Failure to Provide Required SOC and Coverage Notices to Resident and POA
Penalty
Summary
The facility failed to provide required written notice of Medicaid/Medicare coverage, share of cost (SOC), and related financial obligations to a resident and the resident’s responsible party/POA. The resident, who had diagnoses including aphasia following cerebral infarction, hemiplegia, and hemiparesis, was assessed as having no cognitive impairment on an MDS dated 11/18/2025 and reported that their son was the responsible party/POA. The resident stated that while in the facility they were not provided any financial documents and no one from the facility discussed monthly billing for services. About a week prior to the interview, the resident learned from the responsible party/POA that payments were behind for the past four months. The social services director reported that due to ownership changes and high turnover in the business office and social services staff during 2025, some residents’ records had not been updated and some residents with SOC had not yet been notified, even though the business office was responsible for updating and notifying residents and responsible parties. The business office manager stated that residents with SOC are usually identified at pre‑admission, admission, and periodically, and that Resident 2’s responsible party/POA should have received monthly statements and paid the SOC that began in September 2025. However, the business office manager could not verify whether monthly statements or SOC notifications had been mailed to the resident or responsible party and acknowledged that past‑due bill notifications should come from the business office, not from a third‑party company. The responsible party/POA confirmed not receiving monthly statements, not knowing the SOC amount, and only becoming aware of four months of past‑due bills after a collection call from a third‑party company. The facility’s billing policy required monthly resident billing with itemized non‑covered services and written notification at least 60 days prior to changes in the cost of non‑covered items and services.
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