Resident Rights Violated by Unauthorized Medicaid Application Submission
Penalty
Summary
The facility failed to honor a resident's right to make his/her own decisions regarding personal and financial affairs, including the right to refuse services, by submitting a Medicaid application without the resident's knowledge or consent. During an interview, the resident and the resident's daughter reported that the resident had previously informed the social worker that he/she did not want to apply for Medicaid and intended to return home. Despite this expressed wish, the facility proceeded to submit a Medicaid application on the resident's behalf, and the resident stated not knowing how the facility could do that without his/her information and permission. The Administrator confirmed in an interview that a Medicaid application had been submitted for the resident and stated it was done to help him/her. The Business Office Manager reported she had been advised by the facility that it was acceptable to submit the Medicaid application on the resident's behalf. Review of the Medicaid application showed it was completed under the designation "applicant without representative who lacks capacity to appoint a representative." However, review of the medical record revealed the resident had a BIMS score of 14, indicating he/she was cognitively intact and capable of making his/her own decisions. These findings show the facility inaccurately represented the resident's decision-making capacity while submitting the application without consent.
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