| 1651 |
WESTBURY MCDONOUGH, LLC |
115463 |
198 HAMPTON STREET |
MCDONOUGH |
GA |
30253 |
2019-01-31 |
582 |
B |
0 |
1 |
4NRX11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and staff interview, the facility failed to ensure that Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) were completed with the resident's (R) or responsible party's (RP) signature, designation of their choice of whether or not to continue to receive skilled services after discharge off Medicare Part A, documentation of attempts to get the form completed, and/or why the form was not completed for two of three residents reviewed (R#87 and R#92). In addition, the facility failed to obtain or document the attempts to obtain the resident or RP signature on the Notice of Medicare Non-Coverage (NOMNC) for one resident (R#92). The sample size was 55 residents. Findings include: 1. Review of a Beneficiary Notice-Residents discharged Within the Last Six Months form revealed that R#87's discharge date of f Medicare Part A services was 1/15/19, and he remained in the facility with Part A benefit days remaining. Review of R#87's NOMNC revealed that the effective date coverage of his current PT (Physical Therapy) and OT (Occupational Therapy) services would end as of 1/15/19, and he signed the form to acknowledge his right to appeal this decision. Review of R#87's SNFABN revealed that beginning on 1/16/19, he may have to pay out of his pocket for PT and OT if he did not have other insurance that may cover the costs. Review of the What To Do Now section of this notice revealed for him to choose an option about whether to get the care listed above (PT and OT). Further review of the notice revealed that none of the three options were chosen (the options were to continue the care and bill Medicare; or continue the care but don't bill Medicare; or don't want the care listed), and the form was not signed by the resident or RP. Review of the signature line revealed that by signing, it meant you've received and understood the notice. Review of R#87's Admission Minimum Data Set ((MDS) dated [DATE] revealed that he had a Brief Interview for Mental Status (BIMS) score of 15 (a BIMS score of 13 to 15 indicates no cognitive impairment). 2. Review of a Beneficiary Notice-Residents discharged Within the Last Six Months form revealed that R#92's discharge date of f Medicare Part A services was 1/9/19, and he remained in the facility with Part A benefit days remaining. Review of R#92's NOMNC revealed that the effective date coverage of his current PT and OT services would end as of 1/9/19. Further review of this notice revealed that facility staff noted that R#92's RP had been called on 1/2/19 and the notice explained to her including the right to appeal, and that a copy of the notice was mailed to the RP on 1/7/19. However, the NOMNC was not signed, and there was no notation of attempts to reach the RP to ensure she received the form and request for completion and return to the facility. Review of R#92's SNFABN revealed that beginning on 1/10/19, he may have to pay out of his pocket for PT and OT if he did not have other insurance that may cover the costs. Review of the What To Do Now section of this notice revealed for him (or RP) to choose an option about whether to get the care listed above (PT and OT). Further review of the notice revealed that none of the three options were chosen, and the form was not signed by the resident or RP. Review of R#92's 30-Day MDS dated [DATE] revealed that he had a BIMS score of 15. Interview with Social Services staff FF on 1/31/19 at 9:52 a.m. revealed that she reviewed the beneficiary notices with a resident if they were alert and cognitively able to understand the forms. She further stated that she felt R#87 was able to understand and sign his notices, but that she did not feel that R#92 could comprehend them. She stated that when a resident was coming off Part A services, she explained the NOMNC and SNFABN to the resident in their room, and/or called the RP to explain it to them. She stated during continued interview that she mailed the notices to the RP if the resident was unable to sign them, asked for the RP to sign and return the forms to her, and that some RPs returned the forms and some didn't. Social Services staff FF verified that neither R#87 or R#92's SNFABNs were completed nor signed by the resident or RP, and that the NOMNC was not signed by R#92's RP. She stated that she did not want to pressure the resident or RP into selecting one of the options on the SNFABN and sign it, and verified there was no documentation of refusal to sign the forms. She further stated that she guessed they must not have understood the purpose of the forms when she explained it to them. She stated that she called R#92's RP on multiple occasions to ask her to sign and return the notices, and even left the forms in his room before for her to sign, but that she had no documentation of the attempts she made. Social Services staff FF further stated that a room change was done for R#92 on 1/23/19 and the RP was present, but it slipped her mind to get the RP to sign the beneficiary notices at that time. Review of the facility's Advance Beneficiary Notices policy dated (YEAR) revealed: The facility shall inform Medicare beneficiaries of his or her potential liability for payment. For Part A items and services, the facility shall use the Skilled Nursing Facility Advance Beneficiary Notice (SNFABN). A Notice of Medicare Non-Coverage (NOMNC) shall be issued to the resident/representative when Medicare covered service(s) are ending, no matter if resident is leaving the facility or remaining in the facility. Delivery requirements: The notice shall be in a language and/or format that the resident/representative understands. Verbal explanations detailing the reasons for the determination of possible non-coverage shall be provided. The notice shall be hand-delivered as possible to obtain beneficiary signature. If the notice cannot be hand-delivered (for example, such as in the case of an incompetent resident and the representative is out of town), a telephone notice shall be made, followed up immediately with a mailed notice. Documentation shall comply with form instructions regarding telephone notices. Beneficiary refusals to sign: Explain to resident/representative they have the right to refuse to sign the ABN. Review of the Form Instructions Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage (SNFABN) Form CMS- (2018) from CMS's (Centers for Medicare and Medicaid Services) website: www.cms.gov/Medicare/Medicare-General-Information/BNI/FFS-SNF-ABN-.html revealed: The SNFABN provides information to the beneficiary so that s/he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. There are 3 options listed on the SNFABN with corresponding check boxes. The beneficiary must check only one option box. If the beneficiary is physically unable to make a selection, the SNF may enter the beneficiary's selection at his/her request and indicate on the notice that this was done for the beneficiary. Additional Information: SNF's may use this space to clarify and/or provide any additional information they think might be helpful to the beneficiary. For example, SNF's may use this space to include other necessary notes. The beneficiary or their authorized representative must sign the signature box to acknowledge that they read and understood the notice. If the beneficiary refuses to choose an option and/or refuses to sign the SNFABN when required, the SNF should annotate the original copy of the SNFABN indicating the refusal to sign and may list a witness to the refusal. Review of the Form Instructions for the Notice of Medicare Non-Coverage (NOMNC) CMS- from CMS's website https://www.cms.gov/Medicare/Medicare-General-Information/BNI/Downloads/ Instructions-for-Notice-of-Medicare-Non-Coverage-NOMNC.pdf revealed: The provider must ensure that the beneficiary or representative signs and dates the NOMNC to demonstrate that the beneficiary or representative received the notice and understands that the termination decision can be disputed. Notification to the representative may be problematic because that person may not be available in person to acknowledge receipt of the required notification. If the provider is personally unable to deliver a NOMNC to a person acting on behalf of an enrollee, then the provider should telephone the representative to advise him or her when the enrollee's services are no longer covered. The date of the conversation is the date of the receipt of the notice. Confirm the telephone contact by written notice mailed on that same date. Signature Line: The beneficiary/enrollee or the representative must sign this line. Date: If the document is delivered, but the enrollee or the representative refuses to sign on the delivery date, then annotate the case file to indicate the date that the form was delivered. |
2020-09-01 |