Failure to Provide Required Medicare/Medicaid Coverage Notices
Penalty
Summary
The facility failed to provide required notices to residents regarding changes in Medicare/Medicaid coverage and potential financial liability for services not covered. Specifically, three residents were not given the Notice of Medicare Non-Coverage (NOMNC) or the Beneficiary Notice CMS form 10055 when their coverage status changed or services were no longer covered. Record reviews confirmed that these forms were not present in the residents' files, and interviews with facility staff, including the social worker and administrator, confirmed that the notices were not issued as required by policy. The residents involved had complex medical histories, including conditions such as joint replacement aftercare, traumatic brain injury, dementia, contractures, schizoaffective disorder, legal blindness, anemia in chronic kidney disease, esophageal obstruction, pressure ulcers, and Down syndrome. One resident was discharged to a private home with home health services, while two others remained in the facility. The facility's own policy required that the NOMNC be delivered no later than two calendar days before the end of skilled services, but this was not followed for the residents reviewed.