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F0582
D

Failure to Obtain Proper Acknowledgment of Medicare Non-Coverage Notices for Cognitively Impaired Residents

Salem, Ohio Survey Completed on 04-29-2025

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 ensure that the Notice of Medicare Non-Coverage was properly acknowledged by the resident representative for residents with cognitive impairment. In one instance, a resident with dementia residing on a secured unit had a niece listed as their representative. The resident's medical record and MDS assessment confirmed impaired cognition. The Notice of Medicare Non-Coverage form indicated that a call was made to the niece and a message was left, but the form was not signed by the representative, and no further attempts were made to obtain acknowledgment or notify the representative of the right to appeal. In another case, a resident with dementia and cognitive deficits, also on a secured unit, had a grandson assigned as Power of Attorney (POA). The MDS assessment confirmed impaired cognition. The Notice of Medicare Non-Coverage form included a note that the POA had been contacted and the appeal process explained, but the resident, who was unable to understand due to dementia, signed the form instead of the POA. The staff member confirmed that the resident should not have signed and that the POA's signature was required to acknowledge notification of non-coverage and the right to appeal.

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