Failure to Notify Resident of Trust Account Balance Near Medicaid Limit
Penalty
Fine: $236,005
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 notify a resident when their trust account balance was within $200 of the Medicaid resource limit of $2000, as required. Record review showed that the resident, who had Medicaid as a payer source, an intact BIMS score of 15, and was dependent for all activities of daily living, had a trust account balance of $2353.44. There was no documentation in the resident's health record indicating that notification was provided when the balance approached the Medicaid limit. The resident confirmed they were not notified, and the Business Office Manager stated they were unaware of the requirement to provide such notification.