Pennsylvania Department of Health
 MAPLE RIDGE REHABILITATION & HEALTHCARE CENTER
Patient Care Inspection Results

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MAPLE RIDGE REHABILITATION & HEALTHCARE CENTER
Inspection Results For:

There are  135 surveys for this facility. Please select a date to view the survey results.

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MAPLE RIDGE REHABILITATION & HEALTHCARE CENTER - Inspection Results Scope of Citation
Number of Residents Affected
By Deficient Practice
Initial comments:
Based on an abbreviated complaint survey completed on May 15, 2024, it was determined that Maple Ridge Rehabilitation & Healthcare Center had a deficiency of past non-compliance under the following requirements of 42 CFR Part 483 Subpart B Requirements for Long Term Care and the 28 PA Code Commonwealth of Pennsylvania Long Term Care Licensure Regulations.



 Plan of Correction:


483.10(g)(4)(i)-(vi) REQUIREMENT Required Notices and Contact Information:This is a less serious (but not lowest level) deficiency and affects more than a limited number of residents, staff, or occurrences. This deficiency is one that results in minimal discomfort to the resident or has the potential (not yet realized) to negatively affect the resident's ability to achieve his/her highest functional status. This deficiency was not found to be throughout this facility.
§483.10(g)(4) The resident has the right to receive notices orally (meaning spoken) and in writing (including Braille) in a format and a language he or she understands, including:
(i) Required notices as specified in this section. The facility must furnish to each resident a written description of legal rights which includes -
(A) A description of the manner of protecting personal funds, under paragraph (f)(10) of this section;
(B) A description of the requirements and procedures for establishing eligibility for Medicaid, including the right to request an assessment of resources under section 1924(c) of the Social Security Act.
(C) A list of names, addresses (mailing and email), and telephone numbers of all pertinent State regulatory and informational agencies, resident advocacy groups such as the State Survey Agency, the State licensure office, the State Long-Term Care Ombudsman program, the protection and advocacy agency, adult protective services where state law provides for jurisdiction in long-term care facilities, the local contact agency for information about returning to the community and the Medicaid Fraud Control Unit; and
(D) A statement that the resident may file a complaint with the State Survey Agency concerning any suspected violation of state or federal nursing facility regulations, including but not limited to resident abuse, neglect, exploitation, misappropriation of resident property in the facility, non-compliance with the advance directives requirements and requests for information regarding returning to the community.
(ii) Information and contact information for State and local advocacy organizations including but not limited to the State Survey Agency, the State Long-Term Care Ombudsman program (established under section 712 of the Older Americans Act of 1965, as amended 2016 (42 U.S.C. 3001 et seq) and the protection and advocacy system (as designated by the state, and as established under the Developmental Disabilities Assistance and Bill of Rights Act of 2000 (42 U.S.C. 15001 et seq.)
(iii) Information regarding Medicare and Medicaid eligibility and coverage;
(iv) Contact information for the Aging and Disability Resource Center (established under Section 202(a)(20)(B)(iii) of the Older Americans Act); or other No Wrong Door Program;
(v) Contact information for the Medicaid Fraud Control Unit; and
(vi) Information and contact information for filing grievances or complaints concerning any suspected violation of state or federal nursing facility regulations, including but not limited to resident abuse, neglect, exploitation, misappropriation of resident property in the facility, non-compliance with the advance directives requirements and requests for information regarding returning to the community.
Observations:

Based on a review of clinical records, guidance issued by the Centers for Medicare and Medicaid Services and facility documentation, and staff interview, it was determined that the facility failed to develop and implement policies and procedures designed to protect residents from unacceptable practices of disenrolling residents from their Medicare health plans by ensuring all risks of disenrolling are explained, both verbally and in writing, and the residents are found to be competent to make informed decisions for seven of 13 reviewed the facility disenrolled from Medicare health plans (Resident CR1, 13, 50, 59, 61, 75, and 81).


Finding include:

A review of a CMS guidance entitled "Memo to Long Term Care (LTC) Facilities on Medicare Health Plan Enrollment" dated October 2021 revealed that CMS continues to hear reports of the unacceptable practice of nursing facilities or skilled nursing facilities (collectively, long-term care or LTC facilities) disenrolling beneficiaries from Medicare health plans (Medicare Advantage plans with and without Part D, Medicare-Medicaid plans, or Programs of All-Inclusive Care for the Elderly without the beneficiary's or the beneficiary's representative's request, consent, knowledge, and/or complete understanding.

