Failure to Provide Ordered Rehabilitative Services Due to Insurance Issues
Penalty
Summary
The facility failed to provide specialized rehabilitative services for Resident R87, who was admitted with diagnoses of high blood pressure, heart failure, and diabetes. The resident had physician's orders for evaluations and treatments in physical, occupational, and speech therapy, dated 11/26/24. Despite being screened for these therapies, the resident did not receive the recommended services. The physical therapy evaluation noted a decline in functional mobility, requiring a front-wheeled walker, while occupational therapy recommended interventions to promote activities of daily living and reduce fall risk. Interviews revealed that Resident R87 had not received any therapy services due to pending insurance paperwork. The Rehabilitation Manager confirmed that therapy services were not initiated because the resident did not have insurance coverage at the time. The Business Office Manager stated that the resident had applied for medical assistance, which was pending approval. The Nursing Home Administrator acknowledged instructing the therapy department to only screen the resident, resulting in the failure to administer the ordered therapy services.
Plan Of Correction
R87 was picked up retroactively by therapy on 12/19/2024. 30 day lookback of like residents to ensure no other residents were affected. New form created to review residents with possible therapy needs. DON or designee will audit residents for therapy needs weekly for 4 weeks and monthly for 1 month. Audit results will be reviewed through the monthly QAPI process.