§483.10(f)(10) The resident has a right to manage his or her financial affairs. This includes the right to know, in advance, what charges a facility may impose against a resident's personal funds. (i) The facility must not require residents to deposit their personal funds with the facility. If a resident chooses to deposit personal funds with the facility, upon written authorization of a resident, the facility must act as a fiduciary of the resident's funds and hold, safeguard, manage, and account for the personal funds of the resident deposited with the facility, as specified in this section. (ii) Deposit of Funds. (A) In general: Except as set out in paragraph (f)( l0)(ii)(B) of this section, the facility must deposit any residents' personal funds in excess of $100 in an interest bearing account (or accounts) that is separate from any of the facility's operating accounts, and that credits all interest earned on resident's funds to that account. (In pooled accounts, there must be a separate accounting for each resident's share.) The facility must maintain a resident's personal funds that do not exceed $100 in a non-interest bearing account, interest-bearing account, or petty cash fund. (B) Residents whose care is funded by Medicaid: The facility must deposit the residents' personal funds in excess of $50 in an interest bearing account (or accounts) that is separate from any of the facility's operating accounts, and that credits all interest earned on resident's funds to that account. (In pooled accounts, there must be a separate accounting for each resident's share.) The facility must maintain personal funds that do not exceed $50 in a noninterest bearing account, interest-bearing account, or petty cash fund.
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Observations:
Based on a review of clinical records, resident financial documentation, and staff interview, it was determined the facility failed to safeguard, manage, and accurately account for the personal funds of one resident (Resident 40) out of 23 residents reviewed
Findings include:
A clinical record review revealed Resident 40 was admitted to the facility on August 17, 2019, with diagnoses that included malignant neoplasm of the lung (an abnormal growth of cells characterized by uncontrolled and rapid growth, invasion of surrounding tissues, and the potential to spread to other areas of the body).
A clinical record review revealed Resident 40's payor source is Medicaid (a joint federal and state program that helps cover medical costs for some people with limited income and resources. Individuals on Medicaid receive a Personal Needs Allowance- a monthly stipend to cover personal expenses. As of January 1, 2025, the PNA for Pennsylvania is $60 for residents residing in long-term care facilities).
A review of a quarterly Minimum Data Set assessment (MDS-a federally mandated standardized assessment process conducted periodically to plan resident care) dated March 5, 2025, revealed that Resident 40 is cognitively intact with a BIMS score of 15 (Brief Interview for Mental Status-a tool within the Cognitive Section of the MDS that is used to assess the resident's attention, orientation, and ability to register and recall new information; a score of 13-15 indicates cognition is intact).
During an interview conducted on April 29, 2025, at 12:30 PM, Resident 40 stated he was upset about a charge of $6,092 that appeared on his March 2025 financial statement. He explained that the facility managed his personal funds and presented a copy of the resident fund ledger showing a care cost deduction of $6,092 on March 14, 2025.
Review of Resident 40's resident fund ledger from December 1, 2024, through April 28, 2025, revealed the following charges for care costs totaling $10,025: December 2024: $324 January 2025: $0 February 2025: $0 March 2025: $7,712 April 2025: $1,989 Resident 40's income from Social Security and pension benefits totaled $10,210 during the same period: December 2024: $2,014 January 2025: $2,049 February 2025: $2,049 March 2025: $2,049 April 2025: $2,049
According to Pennsylvania Medicaid requirements, the facility was responsible for deducting only the monthly care cost balance after applying the PNA (personal needs allowance-$45.00 before January 2025 and $60.00 after January 2025). Based on the resident's monthly income, the proper care cost charges from January 1, 2025, through April 28, 2025, should have been:
December 2024: $2,014 - $45 = $1,969 January 2025: $2,049 - $60 = $1,989 February 2025: $2,049 - $60 = $1,989 March 2025: $2,049 - $60 = $1,989 April 2025: $2,049 - $60 = $1,989
Resident 40 should have been charged $1,989 each month from January 2025 through April 2025 and charged $1,969 in December 2024, totaling $9,925. A review of credits Resident 40 received from Social Security and his pension ($10,210) and calculating for the personal needs allowance for Pennsylvania ($285) it was determined the facility over charged the resident by $100.00. During an interview on May 1, 2025, at approximately 9:00 AM, the Nursing Home Administrator (NHA) confirmed Resident 40 was overcharged due to billing errors. The NHA confirmed it is the facility's responsibility to safeguard, manage, and accurately account for residents' personal funds deposited with the facility. The NHA indicated Resident 40 would be reimbursed for the overcharge.
28 Pa. Code 201.14(b) Responsibility of licensee.
28 Pa. Code 201.18(b)(2) Management.
28 Pa. Code 201.29(a) Resident rights.
| | Plan of Correction - To be completed: 05/28/2025
The error noted on Resident 40's account has been identified, and resident was refunded the amount owed immediately. The facility has reviewed all Medicaid patients' personal needs allowance (PNA) and adjusted to the appropriate $60.00 per January 1st, 2025, requirements. All accounts noted to be in error have been rectified immediately. All patients and/or responsible parties have received updated statements of accounts per request. Education was provided to the new business office manager on the facilities RFMS policy. A weekly internal audit on all Medicaid patients with payer changes noted throughout the week will be reviewed, adjusted, and corrected. All accounts noted to have an incorrect balance will be immediately adjusted and refunded the amount owed. Ongoing weekly audits will continue for the next two months to ensure accuracy in billing and reimbursement for all MA patients. The administrator will review the monthly billing with business office manager to ensure compliance with same. Weekly audits will be implemented and discussed in the facilities monthly/quarterly QAPI meetings and reviewed by the business office manager as well as the Administrator for the first four weeks and then monthly for two months.
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