CMS guidance noted that "Only a Medicare beneficiary, the beneficiary's authorized or designated representative, or the party authorized to act on behalf of the beneficiary under state law can request enrollment in or voluntary disenrollment from a Medicare health or drug plan. Changes in a beneficiary's health care coverage generally must be initiated by the beneficiary or their representative. If a beneficiary or their legal representative requests assistance from the LTC facility in changing the beneficiary's health care coverage, the LTC facility should take the following steps to help ensure changes to a beneficiary's health care coverage comply with regulations regarding enrollment/disenrollment and resident rights:

1)Explain orally and in writing the impact to the beneficiary if they change coverage (e.g., to a stand-alone prescription drug plan (PDP) and Original Medicare, or to a different Medicare health plan).
2)Develop written policies and procedures regarding the process of assisting beneficiaries with changing their health care coverage. At a minimum, information should include the circumstances under which the facility can assist a beneficiary with a plan change. The need to obtain a document signed by the beneficiary or representative that acknowledges that the specific information regarding the impact of a change in coverage was provided to them orally and in writing, and that that the beneficiary and/or the representative understand the information. The need to obtain an attestation signed by the facility staff member that assisted with the change in enrollment, attesting that the beneficiary or representative requested the change and that the beneficiary or representative (as applicable) received and understood the minimum required information listed above. In cases where beneficiaries request disenrollment from PACE, LTC facilities that are contracted with PACE organizations should work directly with the PACE organization and the participant's interdisciplinary team to ensure the PACE participant receives the information required under the PACE regulations and to coordinate the transition of care, including as specified in their contract requirements.

If a LTC facility cannot provide documentation of a beneficiary's request to change enrollment, this may suggest that the enrollment action was not initiated by the beneficiary or their legal representative and therefore was not legally valid.

Lastly If the facility has the beneficiary sign documentation regarding their understanding of an enrollment change, CMS will expect to find that the beneficiary's assessed cognitive function also supports an ability to understand this type of information. If CMS becomes aware of enrollment actions that the beneficiary alleges were taken without their request, consent, knowledge, and/or complete understanding, CMS will expect the facility to provide the above noted documentation to support that it appropriately assisted the beneficiary with their choice to change coverage, including that the beneficiary's cognitive function supports such decision-making.

A review of Resident CR1's clinical record revealed the resident was admitted to the facility on January 13, 2024, with diagnoses which included type 2 diabetes, peripheral vascular disease, and bilateral below the knee amputations.

Upon admission the resident's primary insurance payer was noted to be Aetna Medicare Advantage Plan. On February 1, 2024, the resident's primary insurance payer was changed to traditional Medicare with Medicaid pending.

Review of documentation dated March 18, 2024, completed by the facility's Business Office Manager (BOM), revealed that on January 31, 2024, the BOM spoke with Resident CR1 about transitioning to straight Medicare "since he will be long term. Went over how the transition will benefit him here at the facility regarding his therapy and possibly getting more time. According to the documentation, the resident chose to disenroll in his Aetna MCA and "give straight MCA [Medicare] a try."

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated January 31, 2024, revealed a request to disenroll the resident from the resident's Medicare Advantage plan so that the resident may be covered under original Medicare prescription plan (Part D) benefits.

Resident CR1 no longer resides at the facility, he expired at the hospital on February 13, 2024.

A review of Resident 13's clinical record revealed the resident was admitted to the facility on November 5, 2023, with diagnoses which included bipolar disorder (disorder which causes extreme mood swings that include emotional highs and lows), aphasia (a disorder which that affects how one communicates. It can impact speech, as well as the way you write and understand both spoken and written language), and high cholesterol.

Effective December 9, 2023, the resident's stay at the facility was paid by Medicaid.
A quarterly MDS dated February 10, 2024, revealed that the resident was cognitively intact with a BIMS score of 15.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated February 13, 2024, revealed a request to disenroll the resident from the resident's GHP Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits. covered under original Medicare prescription plan (Part D) benefits.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on February 13, 2024, the BOM spoke with Resident 13 and the resident's daughter/RP about transitioning to straight Medicare "since we recently got her approved for Medicaid and went over how the transition will benefit her here at the facility pertaining to her therapy and possibly getting more time." According to the documentation, the resident "chose to disenroll from her GHP Medicare Advantage Plan to try out straight Medicare."

Documentation dated April 15, 2024, completed by the BOM, indicated that Resident 13 "is happy with her choice and stated that she has been getting more therapy time." According to the note, Resident 13 will be transitioning home with waiver services and intends not to reenroll in the Medicare Advantage Plan.

Review of Resident 50's clinical record revealed that the resident was admitted to the facility on June 11, 2021, with diagnoses which included congestive heart failure, cognitive communication deficit (communication problems that can occur after a brain injury, stroke, or other neurological damage. These deficits can affect many aspects of thinking and social skills including difficulty concentrating on conversations, or missing important information), and aphasia following a stroke.

A quarterly MDS dated December 2, 2023, revealed that the resident was cognitively intact with a BIMS score of 15.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated December 29, 2023, revealed a request to disenroll Resident 50 from the resident's Aetna Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits and for the resident to be enrolled in a Medicare Drug Plan effective January 1, 2024.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on December 29, 2023, the BOM spoke with Resident 50 about transitioning to straight Medicare at the facility since the resident intended to remain in the facility long-term. According to the documentation, the BOM "went over how the transition could benefit her here at the facility regarding her therapy and possibly getting more time. The BOM further discussed that we can always reenroll her in Aetna MCA if she chooses to do so."

