Failure to Notify Legal Guardian Before Insurance Change
Penalty
Summary
The facility failed to obtain consent or permission from the responsible party (RP) before changing the insurance provider for one of the sampled residents. According to the facility's policies, staff are required to promptly inform and consult with the resident or their legal representative regarding significant changes, including those related to health care decisions and insurance. In this case, review of the electronic medical record (EMR) showed no documentation of any conversation with the resident's legal guardian about the change to Medicare, despite a guardianship order being present in the record. During an interview, the Business Office Manager confirmed that the legal guardian was not notified and that the admission assistant made the insurance change without obtaining the necessary permission.