Delayed Refund Following Retroactive Medicaid Approval
Summary
The facility failed to provide a timely refund to a resident's family member after the resident's Medicaid application for long-term care services was approved retroactively. Documentation showed that the family member had made two private payments totaling $7,853 while the Medicaid application was pending. The facility's admission packet stated that if Medicaid coverage is retroactive for a period for which payment has already been made, the facility would refund or credit any excess amount within thirty days of Medicaid eligibility being established. However, interviews with the Business Office Manager and Accounts Receivable Manager revealed confusion and lack of awareness regarding the status of the refund, with the Accounts Receivable Manager only being alerted to the balance due back to the family member months after Medicaid approval. The resident was initially covered by a Medicare Advantage plan, which later discontinued skilled services, leading to the resident being considered private pay until Medicaid approval. The resident's Social Security check was used for the patient portion of payment, and the family member shared a bank account with the resident, complicating the determination of the funding source. Despite the facility's policy and the retroactive Medicaid coverage, the refund process was delayed, and staff were unclear about the procedures and status of the refund owed to the family member.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A facility failed to display required written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid. Surveyors observed the missing information on the First Floor, Second Floor nursing unit, and Fourth Floor nursing unit, and the NHA confirmed the omission.
The facility failed to display written information on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid on two nursing units, including the [NAME] and Garden units. Surveyors observed the missing information, and the NHA later confirmed the deficiency.
Surveyors found that the facility did not display required written information in common posting areas, such as the lobby and hallways near nursing units, explaining how residents and their representatives can apply for and use Medicare and Medicaid benefits and obtain refunds for previous payments covered by those programs. During an interview, the NHA confirmed that this information was not posted anywhere in the building, resulting in noncompliance with state requirements for licensee responsibility and management.
Missing Medicare and Medicaid Benefit Posting: The facility failed to display the required information on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for prior payments covered by those benefits. During observation, the posting was not present on the required bulletin board, and interviews with the SW, DON, ADM, and Admissions Director confirmed the information was not available to residents and that staff were unsure where it was posted.
The facility did not display required written information about how to apply for and use Medicare and Medicaid benefits, or how to receive refunds for previous payments covered by these benefits. This was confirmed during observations and an interview with the NHA.
The facility failed to display required written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. Surveyors found the posting board between hall 1 and hall 2 lacked the required information and was blocked by two cart stations, and the NHA confirmed the obstruction and missing posting.
Missing Medicare and Medicaid Posting Information
Penalty
Summary
The facility failed to display written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid in areas where postings were available, including the First Floor, Second Floor Nursing Unit, and Fourth Floor Nursing Unit. During observations on 4/7/26 from 12:51 p.m. through 1:10 p.m., surveyors found that the required information was not included on the postings in those locations. During an interview on 4/7/26 at 2:13 p.m., the Nursing Home Administrator confirmed that the facility had failed to display the required written information in the building.
Failure to Display Medicare and Medicaid Benefit Information
Penalty
Summary
The facility failed to display written information on how to apply for Medicare and Medicaid benefits and on receiving refunds for previous payments covered by Medicare and Medicaid on two of two nursing units, identified as the [NAME] and Garden nursing units. During observations on 3/4/25 at approximately 1:30 p.m., surveyors found that the required information was not included on either unit. During an interview on 3/6/26 at approximately 12:00 p.m., the Nursing Home Administrator confirmed that the facility failed to display the written information on applying for Medicare and Medicaid benefits and receiving refunds for previous payments covered by Medicare and Medicaid on both units.
Failure to Post Required Medicare/Medicaid Information for Residents
Penalty
Summary
The facility failed to display required written information for residents and/or their responsible persons on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. During observations on 2/11/26 at approximately 11:30 a.m., surveyors inspected the first-floor lobby and hallways in and around the nursing units, where postings are typically available, and found that information on applying for Medicare and Medicaid and obtaining refunds for prior payments covered by these programs was not posted. In a subsequent interview on 2/12/26 at 9:00 a.m., the Nursing Home Administrator confirmed that the facility had not displayed this required written information anywhere in the building. The deficiency was cited under 28 Pa. Code: 201.14(a) Responsibility of licensee and 28 Pa. Code: 201.18(e) Management.
Missing Medicare and Medicaid Benefit Posting
Penalty
Summary
The facility failed to display information on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits on its required postings bulletin board. During an observation on 02/09/2026 at 3:15 PM, the required posting for Medicare and Medicaid benefits was not displayed in the bulletin board area that was observed. During interviews on 02/09/2026, the SW stated he was unsure where the required posting was located or whether it was posted, the DON stated she was unsure where it was located or whether it was posted, and the ADM stated it might be in the admissions office but was not made available to residents. The Admissions Director stated there was nothing posted in the facility regarding how to apply for and use Medicare and Medicaid benefits, although she was available to help residents if needed. On 02/10/2026, the ADM stated there was no specific facility policy on required postings and that the facility follows HHS and CMS guidelines.
Failure to Display Medicare and Medicaid Benefit Information
Penalty
Summary
The facility failed to display written information for residents and their responsible persons regarding how to apply for and use Medicare and Medicaid benefits, as well as how to receive refunds for previous payments covered by these benefits. During observations conducted in the building, it was noted that this required information was not posted. Additionally, during an interview, the Nursing Home Administrator confirmed that the facility did not have the necessary written information displayed as required by regulations. No information was provided to residents or applicants for admission about these benefits or the refund process.
Missing Medicare and Medicaid Benefit Information Posting
Penalty
Summary
The facility failed to display written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. During observations on 11/13/25 at approximately 2:00 p.m., surveyors found the posting board between nursing unit hall 1 and hall 2 did not have information about the application process for Medicare and Medicaid benefits or refunds for previous payments covered by Medicare and Medicaid. The posting board was also blocked by two cart stations placed in front of it. During rounds and an interview on 11/13/25 at approximately 2:30 p.m., the NHA confirmed the posting board was blocked by the two carts and that the facility failed to display the required written information in the building.
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