Incomplete NOMNC Forms Lacking Required Service Details
Penalty
No penalty information released
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 ensure that the Notice of Medicare Non-Coverage (NOMNC) forms for three residents contained all required information, specifically omitting details about which services would be discontinued. For each resident reviewed, the NOMNC forms either left blank or did not specify the services that were ending, despite being signed or acknowledged by the resident or their representative. This deficiency was confirmed by the Social Service Designee, who verified that the forms lacked the necessary specific information regarding discontinued services.