Delayed Refund Following Retroactive Medicaid Approval
Summary
The facility failed to provide a timely refund to a resident's family member after the resident's Medicaid application for long-term care services was approved retroactively. Documentation showed that the family member had made two private payments totaling $7,853 while the Medicaid application was pending. The facility's admission packet stated that if Medicaid coverage is retroactive for a period for which payment has already been made, the facility would refund or credit any excess amount within thirty days of Medicaid eligibility being established. However, interviews with the Business Office Manager and Accounts Receivable Manager revealed confusion and lack of awareness regarding the status of the refund, with the Accounts Receivable Manager only being alerted to the balance due back to the family member months after Medicaid approval. The resident was initially covered by a Medicare Advantage plan, which later discontinued skilled services, leading to the resident being considered private pay until Medicaid approval. The resident's Social Security check was used for the patient portion of payment, and the family member shared a bank account with the resident, complicating the determination of the funding source. Despite the facility's policy and the retroactive Medicaid coverage, the refund process was delayed, and staff were unclear about the procedures and status of the refund owed to the family member.
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.
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