Failure to Obtain Signed Admission Packets with Medicare/Medicaid Information
Summary
The facility failed to provide and obtain signed admission packets containing written information about how to apply for and use Medicare and Medicaid benefits for six of thirty-one sampled residents. Record review and interviews revealed that these residents did not receive or sign the required admission paperwork, which should have included information on Medicare and Medicaid programs, admission agreements, and resident rights. The absence of these documents was confirmed through audits of the residents' electronic medical records, which showed no signed admission paperwork under the miscellaneous tab for the affected individuals. Interviews with the residents confirmed that they had not been approached to sign any admission paperwork since their admission to the facility. Some residents could not recall being informed about the admission process or being asked to sign any documents. The primary payer sources for these residents included Medicare Part A, Medicaid pending, and Medicare replacement, indicating that the missing documentation affected residents with various types of coverage. Facility staff interviews and document reviews indicated that the responsibility for obtaining signed admission packets fell to the Admission Director, or in their absence, the Regional Director of Business Development and the facility Administrator. Audits conducted by the Medical Records Director and the Regional Director of Business Development identified a significant number of residents without signed admission packets. The issue was further complicated by frequent turnover in key administrative positions, which contributed to lapses in ensuring that all required admission documentation was completed and maintained.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A resident with complex medical and behavioral health needs was not provided with information or assistance to apply for long-term Medicaid benefits after her skilled care Medicaid coverage ended. Despite facility policy requiring such assistance, staff confirmed that the resident was not offered help with the Medicaid application process.
Failure to Assist Resident with Medicaid Application After Change in Payor Status
Penalty
Summary
The facility failed to provide a resident with information and assistance regarding how to apply for Medicaid benefits when her skilled care Medicaid coverage ended. The resident, who had multiple complex medical diagnoses including chronic respiratory failure, severe malnutrition, COPD, substance use disorders, and mental health conditions, was admitted to the facility and later received a notice from the Medicaid provider stating she no longer required daily nursing care and could be cared for at a lower level. Despite this change in payor status, the facility did not offer or assist the resident in applying for long-term Medicaid services, as confirmed by interviews with the Business Office Manager and the resident herself. A review of the facility's policy indicated that residents who continue to need LTC services should be provided with the necessary assistance to apply for Medicaid coverage. However, documentation and staff interviews revealed that this assistance was not provided to the resident in question. The facility's failure to act was further highlighted by the lack of explanation from staff as to why the application process was not initiated, despite the resident's ongoing need for care and the facility's stated policy.
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