was identified during a review of the facility's compliance with regulations requiring notification to residents about changes in their payment coverage.
Plan Of Correction
The Facility submits this Plan of Correction under procedures established by the Department of Health in order to comply with the Department's directive to change conditions which the Department alleges is deficient under State and/or Federal Long Term Care Regulations. This Plan of Correction should not be construed as either a waiver of the facility's right to appeal or challenge the accuracy or severity of the alleged deficiencies or an admission of past or ongoing violation of State or Federal regulatory requirements. 1. Resident 76 was notified of remaining Medicare days. 2. Residents who discharged while still covered by Medicare A in the last two months were reviewed for issuance of CMS-10123 notice. 3. The RNACs were educated on providing notice to residents discharging with Medicare A days remaining. 4. Audits for CMS-10123 notice will be completed weekly x4 then monthly x2 with results presented in QAPI. 5. Compliance date: January 28, 2025.