Failure to Provide Written Notice of Medicare Non-Coverage and Potential Liability
Penalty
Summary
The facility failed to provide written notification to a resident and their designated representative regarding potential financial liability for services not covered by Medicare following the end of the resident's skilled nursing facility (SNF) Medicare Part A stay. The resident, who had mild cognitive impairment and an advance directive designating a representative, was notified by phone that Medicare coverage for skilled services would end. However, the required Skilled Nursing Facility Advance Beneficiary Notice (SNF ABN), which details the costs the resident would be responsible for if they remained in the facility, was not issued to either the resident or their representative. The record showed that while a Notice of Medicare Non-Coverage (NOMNC) was communicated by phone, no written ABN was provided, nor was a signature obtained. The resident's representative confirmed they were not informed about appeal rights, specific costs, or asked to sign any forms, despite being available for in-person communication. The facility administrator acknowledged that both the NOMNC and ABN should have been provided in person or sent by mail or email, with a physical signature obtained as soon as possible.