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F0582
B

Failure to Provide Required Medicare Non-Coverage Notices

Costa Mesa, California Survey Completed on 08-29-2025

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 the required written Notice of Medicare Non-coverage (NOMNC) and the Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) to a resident who was being discharged from Medicare Part A services and remaining in the facility under private pay insurance. Medical record review showed that the NOMNC form was undated and lacked the signature of the resident or their representative. Similarly, the SNF ABN form was not signed by the resident or representative, and there was no documentation that copies of these notices were provided to them at the time of the Medicare Part A discharge. Interviews with the Business Office Manager revealed that attempts were made to notify the resident's responsible party by phone, but there was no evidence that the required forms were mailed or otherwise delivered for review and signature. The resident's representative confirmed not receiving the written notices and did not recall being informed about appeal rights or the appeal process. The Director of Nursing acknowledged these findings during the survey.

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