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F0582
D

Failure to Provide QIO Information on Medicare Non-Coverage Notice

Canal Fulton, Ohio Survey Completed on 06-18-2025

Penalty

No penalty information released
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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 provide required information regarding the Quality Improvement Organization (QIO) on the Notice of Medicare Non-Coverage letter given to a resident whose skilled services and therapies were ending. Review of the resident's medical record showed that the notice, signed by the resident or their representative, did not include the QIO's name or phone number, which is necessary for the resident to request a timely appeal of the termination of services. This omission was confirmed during interviews with both the Social Service Coordinator and the Director of Nursing, who acknowledged that the notice lacked the required appeal information.

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