cms_WV: 11118
Data source: Big Local News · About: big-local-datasette
| rowid | facility_name | facility_id | address | city | state | zip | inspection_date | deficiency_tag | scope_severity | complaint | standard | eventid | inspection_text | filedate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 11118 | NEW MARTINSVILLE CENTER | 515074 | 225 RUSSELL AVENUE | NEW MARTINSVILLE | WV | 26155 | 2009-04-30 | 156 | E | 0 | 1 | 6TSD11 | Based on record review and staff interview, this Medicare-participating facility failed, for four (4) of four (4) residents reviewed, for whom a determination was made by the facility that Medicare will not pay for skilled nursing or specialized rehabilitative services and that an otherwise covered item or service may be denied as not reasonable and necessary, to notify the resident or his/her legal representative in writing why these specific services may not be covered; the beneficiary ' s potential liability for payment for the non-covered services; the beneficiary right to have a claim submitted to Medicare; and the beneficiary ' s standard claim appeal rights that apply if the claim is denied by Medicare. This practice had the potential to affect all residents for whom a determination of non-coverage by Medicare had been made by the facility. Resident identifiers: #52, #99, #66, and #4. Facility census: 101. Findings include: a) Residents #52, #99, and #66 A review of the forms entitled "SNF Determination on Continued Stay" for these residents revealed only the date that Medicare-covered services would be discontinued; there was no mention in writing of what specific service may no longer be covered or why. The only verbiage included in the form was "no longer requires skilled services" or "exhausted benefits". During an interview with the administrator and the office person responsible for providing this notification at 3:20 p.m. on 04/27/09, they acknowledged that this was form given to the resident and/or the responsible party as the notification of discontinuance of Medicare-covered skilled services and of their right to appeal this decision. They also agreed, after reviewing the forms, that the documentation did not on these residents' forms did not specify the service that was no longer being covered. When asked, neither person was able to state, during the interview, exactly what service had been discontinued for each of these three (3) residents. b) Resident #4 A review of the Notice of Medicare Provider Non-coverage notice provided to Resident #4 and/or her responsible party revealed: "Resident will no longer receive speech therapy effective 4/26/09." However, this notice did not include any reason for why the service was being discontinued. During an interview with the administrator and the office person responsible for notification at 3:20 p.m. on 04/27/09, they acknowledged that this was the only documentation given to the resident. c) In the interview of 04/27/09, the person responsible for obtaining signatures on the non-coverage notification forms stated she assumed that someone else had explained the service involved and why it was being stopped prior to the notification being signed, but both she and the administrator acknowledged, after reviewing the above residents' forms, that the Medicare-covered skilled services being discontinued and/or the reasons for discontinuation were not there. . | 2014-08-01 |