Failure to Provide Proper Medicare Non-Coverage Notice to Cognitively Impaired Resident
Penalty
Summary
The facility failed to ensure that a resident was appropriately notified regarding changes in their Medicare coverage through the provision of the Notice of Medicare Non-Coverage (NOMNC) form. Record review showed that the resident, who had diagnoses including psychosis and hemiplegia, was severely cognitively impaired and unable to understand or process information. Despite this, the NOMNC form was provided directly to the resident, and there was no evidence that a responsible party or legal representative was involved in the notification process. The Social Services Director acknowledged that the resident was not capable of understanding the information and that a guardianship should have been pursued at the time of admission, but this was not done. Interviews with facility staff, including the DON, confirmed that the resident was mentally incapable of making decisions and that the NOMNC process was not properly followed. The facility's policy required that the NOMNC be issued to the resident or their representative when Medicare-covered services are ending, regardless of whether the resident is leaving or remaining in the facility. In this case, the lack of a guardian or representative meant the resident did not receive appropriate notification or the opportunity to exercise their rights regarding Medicare coverage changes.