Failure to Issue Required SNF-ABN Notices When Medicare Part A Services Ended
Penalty
Summary
The deficiency involves the facility’s failure to provide required Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility Advanced Beneficiary Notification (SNF-ABN) forms when Medicare Part A skilled services were discontinued before the exhaustion of the 100 covered days, while the residents remained in the facility. For one resident whose Medicare Part A skilled stay began on 5/19/25 and ended on 5/30/25, record review showed no evidence that a SNF-ABN was issued, even though the resident had remaining covered days and continued to reside at the facility. The Business Office Manager (BOM) stated that the resident’s discharge from Medicare Part A services was initiated by the insurance company, which emailed a CMS Notice of Medicare Non-Coverage (NOMNC) for the facility to present, and acknowledged she was not aware that a SNF-ABN also needed to be provided. The Social Worker (SW) interviewed, who was not employed at the time of this resident’s NOMNC issuance, reported that the SW role had been limited to providing the NOMNC and that she had never provided a SNF-ABN, and was unaware that both notices were required. A second resident was admitted under Medicare Part A skilled services beginning 8/19/25, with covered services ending on 9/5/25, and also remained in the facility with Medicare days still available. Review of this resident’s record likewise revealed no SNF-ABN. The BOM reported that this resident’s discharge from Medicare Part A services was also initiated by the insurance company, which sent a blank NOMNC form for completion and delivery to the resident, and again stated she did not know a SNF-ABN was required. The SW confirmed she had issued the NOMNC for this resident at the time Part A services ended, but was not aware she was required to provide both a NOMNC and a SNF-ABN and did not know about the SNF-ABN form that includes an estimated out-of-pocket cost. The Administrator acknowledged awareness of both the SNF-ABN and NOMNC forms and stated his expectation that appropriate notices would have been given, but indicated he had not seen the SNF-ABN form used at this facility.
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