Failure to Provide Required Medicare Non-Coverage Notices to Beneficiaries
Penalty
Summary
The facility failed to provide required Medicare beneficiary notices to two residents whose skilled services were ending, resulting in a deficiency related to lack of Notice of Medicare Non-Coverage (NOMNC) Form CMS-10123. For one resident, skilled services ended on 11/20/25, and for the other resident, skilled services ended on 01/13/26; in both cases, the facility lacked documentation that the resident or their representative received Form 10123, which should have included a detailed explanation of non-coverage and the appeal process. During an interview on 01/23/26 at 1:40 PM, an administrative staff member confirmed that Form 10123 was not provided to these two residents and acknowledged that it should have been given to the resident or representative. Additionally, when requested on 01/23/26, the facility was unable to provide a policy for Beneficiary Notices.
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