Failure to Notify Responsible Party of Medicare Non-Coverage and Bed-Hold Policy
Penalty
Summary
The facility failed to provide the required written Notice of Medicare Non-Coverage (NOMNC) to the responsible party for a resident who was discharged home with family. The resident, who had multiple diagnoses including a fractured sacrum, chronic bronchitis, COPD, repeated falls, altered mental status, depression, anxiety, and liver cancer, was admitted and later discharged from the facility. Documentation showed that the resident was cognitively intact and required varying levels of assistance with activities of daily living. The resident participated in care planning and expressed a goal to return home, but the responsible party did not participate in the care plan meeting. Record review and staff interviews confirmed that while the resident personally received and signed the NOMNC form, the responsible party—identified in the admission agreement as the resident's representative—was not provided with the NOMNC or any bed-hold information as required by facility policy. The DON and Administrator both acknowledged that the responsible party had not been sent the necessary notifications. Additionally, when requested, the facility was unable to provide a policy for Admission, Transfer, and Discharge.