Failure to Provide Required Medicare Coverage and Non-Coverage Notices
Penalty
Summary
The facility failed to ensure that residents were informed of items and services included in nursing facility services for which they may not be charged, and of other items and services for which they may be charged and the amounts, when Medicare Part A coverage ended. For one resident admitted in late November 2025, census information showed a Medicare A coverage period that ended on December 23, 2025. Review of this resident’s Skilled Nursing Facility Beneficiary Notification Review form showed the required Skilled Nursing Facility-Advance Beneficiary Notice of Non-Coverage (SNF-ABN) was not provided to inform the resident of the cost of items and services no longer covered under Medicare A. Another resident admitted in mid-December 2025 had Medicare A coverage that ended in mid-January 2026 upon discharge home, and review of that resident’s Skilled Nursing Facility Beneficiary Notification Review form revealed the required Notice of Medicare Non-Coverage (NOMNC) was not provided to indicate that the stay was no longer covered under Medicare A. A third resident admitted in early August 2025 had a Medicare A coverage period that ended in late October 2025. Review of this resident’s Skilled Nursing Facility Beneficiary Notification Review form showed the required SNF-ABN was not provided to inform the resident of the cost of items and services no longer covered under Medicare A and the cost of those items and services. In an interview on February 24, 2026, at 12:15 PM, the Nursing Home Administrator confirmed that the facility had not provided these residents with the required Medicare coverage and non-coverage notices, as required under 28 Pa. Code 201.14(a) regarding the responsibility of the licensee.
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