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F0582
D

Failure to Provide Required Beneficiary Notice Upon Change in Medicare Coverage

Portola Valley, California Survey Completed on 08-07-2025

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 provide an Advanced Beneficiary Notice (ABN) to a resident who was discharged from Medicare Part A coverage to long-term custodial care. During a review of records and an interview with the Social Worker, it was found that although a Notice of Medicare Non-Coverage (NOMNOC) was issued and signed by the resident's family member, the required Skilled Nursing Facility Beneficiary Notice of Non-Coverage (SNFABN) was not completed for the resident. The Social Worker acknowledged that the SNFABN was not used and stated awareness that it is required for long-term residents. This omission occurred when the resident transitioned from Medicare-covered services to custodial care, and the facility did not inform the resident of potential financial liability for services not covered under Medicare/Medicaid or the facility's per diem rate, as required by CMS guidance.

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