Jessnic Home Health Agency 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 a completed written Notice of Medicare Non-Coverage (CMS form 10123) no later than two days in advance of terminating ongoing care in four of four discharged records reviewed (Patient 1, 2, 3 and 4) whose reason for discharge was goals met. The agency failed to provide the CMS form titled, “Notice of Medicare Non-Coverage.” This failure could place the patients at risk of harm due to inadequate or inappropriate continuity of care in the patient’s post-discharge needs and could prevent the patient from exercising their right to appeal the discharge decision if desired. Findings include: Patient 1: Record review of the agency discharge roster included a discharge date of 02/14/2023 with goals met as the reason for discharge. Record review of the medical record included a plan of care dated 12/18/2022 to 02/15/2023. The plan of care included orders for nursing visits zero times a week for one week, two times a week for two weeks, and one time a week for seven weeks. The record did not include a Notice of Medicare Non-Coverage. The surveyor requested the Notice of Medicare Non-Coverage from the Alt Adm/DON and received an email on 03/14/2024 at 12:44 PM that contained a Notice of Medicare Non-Coverage signed by Patient 1 on 02/14/2023. The form included a discharge date of 02/14/2023. Patient 1 signed the Notice of Medicare Non-Coverage on the same day as discharge. The Alt Adm/DON stated during an interview on 03/14/2024 at 2:15 PM she did not remember why the discharge notice was signed on the same day as discharge. Patient 2: Record review of the agency discharge roster included a discharge date of 03/12/2021 with goals met as the reason for discharge. Record review of the medical record included a plan of care dated 01/13/2021 to 03/13/2021. The plan of care included orders for nursing visits one time a week for nine weeks. The record did not include a Notice of Medicare Non-Coverage. Patient 3: Record review of the agency discharge roster included a discharge date of 11/08/2021 with goals met as the reason for discharge. Record review of the medical record included a plan of care dated 09/10/2021 to 11/08/2021. The plan of care included orders for nursing visits one time a week for ten weeks. The record did not include a Notice of Medicare Non-Coverage. Patient 4: Record review of the agency discharge roster included a discharge date of 04/13/2022 with goals met as the reason for discharge. Record review of the medical record included a plan of care dated 02/13/2022 to 04/13/2022. The plan of care included orders for nursing visits zero times a week for one week, two times a week for one week, and one time a week for eight weeks. The record did not include a Notice of Medicare Non-Coverage. The surveyor requested the Notice of Medicare Non-Coverage for Patients 2, 3, and 4 from the Alt Adm/DON on 03/14/2024 at 1:44 PM. The Alt Adm/DON stated during an interview on 03/14/2024 at 2:15 PM a Notice of Medicare Non-Coverage for Patient 2, 3, and 4 had not been found because the agency had recently relocated, everything was not unpacked and the notices were probably in a box. The surveyor agreed to accept the Notice of Medicare Non-Coverage for Patients 2, 3, and 4 if received via email no later than 03/15/2024 at 5:00 PM. The surveyor did not receive the Notice of Medicare Non-Coverage notices. Agency policy titled, “PATIENT DISCHARGE PE.6” with a revised date of 01/01/2014 read in part, “…POLICY… Agency will deliver the Notice of Medicare Non-Coverage… to the patient (or authorized representative), at least 2 calendar days before Medicare covered services end… PROEDURE… 2.13… Agency will keep the following in the patient’s file: a copy of the written notification provided…” Regulation: Effective July 1, 2005, the new Medicare regulations, Benefits Improvement and Protection Act, gave beneficiaries access to the new expedited determination process when their home health agency services were ending. There were two notices required by these regulations. The first was a generic notice called a Notice of Medicare Provider Non-coverage labeled “FORM No. CMS 10123” that the provider would deliver at least two days prior to when a beneficiary’s Medicare coverage of services was ending. The telephone number for the QIO was to be included in the notice. The second was a detailed notice, called a Detailed Explanation of Provider Non-Coverage that the provider would deliver to the beneficiary and the appropriate QIO only if the beneficiary requested an expedited review by the QIO of the decision that coverage for items and/or services should end.”