Review of Resident 59's clinical record revealed that resident was admitted to the facility on January 3, 2022, with diagnoses which included heart disease, diabetes, and chronic post-traumatic stress disorder.

A quarterly MDS dated February 15, 2024, revealed that the resident was cognitively intact with a BIMS score of 15.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated February 15, 2024, revealed a request to disenroll Resident 59 from the resident's GHP Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits and for the resident to be enrolled in a Medicare Drug Plan effective March 1, 2024.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on February 15, 2024, the BOM spoke with the resident about transitioning to straight Medicare. According to the documentation, the resident is a long-term resident who is off and on part B services often. The BOM "went over how the transition will benefit him here at the facility regarding his therapy and possibly getting more time and also cut down on submitting for auths [authorizations] and having a specific time range to work with. We spoke about referrals and his doctors, and I let him know that with Medicare, referrals aren't usually needed and Medicare you can go to any doctor in the U.S. and he will not have a problem. He chose to disenroll in his GHP MCA and give straight Medicare a try."

Review of Resident 61's clinical record revealed admission to the facility on September 28, 2023, with diagnoses which included cognitive communication deficit, dementia, and hypertension.

A quarterly MDS dated January 31, 2024, revealed that the resident was cognitively intact with a BIMS score of 15.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated February 15, 2024, revealed a request to disenroll Resident 61 from the resident's GHP Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits and for the resident to be enrolled in a Medicare Drug Plan effective March 1, 2024.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on February 15, 2024, the BOM spoke to Resident 61 about transitioning to straight Medicare at the facility since she would be staying long term. The BOM further stated that she "went over how the transition will benefit her here, especially since she is off and on her part B services at the facility regarding her therapy and possibly getting more time without having to struggle with auths [authorizations] and time frames."

Review of Resident 75's clinical record revealed admission to the facility on September 13, 2021, with diagnoses which included aphasia following a stroke, dementia, and COPD.

A quarterly MDS dated November 17, 2023, revealed that the resident was moderately cognitively impaired with a BIMS score of 11.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated December 29, 2023, revealed a request to disenroll Resident 75 from the resident's Aetna Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits and for the resident to be enrolled in a Medicare Drug Plan effective January 1, 2024.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on December 29, 2023, the BOM spoke with Resident 75 about transitioning to straight Medicare due to her often voicing not getting enough therapy time. The BOM "went over how the transition will benefit her here at the facility regarding her therapy and possibly getting more time as she wished. She chose to disenroll in her Aetna MCA and give straight MCA a try."

Review of clinical record revealed admission to the facility on December 1, 2021, with diagnoses which included COPD, diabetes, and hypertension.

A quarterly MDS dated December 7, 2023, revealed the resident was cognitively intact with a BIMS score of 15.

A review of a facility form entitled "Medicare Advantage Disenrollment Form" dated January 31, 2024, revealed a request to disenroll Resident 81 from the resident's GHP Medicare Advantage plan so that the resident will be eligible for Medicare Part A and Part B benefits and for the resident to be enrolled in a Medicare Drug Plan effective February 1, 2024.

Review of documentation dated March 18, 2024, completed by the facility's BOM, revealed that on January 31, 2024, about transitioning to straight Medicare at the facility since he will be a long-term resident. According to the documentation, the BOM discussed "how the transition will benefit him here at the facility regarding his therapy, getting more skilled time part B services and avoiding having to submit auths and also being capable to monitor progress in-house."

These changes in Medicare health plans were initiated by the facility and not by the beneficiary or their representative.

Interview with the Nursing Home Administrator and Business Office Manager on May 15, 2024, confirmed that the facility did not have any policies or procedures in place that outline the process of assisting beneficiaries and their representatives with changing their Medicare health plans.

This deficiency is cited as past non-compliance.

The facility's corrective action plan included the following:

1.The facility policy and procedure was updated. The residents identified, will be contacted to review verbally and in writing their current plans. The facility will reconnect with those residents not capable of making their own decisions.
2.Nursing Home Administrator or designee will conduct an initial audit to validate that any changes made to current residents Medicare Health Plans follow the facility's policy.
3.Nursing Home Administrator or designee will re-educate the Business office manager and Social Service Director regarding Medicare Health Plan Enrollment Policy and Procedure.
4.Nursing Home Administrator or designee will conduct weekly random audits for four weeks and then monthly audits for two months thereafter to validate that current residents who have recently elected to change their Medicare Health Plan is following the facility policy. Results of the audits will be reviewed by the Quality Assurance Performance Improvement Committee and changes will be made as necessary.

The facility's completion date was April 12, 2024, and verified during survey completed May 15, 2024.




28 Pa. Code 201.29 (a)(c) Resident rights

28 Pa. Code 201.18 (b)(1)(2)(3) Management



 Plan of Correction - To be completed: 05/30/2024

Past noncompliance: no plan of correction required.

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