cms_GA: 9325
In collaboration with The Seattle Times, Big Local News is providing full-text nursing home deficiencies from Centers for Medicare & Medicaid Services (CMS). These files contain the full narrative details of each nursing home deficiency cited regulators. The files include deficiencies from Standard Surveys (routine inspections) and from Complaint Surveys. Complete data begins January 2011 (although some earlier inspections do show up). Individual states are provides as CSV files. A very large (4.5GB) national file is also provided as a zipped archive. New data will be updated on a monthly basis. For additional documentation, please see the README.
This data as json, copyable
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rowid
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facility_name
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facility_id
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address
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city
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state
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zip
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inspection_date
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deficiency_tag
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scope_severity
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complaint
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standard
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eventid
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inspection_text
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filedate
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| 9325 |
SENIOR CARE CENTER - BRUNSWICK |
115721 |
2611 WILDWOOD DRIVE |
BRUNSWICK |
GA |
31520 |
2011-02-23 |
156 |
B |
0 |
1 |
X28E11 |
Based on a review of the facility's " Notice of Medicare Provider Non-Coverage " form, it was determined that the facility failed to issue the mandatory denial notices to three residents (#25, #26 and #27) that included their potential liability for payment of non-covered services in order to allow them to make an informed decision about whether or not they wanted to continue to receive specific items or services, knowing that they might have to pay for those items or services themselves, and failed to specify the reason why the facility expected Medicare to deny payment. Findings include: According to CMS' "Liability Notices/Notice of Medicare Provider Non-coverage" instructions, the "Notice of Medicare Provider Non-Coverage" form (CMS- ) was supposed to be issued when all covered services ended for coverage reasons. If the facility expected the beneficiary to remain in the facility in a non-covered stay, either the CMS- form or a Denial Letter was required to be issued to inform the beneficiary of the potential liability for the non-covered stay. The standards for use by Skilled Nursing Facilities (SNF) in implementing the CMS- form as described in the "70-Form CMS- Skilled Nursing Facility Advance Beneficiary Notice", instructed the SNF to give the specific reason(s) why it expected Medicare to deny payment. The reason(s) cited were to be in understandable lay language and sufficiently specific to allow the resident to understand the basis for the expectation that Medicare would deny payment. Estimated cost amounts could be provided either with the description of extended care items and services or on the "estimated cost" line. However, the facility failed to issue either a CMS- form or a denial letter to residents #25, #26, and #27. The facility believed that three residents' (#25, #26 and #27) continued stay in the facility would not be paid for by Medicare Part A. However, the "Notice of Medicare Provider Non-Coverage" form issued to those residents on 9/16/10, 12/4/10 and 12/10/10 respectively, did not conform with the notice requirements to explain to the beneficiary his/her potential liability for payment of non-covered services in form CMS- " Skilled Nursing Facility Advance Beneficiary Notice " or one of the five uniform denial letters. In an interview on 2/23/11 at 1:00 p.m., the Administrator confirmed that the CMS- form with an estimated cost of the items or services, had not been provided to the residents. 1. The facility issued a "Notice of Medicare Provider Non-Coverage" form (CMS- ) to resident #25 on 9/16/10. The facility documented on that form that the current "Reh-" services would end on 9/21/10. The facility failed to describe the specific items or services that were to have been discontinued and an estimated cost for the continuation of those items or services. 2. The facility issued a "Notice of Medicare Provider Non-Coverage" form (CMS- ) to resident #26 on 12/4/10. The facility documented on that form that "Part A" services would end on 12/7/10. The facility failed to describe the specific items or services that were to have been discontinued and an estimated cost for the continuation of those items or services. 3. The facility issued a " Notice of Medicare Provider Non-Coverage " form (CMS- ) to resident #27 on 12/10/10. The facility documented on that form that "Reh services" services would end on 12/14/10. The facility failed to describe the specific items or services that were to have been discontinued and an estimated cost for the continuation of those items or services. |
2015-08-01 |