Failure to Provide Required SNFABN Notification to Resident
Penalty
Summary
The facility failed to provide a required Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) to a resident when Medicare Part A skilled services were ending, as indicated by a review of the resident's records and staff interviews. The resident, who was cognitively intact and had multiple diagnoses including muscle weakness, dysphagia, COPD, type 2 diabetes mellitus, and chronic kidney disease, was not given the SNFABN prior to the termination of Medicare coverage, despite remaining in the facility. The SNF Beneficiary Notification Review form confirmed that the last covered day for Medicare Part A services had passed, and the resident had not exhausted benefit days, yet no SNFABN was issued. Interviews with the Admissions staff and Interim Director of Nursing revealed a lack of familiarity with the SNFABN process and uncertainty about why the notice was not provided. The facility's policy and procedure required that residents be informed of their potential liability for non-covered services and be given the SNFABN at the initiation, reduction, or termination of services. However, the responsible staff did not follow this policy, resulting in the resident not being informed of the end of Medicare coverage or their appeal rights.