Failure to Provide Spend-Down Notices for Resident Funds Exceeding Medicaid Limits
Penalty
Summary
The facility failed to provide required spend-down notices to two residents whose funds were managed by the facility and whose account balances exceeded the Medicaid asset limit. For one resident with moderate cognitive impairment and multiple diagnoses including vascular dementia and major depressive disorder, quarterly account statements showed balances above the $2,000 Medicaid limit, but no spend-down notices were issued. Similarly, another resident with no cognitive impairment and a history of neurocognitive disorder and traumatic brain injury also had account balances above the allowable Medicaid limit, and did not receive any spend-down notices. Interviews with the Business Office Manager confirmed that the facility was aware of the Medicaid asset limit and that no spend-down notices were provided to any residents, including those whose balances exceeded the limit. The Director of Nursing confirmed that one resident was losing Medicaid coverage due to being over the asset limit, and would only regain coverage after spending down the excess funds. The deficiency was identified through record review and staff interviews, affecting two of five residents reviewed for resident funds.