This week’s “Ftag of the Week” on the CMSCG Blog is F582 Medicaid/Medicare Coverage/ Liability Notice, which is part of the Resident Rights regulatory group. The revised guidance to surveyors effective October 2022 included updates to this regulation, so we will review it in two parts.
Regulatory Requirements – Medicaid Eligibility
The first part of this regulation outlines some requirements related to Medicaid-eligible residents. At the time of admission or when a resident becomes eligible for Medicaid, the facility is required to inform the resident, in writing, of the items and services that are included under the State plan. Residents may not be charged for those items included in nursing facility services. The resident must also be informed of other items and services that the facility offers, such as salon services, but for which the resident may be charged, as well as the cost of those services. If changes are made to any of those items and services, the resident must be notified as well.
Items and Services Covered/ Not Covered
The second part of this regulation outlines requirements for informing each resident, before, or at the time of admission, services that are available in the facility – as well as associated costs – and any charges for services not covered by Medicare or Medicaid or by the facility’s per diem rate. This information must also be provided “periodically” throughout the resident’s stay. Periodically, as defined by this regulation, refers to whenever there is a change being introduced that will affect a resident’s liability, and whenever there are changes to services. This is because residents must be told in advance when there are changes that will occur in their bills.
If a change in coverage is made to items and services covered by Medicare and/or by the Medicaid State plan, notice must be provided to residents as soon as “reasonably possible.” For changes that are related to items and services offered by the facility, written notice at least 60 days in advance must be provided to residents.
Refunds
A deposit may be required for a Medicare beneficiary who, upon admission, requires services that are not covered by Medicare. The notice provisions about the services available and their costs discussed above is applicable here. If a resident may be charged for a service or item not required by the resident’s care plan, notice must be provided.
It is the responsibility of the facility to ensure that any deposits made or charges already paid for by a resident during their stay are refunded per this guidance. The regulatory guidance notes that CCRC residents may be considered an exception to this requirement, if they were admitted to the CCRC’s nursing home and then discharged back to other residences in the CCRC.
- A resident who dies, is hospitalized or is transferred and does not return to the facility must be refunded any deposit or charges already paid, less the facility’s per diem rate, for days the resident resided or reserved/retained a bed in the facility, regardless of any minimum stay or discharge notice requirements. This refund must be provided to the resident/ representative or estate, as applicable.
- Within 30 days of a resident’s date of discharge from the facility, the facility must refund the resident/ representative any and all refunds that are due to the resident.
Note that the terms of an admission agreement cannot conflict with these regulatory requirements.
Recertification Survey Citation – 582 S/S: D
A facility failed to refund a resident all funds due to the resident within 30 days of the resident’s discharge for one yes. The resident was discharged to the community. Review of the resident’s funds determined that the facility withdrew costs associated with the provision of care for the day after the resident had been discharged. It was determined that the care costs for that date were never refunded to the resident.
Key Notices
Two of the notices that need to be provided to the resident are Beneficiary Notices. The Notice of Medicare Non-Coverage (NOMNC) and the Skilled Nursing Facility Advanced Beneficiary Notice of Non-Coverage (SNF ABN) are the key notices provided. Both of these have revised regulatory guidance – and are frequently identified on survey – so in Part 2 of this “Ftag of the Week,” we will review what you need to know about NOMNC and SNF ABN.
