F0582

D

Failure to Provide and Document Written Medicare Non-Coverage Notices and Financial Liability Information

Weatherford, Texas Survey Completed on 02-12-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide required written notices regarding Medicare and Medicaid coverage, non-coverage, and potential financial liability to certain residents and/or their representatives. For two residents reviewed for rights, the facility did not obtain signatures on the Notice of Medicare Non-Coverage (NOMNC) forms and did not document that written copies were provided. The facility’s own policy requires that residents be informed in writing when Medicare may not pay for skilled services, of their potential liability, and that a NOMNC be issued at least two calendar days before Medicare Part A or Part B therapy benefits end, including information on the right to an expedited review by a Quality Improvement Organization.

For one resident, an older female with metabolic encephalopathy, seizures/convulsions, and spastic quadriplegic cerebral palsy, the NOMNC dated 08/06/2025 showed no resident or representative signature, even though the effective date of Medicare coverage ending was 08/08/2025. A note on the form stated that verbal NOMNC was given to the resident’s POA by phone due to the resident’s cognitive impairment. Her MDS showed a BIMS score of 99, indicating severely impaired cognition, and she was receiving PT, OT, and speech therapy. Her care plan and physician orders documented ongoing PT and OT services for mobility limitations and contractures, and continued therapy orders were in place during the period when the NOMNC should have been properly issued and acknowledged in writing.

For another resident, an older male admitted with hyperkalemia, acute respiratory failure with hypoxia, muscle weakness, and encephalopathy, the NOMNC dated 12/31/2025 also lacked any signature. A note indicated verbal notification was given to his son, but there was no documentation that a written copy was provided or signed. His MDS showed a BIMS score of 15, indicating intact cognition, and he was receiving PT, OT, and ST minutes as part of a Medicare Part A skilled stay per physician orders. During interviews, the MDS LPN stated she gave verbal information to both residents’ representatives and said she would leave copies of the forms in the residents’ rooms but did not document that copies were left or picked up. The resident representative for the male resident reported he was called about skilled days ending but never received, saw, or signed any form. The administrator stated the preferred method was written consent and that she expected NOMNCs to be completed and signed by the resident or representative, and acknowledged that the failure could result in residents not being aware of the appeals process or having time to prepare for discharge from therapy.