Failure to Ensure Residents Understood Health Insurance Changes
Penalty
Summary
The facility failed to ensure that residents were fully informed and understood changes to their health insurance coverage, specifically regarding enrollment in a new Medicare Advantage plan by a third-party vendor. Several residents reported not understanding the implications of signing up for the new plan, with some indicating they were pressured or inadequately informed by facility staff and the insurance agent. One resident, who has moderate cognitive impairment and multiple complex medical diagnoses including cancer, dementia, and anxiety, stated he did not understand the new insurance would affect his medication coverage and experienced significant distress when he was unable to access his cancer medication. The Director of Nursing confirmed there was a period during which the resident's medication access was uncertain due to the insurance change. Another resident, whose primary language is Polish and who is cognitively intact but has a significant medical history including heart disease and depression, reported not understanding the insurance documents he signed and felt misled about the services he would receive. His son, who holds Power of Attorney, was not contacted about the insurance change, and the facility lacked documentation of the Power of Attorney or any communication with the son regarding the change. The enrollment form for this resident was completed with a typed signature and indicated assistance from an insurance agent, but there was no evidence the information was provided in a language the resident could understand. A third resident, also cognitively intact and with a history of Parkinson's disease and depression, described being approached by the Social Service Director to hear a presentation about the new insurance. Despite initially declining, the resident felt pressured to enroll and later became emotionally distressed upon learning the change meant a new doctor and nurse practitioner. The facility administrator acknowledged there was no policy regarding obtaining consents for such changes, and the only documentation provided to residents was a brochure outlining general rights, including the right to information in a language they understand.