Failure to Provide Personal Needs Allowance and Financial Assistance for Medicaid Residents
Penalty
Summary
The facility failed to provide effective administrative oversight to ensure that residents on Medicaid received their Personal Needs Allowance (PNA), assistance with supplemental income financial applications, and proper management of personal funds. The administrator and business office manager did not ensure that residents were receiving their entitled PNA, nor did they assist residents in applying for Supplemental Security Income (SSI) or disability benefits when appropriate. The facility also failed to prevent the use of residents' personal funds for Medicaid-covered services, as evidenced by the deduction of room and board payments from a resident's trust account. One resident, who had been in the facility for nearly a year, reported not receiving her social security or the $60 monthly PNA, leaving her without money for personal expenses such as haircuts or shoes. The resident's trust account showed a significant deduction for room and board, and no deposits had been made since her admission. The business office manager confirmed that the resident was owed the PNA for the past year and that her trust funds had been depleted due to improper deductions. Additionally, the facility did not ensure that residents without income were assisted in applying for SSI or disability benefits, resulting in several residents not receiving any monthly PNA. Interviews with staff revealed a lack of knowledge and action regarding the application process for SSI or disability benefits. The social services staff and business office manager both stated they had not assisted any residents with these applications. The administrator was unaware of the issues with residents' income and PNA, and there was no documentation to show that residents had been informed or assisted regarding their financial entitlements. This lack of oversight and failure to follow established procedures affected all Medicaid residents in the facility.