cms_NE: 158

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

rowid facility_name facility_id address city state zip inspection_date deficiency_tag scope_severity complaint standard eventid inspection_text filedate
158 RIVER CITY NURSING AND REHABILITATION 285058 7410 MERCY ROAD OMAHA NE 68124 2017-07-12 156 E 0 1 0ROU11 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to provide notices of non-coverage of Medicare services for 3 (12,165, 16) and failed to provide a list of services not covered by Medicaid for 2 residents (Resident 122 and 47). Findings are: The facility Policy and Procedure titled When to Deliver the Notice of Medicare Non-Coverage CMS (NOMNC), undated, revealed that: A Medicare provider or health plan must deliver a completed copy of the Notice of Medicare Non-Coverage to beneficiaries/enrollees receiving covered skilled nursing. The NOMNC must be delivered at least two calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily. Providers must deliver the NOMNC to all beneficiaries eligible for the expedited determination process. A NOMNC must be delivered even if the beneficiary agrees with the termination of services. 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. A) Record review of Admission Record for Resident 12 revealed that, Resident 12 was admitted to the facility on [DATE] with Medicare services. Record review of Resident 12's Electronic Medical Record revealed that Resident 12 services changed from Medicare to Private pay. Record review revealed the facility did not have documentation of NOMNC or SNF Denial Letter for services. Interview with facility Business Office Manager (BOM) on 7/11/17 at 2:23 PM confirmed that the facility failed to provide Resident 12 with NOMNC and Denial Letter. The BOM confirmed that there was no documentation of Resident 12 being provided notice of when Medicare Services would end. B) Record review of Admission Record for Resident 16 revealed that Resident 16 was admitted to the facility on [DATE] with Medicare services provided Record review of NOMNC, for Resident 16, dated 3/24/17, revealed that, Medicare covered services would end on 3/24/17. The document failed to have resident choice to appeal, and had no Patient or Representative signature or date. Interview with BOM on 7/11/17 at 2:23 PM confirmed that the facility failed to provide NOMNC, and Denial letter for Resident 16. C) Record review of Admission Record for Resident 165 revealed that, Resident 165 was admitted to the facility on [DATE] and received Medicare Services. Record review of NOMNC for Resident 165 dated 1/12/17 revealed Resident was notified of right to appeal denial decision. Resident 165's signature was on the form dated 01/10/17. Record review revealed no documentation that Resident 165 was provided a form with the choice to receive Medicare services, or to appeal Medicare decision, or choose not to receive the services. Interview with the facility BOM on 7/11/17 at 2:23 PM confirmed that Resident 165 was not provided with choice to appeal Medicare decision, pay for services to continue, or to stop services. D. A review of Resident 47's Admission Record dated 7/12/17 revealed that Resident 47 was admitted to the facility on [DATE] and was a Medicaid recipient. An interview conducted on 7/5/17 at 10:59 AM with Resident 47's Responsible Party revealed that the Responsible Party had not received a list of services not covered by Medicaid. A review of Resident 47's medical record revealed no documentation that a list of non-covered services was supplied to the resident's Responsible Party. E. A review of Resident 122's Admission Record dated 7/12/17 revealed that Resident 122 was admitted to the facility on [DATE]. An interview conducted on 7/5/17 at 10:30 AM with Resident 122's spouse revealed that neither the resident nor the spouse received from the facility a list of services not covered by Medicaid. An interview conducted on 7/11/17 at 4:04 PM with the Business Office Assistant revealed that the facility did not have a document to be given to residents on Medicaid to inform them of non-covered services. The Business Office Assistant reported that when a resident transitioned to Medicaid they would review with the resident what the share of cost was and what medications would be covered. The Business Office Assistant reported that they did not know what services were and were not covered by Medicaid. 2020-09-01