§483.10(f)(10)(iv) Notice of certain balances.
The facility must notify each resident that receives Medicaid benefits-
(A) When the amount in the resident's account reaches $200 less than the SSI resource limit for one person, specified in section 1611(a)(3)(B) of the Act; and
(B) That, if the amount in the account, in addition to the value of the resident's other nonexempt resources, reaches the SSI resource limit for one person, the resident may lose eligibility for Medicaid or SSI.
§483.10(f)(10)(v) Conveyance upon discharge, eviction, or death.
Upon the discharge, eviction, or death of a resident with a personal fund deposited with the facility, the facility must convey within 30 days the resident's funds, and a final accounting of those funds, to the resident, or in the case of death, the individual or probate jurisdiction administering the resident's estate, in accordance with State law.
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Observations:
Based on review of resident financial accounts, facility documentation, review of closed clinical records, and staff interview, it was determined that the facility failed to settle and send the remaining funds from the financial account within 30 days of discharge to the resident's estate/responsible party for four of seven residents reviewed (Residents CR1, CR3, CR5, and CR6).
Findings include:
A review of the financial account for Resident CR1's closed record indicated that the resident was discharged from the facility on August 23, 2021. A debit of $5,634.96 dollars was made on November 23, 2021, from the resident's account. Review of a check written by the facility to Resident CR1 for the above amount was dated November 23, 2021. There was a zero-balance at the time of the account termination on November 24, 2021. Further review of the account revealed deposits were made from the SSA Treasury (Social Security Income) for $1,198.00 dollars on September 3, October 1, and November 3, 2021. Withdrawals were made for $1,153.00 on September 1, October 1, and November 3, 2021, for care costs after the resident's discharge. Interview with the interim Nursing Home Administrator on December 1, 2021, at 1:00 PM revealed that the facility's electronic record automatically sweeps the account for care charges incurred during a resident's stay and a check will be written to Resident CR1 for the amount owed. Funds were not conveyed to the resident within 30 days of discharge.
A review of the financial account for Resident CR3 indicated that the resident expired on October 5, 2021, and the resident's account balance was $3,743.40 dollars. The account revealed deposits were made from the SSA Treasury on October 13, 2021, for $1,252.00 dollars and on November 3, 2021, for $1,660.05 dollars from the Commonwealth of PA. Withdrawals were made for care costs of $1,207.00 dollars on October 13, 2021. Interview with Employee 1, regional business office manager, on December 1, 2021, at 1:00 PM revealed that she froze the account on November 26, 2021, to contact the family and allow time for the return of the direct deposits. There was no evidence that funds were conveyed to the responsible party within 30 days of the resident's death.
A review of a list of resident discharges from July 1, 2021 to November 30, 2021, revealed Resident CR5 was discharged to a hospital on July 21, 2021. A review of the financial account for Resident CR5 revealed a balance of $220.00 dollars. There was no evidence that funds were conveyed to the resident/responsible party within 30 days of the resident's discharge.
The discharge list revealed Resident CR6 expired on July 28, 2021. A review of the financial account for Resident CR6 revealed a balance of $100.00 dollars. There was no evidence that funds were conveyed to the resident/responsible party within 30 days of the resident's discharge.
During an interview with the Interim Nursing Home Administrator and Employee 1 on December 1, 2021, at 1:00 PM revealed that the funds remaining in Residents CR1, CR3, CR5, and CR6's accounts were not conveyed to the residents/estate within 30 days of discharge and the deceased residents had responsible parties to whom the funds could be conveyed.
28 Pa. Code 201.18 (b)(2)(3)(e)(1) Management
28 Pa. Code 201.29 (a) Resident rights
| | Plan of Correction - To be completed: 01/13/2022
The facility will send remaining funds from the financial account within 30 days of discharge to the resident's estate/responsible party.
The facility has CLOSED the identified residents accounts. The Regional Business Office Manager has processed the resident accounts for payment to the appropriate person ( POA, resident and/or transferring facility).
Resident CR1's account has been closed and a refund of $3,459.00 has been processed.
Resident CR3's account has been closed and a refund of $7862.45has been processed.
Resident CR5's account has been closed and a refund of $220.00 has been processed.
Resident CR6"s account has been closed and a refund of $100.00 has been processed.
The facility Business Office Manager will do a monthly audit of all discharged resident accounts to ensure the account is closed and any refund due is processed to ensure payment within 30 days.
The results of the audits will be submitted and reviewed each month at the facility Quality Assurance meeting to ensure compliance.
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