Failure to Provide Required Medicare Coverage Notices
Penalty
Summary
The facility failed to provide the required notices to residents or their representatives following the end of their Medicare coverage for two residents. For Resident 28, Medicare Part A coverage began on December 9, 2024, and ended on January 6, 2025. Although the facility initiated discontinuation from Medicare Part A coverage, a Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF-ABN) was issued only telephonically, and there was no evidence of a written notice being provided. Resident 28 remained in the facility after the discontinuation of her Medicare A coverage. Similarly, for Resident 108, Medicare A coverage started on October 1, 2024, and ended on October 30, 2024. The facility also initiated discontinuation from Medicare Part A coverage for this resident, but a SNF-ABN notice was not sent at the time. Resident 108 continued to stay at the facility after her Medicare A coverage ended. During an interview, the Nursing Home Administrator could not provide additional evidence that written SNF-ABN notices were given to either resident.
Plan Of Correction
1. SNF-ABN notice provided to Residents 28 and 108 by Social Services Director. 2. DON or Designee will complete a comprehensive review of all current residents to ensure provision of a SNF-ABN notice when applicable. 3. To ensure continuity of care, NHA or Designee will provide re-education to the Social Services Directors on FTag 582 Medicaid/Medicare Coverage Liability Notices. 4. Director of Nursing / Designee will conduct three resident SNF-ABN audits per week for 4 weeks, followed by three resident SNF-ABN audits per month for two months. 5. Results will be reported at Quarterly QAPI Meetings to determine the need for further audits.