Failure to Inform Resident of Insurance Coverage
Summary
The facility staff failed to inform a resident about her medical coverage during her stay, resulting in a deficiency. The resident, who had diagnoses of depression and anxiety disorder, was admitted to the facility with intact cognitive skills and the capacity to make decisions. However, the facility did not inform her that she lacked secondary insurance coverage, which would cover costs not paid by her primary insurance. This oversight led to the resident receiving a medical bill for the uncovered amount. The facility's electronic medical records lacked documentation indicating that the resident was informed about her lack of secondary coverage. Interviews with the Business Office Manager (BOM) and the Director of Nursing (DON) revealed that the facility's protocol required staff to verify and inform residents about their insurance coverage upon admission and assist them in applying for secondary coverage if needed. However, the BOM admitted that there was no conversation or documentation regarding the resident's lack of secondary coverage, and the DON confirmed that it was the staff's responsibility to assist residents with applying for Medicare services. The resident expressed that she was unaware of her lack of secondary coverage and would have chosen not to stay at the facility had she been informed. She expected the facility staff to inform her of her medical benefits and assist with any issues, but this did not occur. The BOM and DON acknowledged the importance of informing residents about their insurance status to prevent issues with continuous care and financial responsibility for uncovered portions of care.
Penalty
Resources
Below are regulatory guidelines relevant to this citation:
A facility failed to display required written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid. Surveyors observed the missing information on the First Floor, Second Floor nursing unit, and Fourth Floor nursing unit, and the NHA confirmed the omission.
Surveyors found that the facility did not display required written information in common posting areas, such as the lobby and hallways near nursing units, explaining how residents and their representatives can apply for and use Medicare and Medicaid benefits and obtain refunds for previous payments covered by those programs. During an interview, the NHA confirmed that this information was not posted anywhere in the building, resulting in noncompliance with state requirements for licensee responsibility and management.
The facility did not display required written information about how to apply for and use Medicare and Medicaid benefits, or how to receive refunds for previous payments covered by these benefits. This was confirmed during observations and an interview with the NHA.
The facility did not display written information on how to apply for Medicare and Medicaid benefits or how to receive refunds for previous payments covered by these programs on either the West Wing or East Wing. This was confirmed by observation and staff interview.
The facility did not display written information for residents or their responsible persons on how to apply for Medicare and Medicaid benefits or obtain refunds for payments covered by these programs, as confirmed by observation and the DON.
The facility did not display required written information about applying for Medicare and Medicaid benefits or obtaining refunds for previous payments covered by these programs on both nursing floors, as confirmed by observations and the NHA.
Missing Medicare and Medicaid Posting Information
Penalty
Summary
The facility failed to display written information for residents and/or their responsible person on how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by Medicare and Medicaid in areas where postings were available, including the First Floor, Second Floor Nursing Unit, and Fourth Floor Nursing Unit. During observations on 4/7/26 from 12:51 p.m. through 1:10 p.m., surveyors found that the required information was not included on the postings in those locations. During an interview on 4/7/26 at 2:13 p.m., the Nursing Home Administrator confirmed that the facility had failed to display the required written information in the building.
Failure to Post Required Medicare/Medicaid Information for Residents
Penalty
Summary
The facility failed to display required written information for residents and/or their responsible persons on how to apply for and use Medicare and Medicaid benefits and how to receive refunds for previous payments covered by those benefits. During observations on 2/11/26 at approximately 11:30 a.m., surveyors inspected the first-floor lobby and hallways in and around the nursing units, where postings are typically available, and found that information on applying for Medicare and Medicaid and obtaining refunds for prior payments covered by these programs was not posted. In a subsequent interview on 2/12/26 at 9:00 a.m., the Nursing Home Administrator confirmed that the facility had not displayed this required written information anywhere in the building. The deficiency was cited under 28 Pa. Code: 201.14(a) Responsibility of licensee and 28 Pa. Code: 201.18(e) Management.
Failure to Display Medicare and Medicaid Benefit Information
Penalty
Summary
The facility failed to display written information for residents and their responsible persons regarding how to apply for and use Medicare and Medicaid benefits, as well as how to receive refunds for previous payments covered by these benefits. During observations conducted in the building, it was noted that this required information was not posted. Additionally, during an interview, the Nursing Home Administrator confirmed that the facility did not have the necessary written information displayed as required by regulations. No information was provided to residents or applicants for admission about these benefits or the refund process.
Failure to Display Required Medicare and Medicaid Information
Penalty
Summary
The facility failed to display written information regarding the application process for Medicare and Medicaid benefits, as well as information on receiving refunds for previous payments covered by these programs. During an observation in the Main Entrance Hallway, it was noted that although various information was posted for residents, there was no information available about applying for Medicare and Medicaid benefits or about obtaining refunds for payments previously covered by these programs. This deficiency was confirmed during an interview with the Nursing Home Administrator, who acknowledged that the required information was not displayed on either the West Wing or East Wing nursing floors.
Failure to Display Required Medicare and Medicaid Information
Penalty
Summary
The facility failed to display written information for residents and/or their responsible persons regarding how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by these programs. During observations of the first-floor lobby and the second-floor nursing unit posting locations, it was noted that this required information was not posted. In an interview, the Director of Nursing confirmed that the facility did not have the necessary written information displayed as required by regulations. No specific residents or medical conditions were mentioned in relation to this deficiency.
Failure to Display Medicare and Medicaid Application Information
Penalty
Summary
The facility failed to display written information regarding how to apply for Medicare and Medicaid benefits and how to receive refunds for previous payments covered by these programs on both the First Floor and Second Floor nursing units. This deficiency was identified during observations conducted on both nursing floors, where the required information was not present. The Nursing Home Administrator confirmed during an interview that the facility did not have the necessary written information displayed as required by regulations.
Trusted data from CMS and state health departments
Every citation, penalty and Plan of Correction is sourced from public CMS records (latest release August 26, 2026) and official state health department websites — never guesswork.
In your survey window? See what surveyors are citing.
The Survey-Prep Report maps your facility's risk from 12 months of CMS and state citation data — what's being cited around you and what to check first. $129 one-time.