Failure to Provide and Document Required Medicare/Medicaid Coverage Notices
Penalty
Summary
The facility failed to provide appropriate and timely notices of payor source changes to residents when they were discharged from Medicare Part A Skilled Services, despite days of eligibility remaining. Specifically, staff did not ensure that required beneficiary notifications, such as the Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNF ABN) and the Notice of Medicare Non-Coverage (NOMNC), were properly completed, signed by the resident or their representative, or documented when signatures were refused or not possible. In both reviewed cases, staff members signed the forms themselves without obtaining the required resident or representative signatures, and there was no documentation of attempts to contact responsible parties or to record refusals to sign. One resident, who had a history of hypertensive heart disease and stage 3 chronic kidney disease, was admitted with a responsible party and was assessed as independent in cognitive skills but with memory problems. The resident experienced a payor change, and the SNF ABN and NOMNC forms were signed by staff after the resident was discharged from Part A Skilled Services. The forms did not specify which care was not covered, and there was no evidence that the resident or their representative received or signed the forms. The case manager confirmed that she was unsure of the correct procedures, did not document any verbal consent, and had checked an option on the form without understanding its meaning. Another resident, with diagnoses including depression, cognitive communication deficit, and chronic kidney disease, was also subject to a payor change. The SNF ABN form for this resident was signed by two staff members, with no signature from the resident, who was cognitively intact and listed as their own responsible party. The resident stated they did not know who signed the form, and the case manager confirmed that the resident refused to sign but that this was not documented. Interviews with facility leadership confirmed that staff were expected to provide these notices timely and to document when they were given and whether the resident or responsible party signed or refused, but this was not done in these cases.