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F0582
D

Failure to Provide SNFABN Form Upon Discharge from Medicare Coverage

Stratford, Iowa Survey Completed on 05-21-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide the required Skilled Nursing Facility Advance Beneficiary Notice of Non Coverage (SNFABN) form to two residents whose Medicare Part A skilled stay ended and who continued to reside in the facility under private pay. Clinical record reviews for both residents showed no documentation that the SNFABN form was given to either the residents or their representatives at the time of discharge from Medicare coverage. Staff interviews confirmed that the necessary forms could not be located for these residents. Both residents had severely impaired cognition as indicated by their Brief Interview for Mental Status (BIMS) scores. One resident had diagnoses including hypertension, cerebrovascular accident, aphasia, and dysphagia, and was using a feeding tube. The other resident had diagnoses of pneumonia, urinary tract infection, depression, coronary artery disease, and hypertension. Despite facility policy requiring advance written notice of potential liability for non-covered services, the required notification was not documented for either resident.

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