Failure to Provide Proper Notice of Medicare Non-Coverage to Resident's Representative
Penalty
Summary
The facility failed to provide a Notice of Medicare Non-Coverage (NOMNC) to the representative of a resident with multiple medical conditions, including heart failure, dementia, edema, hypertension, dysphagia, generalized muscle weakness, unsteadiness, malaise, and disorientation. The resident was admitted with limited decision-making capacity and was dependent on staff for most activities of daily living. Upon review, it was found that the resident was discharged home with family, and the family member was informed of the discharge date and the start of financial responsibility if the resident remained in the facility. However, the required NOMNC, which informs beneficiaries of the end of Medicare-covered services and their appeal rights, was not properly delivered to the resident's representative. Specifically, the responsible nurse left only a single voicemail and did not attempt further contact or send the NOMNC by certified mail as required by the form's instructions. The Interim Director of Nursing confirmed that the NOMNC form was incomplete and not completed according to instructions, emphasizing the importance of timely and proper notification to allow the resident or their representative to make informed decisions and exercise appeal rights. Facility policy and job descriptions reviewed also indicated the responsibility to coordinate care and inform residents and their representatives of their rights, which was not fulfilled in this instance.