Failure to Provide Occupational Therapy Services as Ordered
Penalty
Summary
The facility failed to provide specialized rehabilitative services, specifically Occupational Therapy (OT), to a resident as outlined in her plan of treatment. The resident, an older female with diagnoses including hypertensive heart disease with heart failure, polyneuropathy, and chronic pain syndrome, was admitted with significant self-care deficits and required a wheelchair for mobility. Her care plan identified the need to maintain or improve her current level of function, but did not specify interventions related to rehabilitation services. An OT evaluation and plan of treatment were completed, recommending OT three times per week for 60 days. However, the resident did not receive any OT services as recommended. The Occupational Therapy Discharge Summary was initiated but not completed or submitted on the same day as the evaluation. The Director of Therapy, who was not involved in the resident's care at the time, confirmed that the resident did not receive OT and was unable to determine why the services were not provided. Additionally, a Provider Notice of Adverse Benefit Determination indicated that the request for OT services was denied due to insufficient documentation of medical necessity. The facility was unable to provide a policy related to rehabilitation services when requested by the surveyor.