Nexus Home Healthcare Inc.

“Written notice for non-covered care CFR(s): 484.50(c)(8) Receive proper written notice, in advance of a specific service being furnished, if the HHA believes that the service may be non-covered care; or in advance of the HHA reducing or terminating on-going care. The HHA must also comply with the requirements of 42 CFR 405.1200 through 405.1204. This Element is not met as evidenced by: Based on record review and interview, the agency failed to provide the completed written Notice of Medicare Non-Coverage notice at least two days in advance of terminating on-going care in two of seven patient discharged records reviewed (Patients 1 and 2). The failure of the agency to protect the rights of the patient by informing in advance of their right to appeal the discontinuation of home health services prevented the identified patients from exercising their right to appeal the discharge decision if they chose to appeal. Findings included: During an interview with the Adm on 01/14/2026 at 10:15 AM, the Adm stated the Alt Adm/DON was responsible for ensuring discharge notices were given to patients as required. Patient 1: Record review of the electronic medical record included a plan of care dated 04/14/2025 to 06/12/2025 with a start of care date of 12/15/2024. The record included two visits conducted by PTA dated 05/31/2025 and 06/07/2025. The two visit notes did not include PTA provided the completed written Notice of Medicare Non-Coverage notice (a Medicare form utilized by health care providers to notify patients of their intent to discontinue services that may no longer be covered by Medicare) at least two days in advance of discharge. The record included a discharge OASIS assessment (a standardized data set that measures quality and outcomes of home health patients) completed by PT B on 06/12/2025. The discharge OASIS included the discharge reason was goals met. The record contained a written Notice of Medicare Non-Coverage notice signed and dated on 06/12/2025 by Patient 1, the same day of discharge. The agency failed to provide the NOMNC 2 days prior to discharge. During an interview with PTA on 01/20/2026 at 1:15 PM, the surveyor asked who was responsible for providing patient discharge notices prior to agency discharge. PTA stated the patient was unable to sign his name due to medical conditions so only a verbal notice was given. PTA stated everything had been done verbally and no discharge notices were left with the patient. During an interview with PT B on 01/20/2026 at 1:51 PM, the surveyor asked who was responsible for providing patient discharge notices prior to agency discharge. PT B stated PTA was responsible. The surveyor asked why the Notice of Medicare Non-Coverage notice was signed and dated on the same day as discharge. PT B stated he could not remember the details, but he may have given the notice on the same day of discharge if PTA did not provide the notice to the patient in advance. During an interview with the Adm, Alt Adm/DON and the Director of Operations on 01/21/2026 at 2:00 PM, the surveyor asked why the Notice of Medicare Non-Coverage notice was not given at least 2 days in advance of discharge. The Adm stated the agency had overlooked providing the notice since the therapist might not have been sure if the patient would or would not be discharged. Patient 2: Record review of the electronic medical record included a plan of care dated 11/20/2025 to 01/18/2026 with a start of care date of 11/20/2025. The record included a discharge OASIS assessment completed by PT A on 01/12/2026. The discharge OASIS included the discharge reason was goals met. The record contained a written Notice of Medicare Non-Coverage notice signed and dated on 01/12/2026 by Patient 2, the same day of discharge. The agency failed to provide the NOMNC 2 days prior to discharge. During an interview with PT A on 01/20/2026 at 1:45 PM, the surveyor asked why the Notice of Medicare Non-Coverage notice was signed and dated on the same day as discharge. PT A stated it was a mistake and sometimes he forgot to give the discharge notice in advance. PT A further stated if the notice if was not signed before discharge, he had the patient sign the same day of discharge. During an interview with the Adm, Alt Adm/DON and the Director of Operations on 01/21/2026 at 2:17 PM, the surveyor asked why the Notice of Medicare Non-Coverage notice was not given at least 2 days in advance of discharge. The Adm stated it was the same answer given for Patient 1 [the agency had overlooked providing the notice since the therapists might not have been sure if the patient would or would not be discharged]. During an interview with the Adm, Alt Adm/DON and the Director of Operations on 01/21/2026 at 2:25 PM, the surveyor asked why agency policy was not followed for providing the discharge notice. The Adm stated that organizational behaviors and variables can increase the cognitive load in clinicians which can result in inconsistencies. The Adm stated it made the most sense to have the discharge notice signed on the same day of discharge, even though that was not the requirement. Agency policy PE.30 Patient/Client Transfer and Discharge Notices last reviewed 080120 read in part…”Purpose To provide guidance on completion of the required discharge notices. Policy I. Prior to transferring or discharging a patient/client, the Agency will provide written notification to the patient/client or the patient’s/client’s parents, family, spouse, significant other or legal representative….Procedure I. Notice of Medicare Non-Coverage (NOMNC)… A. Agency staff will provide valid delivery notice (involves both delivery and completion) of the NOMNC to the patient/client, or representative (if any), when the end of all covered care is foreseen, even if the patient/client agrees with the discharge. B. At least two (2) calendar days before Medicare covered services end or the second to last day of service if care is not provided daily, the Agency representative will provide the NOMNC to the patient/client, or representative (if any)… C. If the Agency fails to give valid notice, patient/client coverage continues for at least two (2) days after the notice is received… I. The Agency will have the patient/client, or representative, complete and sign the NOMNC. The patient/client, or representative, should sign and date two copies, keeping one and returning the other to the Agency… S. The Agency will retain a copy of all completed NOMNCs in the patient’s/client’s records and will give completed copies to: 1. The patient/client or representative…””