Failure to Provide Prescribed Therapy Services Due to Authorization Delays
Penalty
Summary
The facility failed to ensure that a resident received specialized rehabilitative services, specifically physical therapy (PT) and occupational therapy (OT), as outlined in the resident's plan of care. The resident was admitted with multiple diagnoses, including a lumbar vertebra fracture, dementia, muscle weakness, and difficulty walking. The care plans for both PT and OT specified therapy services to be provided three to five times per week for various therapeutic interventions. However, medical record and therapy service log reviews revealed multiple periods in October and November during which the resident did not receive the prescribed therapy sessions. Interviews with the Rehab Director confirmed that the therapy frequencies were not met as written in the plan of care. The Rehab Director attributed the missed therapy sessions to delays in obtaining insurance authorizations from the corporate office, which resulted in interruptions in therapy services. Additionally, it was noted that the facility did not have a formal policy regarding therapy services, though it was expected that therapies would be provided according to the care plan.