Failure to Provide Required SNF ABN Prior to Medicare Coverage Changes
Penalty
Summary
The facility failed to provide the required Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNF ABN) to residents prior to the discontinuation of Medicare coverage for skilled nursing services. Specifically, three residents whose Medicare coverage was ending did not receive the SNF ABN in advance of the change. For one resident, the last covered day for Medicare A services was documented, and a message was left for the resident's parents about the end of coverage, but the Notice of Medicare Non-Coverage (NOMNC) was only mailed after the coverage ended. For the other two residents, documentation showed they were notified of the end of Medicare services and provided with a signed NOMNC, but there was no evidence that the SNF ABN was used as required. Interviews with facility staff revealed that the facility had stopped using the SNF ABN form as of January 2025, based on an assumption that an update to the NOMNC form made the SNF ABN unnecessary. The Nursing Home Administrator confirmed that the SNF ABN should have been completed for these residents. This failure to provide the appropriate notice in advance of changes to Medicare coverage resulted in noncompliance with resident rights regulations.