Failure to Provide Required Medicare Coverage Termination Notices
Penalty
Summary
The facility failed to provide required Centers for Medicare and Medicaid Services (CMS) notifications to residents or their representatives regarding the termination of Medicare Part A skilled services. Specifically, the facility did not issue the Notice of Medicare Non-Coverage (NOMNOC) or the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) to three residents when their Medicare Part A coverage ended due to reaching their maximum potential or meeting therapy goals. This omission prevented the residents and their representatives from being informed about the end of coverage, their financial liability for continued services, and their right to appeal the decision. For one resident, Medicare Part A services ended after 77 days when therapy determined the resident had reached their highest practical level. The resident remained in the facility under a different payer source, but there was no documentation of the required NOMNOC or SNF ABN in the medical record. Interviews with the Business Office Manager and Facility Administrator confirmed that these notifications were not provided as required. Another resident's Medicare Part A services ended after 31 days when all therapy goals were achieved, and the resident was discharged home. Similarly, there was no NOMNOC in the medical record, and the Facility Administrator confirmed the notification was not given. A third resident's Medicare Part A services ended after 32 days due to reaching maximum potential, and the resident continued in the facility as a private pay patient. Again, there was no documentation of the required notifications, and the Facility Administrator confirmed they were not provided.