Failure to Notify Medicaid Residents of Excess Trust Fund Balances and Complete TPL Forms After Death
Penalty
Summary
Surveyors identified that the facility failed to notify Medicaid residents or their representatives when resident trust fund balances approached or exceeded the Medicaid resource limit, as required by facility policy. Review of the business office Resident Statement Landscapes showed that three Medicaid residents had trust fund balances significantly above the Medicaid limit ($12,161.13, $8,496.39, and $7,460.29), with no Resident Fund Balance Notifications documented in their medical records. During interview, the Business Office Manager acknowledged that she had not sent any Resident Fund Balance Notifications when residents reached the $200 threshold below the Medicaid limit and stated she was only now aware that such letters should have been sent. The Administrator stated she expected Medicaid resource letters to be sent when resident balances were within $200 of the resource limit. Surveyors also found that the facility failed to complete and send third party liability (TPL) forms within 30 days for deceased residents who had remaining funds in their accounts. Record review showed that two residents who had expired still had balances of $837.25 and $4,239.70, respectively, with no TPL letters sent. In interview, the Business Office Manager stated that TPL letters should be sent within 30 days of a resident’s death and acknowledged that these letters had not been sent for the deceased residents reviewed. The Administrator stated she expected TPL letters to be sent within 30 days of a resident’s death.
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