Failure to Ensure Understanding of Coverage Notices
Penalty
Summary
The facility failed to ensure that residents were adequately informed about their Medicare and Medicaid coverage and liabilities, specifically regarding the Notice of Medicare Non-Coverage (NOMNC) and Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) forms. This deficiency was identified through a review of facility admission documents and staff interviews. It was found that the facility did not explain these forms in a manner that was understandable to the residents and their representatives, as required by regulations. This failure was particularly noted in the case of one resident, who had a moderate cognitive impairment as indicated by a Brief Interview for Mental Status (BIMS) score of 11. The resident in question, who was admitted to the facility in mid-July 2024, had a responsible party listed as her daughter. Despite the resident's cognitive impairment, the NOMNC and SNF ABN forms were signed by the resident herself in mid-August 2024, without evidence that the forms were explained in a comprehensible manner. The Nursing Home Administrator confirmed this oversight during an interview, acknowledging that the facility did not meet the requirement to ensure that these forms were understood by the resident and her representative.
Plan Of Correction
Resident R27 is in facility. A one-week retroactive review of all notices signed will be completed to ensure that signors have the capacity to consent, and any residents that are unable to consent have been signed by the party responsible. The NHA or designee will educate social services and RNAC's on Notice of Resident Rights and Responsibilities policy. The SSD or designee will audit all ABN/NOMNC's signed to ensure that the appropriate responsible party is receiving and signing the form. Monthly X 3 months. Audit results will be reviewed through QAPI for further recommendation.