Failure to Provide Recommended Recliner Wheelchair DME
Penalty
Summary
The facility failed to provide a recliner wheelchair, a recommended piece of DME, to a resident following a physical therapist’s assessment and order. The resident had been readmitted with diagnoses including an unspecified displaced fracture of the neck of the left humerus, UTI, and metabolic encephalopathy, and had a Minimum Data Set indicating severely impaired cognition and dependence on staff for toileting hygiene, bathing, dressing, personal hygiene, and mobility. On 12/26/2025, Physical Therapist 1 documented that the resident was compliant with skilled interventions, required extra time to process new information, and recommended a recliner wheelchair due to poor sitting balance and a non–weight-bearing left upper extremity. Despite this recommendation, the resident did not receive a recliner wheelchair and was later observed awake and lying in bed. The Director of Rehabilitation Services stated that the resident did not have a recliner wheelchair and explained that she initially believed the recliner wheelchair would not be covered under Medicare Part A, so she did not order it. After reviewing the Medicare Benefit Policy Manual, she acknowledged that the recliner wheelchair should have been ordered at the time of the therapist’s recommendation and that it was important to follow the recommendation to prevent the resident from sliding or falling forward from the wheelchair. The DON confirmed that the recliner wheelchair should have been ordered following the therapist’s assessment and that the failure of the Director of Rehabilitation Services to order the equipment and communicate with nursing resulted in a delay in treatment, with the potential to cause functional decline and decreased mobility. The facility’s policy, based on the Medicare Benefit Policy Manual Chapter 8, indicated that DME for Part A inpatients is covered as part of the SNF prospective payment system and is not separately payable.
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