§483.10(g)(17) The facility must-- (i) Inform each Medicaid-eligible resident, in writing, at the time of admission to the nursing facility and when the resident becomes eligible for Medicaid of- (A) The items and services that are included in nursing facility services under the State plan and for which the resident may not be charged; (B) Those other items and services that the facility offers and for which the resident may be charged, and the amount of charges for those services; and (ii) Inform each Medicaid-eligible resident when changes are made to the items and services specified in §483.10(g)(17)(i)(A) and (B) of this section.
§483.10(g)(18) The facility must inform each resident before, or at the time of admission, and periodically during the resident's stay, of services available in the facility and of charges for those services, including any charges for services not covered under Medicare/ Medicaid or by the facility's per diem rate. (i) Where changes in coverage are made to items and services covered by Medicare and/or by the Medicaid State plan, the facility must provide notice to residents of the change as soon as is reasonably possible. (ii) Where changes are made to charges for other items and services that the facility offers, the facility must inform the resident in writing at least 60 days prior to implementation of the change. (iii) If a resident dies or is hospitalized or is transferred and does not return to the facility, the facility must refund to the resident, resident representative, or estate, as applicable, any deposit or charges already paid, less the facility's per diem rate, for the days the resident actually resided or reserved or retained a bed in the facility, regardless of any minimum stay or discharge notice requirements. (iv) The facility must refund to the resident or resident representative any and all refunds due the resident within 30 days from the resident's date of discharge from the facility. (v) The terms of an admission contract by or on behalf of an individual seeking admission to the facility must not conflict with the requirements of these regulations.
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Observations:
Based on a review of clinical records, facility documentation, and an interview with staff, it was determined that the facility failed to provide the required advance notice, through a Notice of Medicare Non-Coverage (CMS 10123-NOMNC), regarding the termination of Medicare services for one of the three residents sampled (Resident 143).
Findings include:
A closed record review revealed that Resident 143 was admitted to the facility on October 13, 2023, and was discharged on November 8, 2023.
A closed record review revealed that the facility provided Resident 143's representative with a Notice of Medicare Non-Coverage (CMS 10123-NOMNC) letter dated November 6, 2023. The notice indicated that Medicare would likely not pay for the resident's skilled services after November 7, 2023 (one day notice).
A facility must notify the beneficiary of the decision to terminate covered Medicare services no later than two days before the proposed end of the services.
During an interview on January 25, 2024, at approximately 10:45 AM, the Director of Nursing (DON) confirmed that the facility failed to notify Resident 143 or Resident 143's representative of the decision to terminate covered Medicare services no later than two days before the proposed end of the services.
28 Pa. Code 201.29(a) Resident rights.
28 Pa. Code 211.12(d)(3) Nursing services.
| | Plan of Correction - To be completed: 03/09/2024
Resident 143 cannot be retroactively correct for NOMNC notification. Education provided to Director of Nursing regarding time frame for NOMNC notification to resident and or resident representative. Inter-disciplinary procedure will be updated to confirm exact dates for issuing NOMNC notification to resident and or resident representative. Facility designee will complete weekly audit x 4, monthly x 2 for correct dates and notifications of NOMNC issuance. Findings to be reported to QAPI.
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