Facility notified appellant of debt owed; facility provided reasonable and appropriate notice of the debt owed; appellant failed to pay; physician confirmed that 24-hour care by a home health agency will meet appellant’s needs.
Category: Nursing facility discharge
Appeal 1607197
- Facility notified appellant of its intent to transfer her to a different center because she failed to pay for services rendered at the facility. Decision is to proceed with the transfer.
Appeal 1603204
- Facility informed the appellant of its intent to discharge her for nonpayment. The issue is whether the facility is justified in seeking to discharge the appellant, and whether it followed proper procedures in doing so. Appeal is approved. Decision is to rescind notice and provide reasonable and appropriate notice to the appellant and her representative to pay for (or have Medicaid or Medicare) her stay at the facility.
Appeal 1601439
- Appellant failed to pay his patient paid amount so was sent a Notice of Intent to Discharge of Transfer. Records conclude that he has failed to pay for his stay at the nursing facility after reasonable and appropriate notice. Appeal denied.
Appeal 1513371
The patient paid amount charged for May 2015 is incorrect; and therefore, the amount the nursing facility asserts that Appellant owes is also incorrect.
Appeal 1501589
Appellants have failed, after reasonable and appropriate notice, to pay for or have a third party pay for their stay at the facility and thus may be discharged; however, the facility has not provided sufficient preparation and orientation to Appellants to ensure safe and orderly transfer or discharge from the facility to another safe and appropriate place.
Appeal 1410160
Appellant must have “sufficient preparation and orientation to ensure a safe and orderly transfer to another safe and appropriate place”; the record strongly suggests that the appellant’s previous place of residence, shared with her son, is not a “safe and appropriate place.”
Appeal 1407261
Even though the facility has provided notice of an outstanding balance, it is premature to conclude that there has been a failure to pay while Appellant’s MassHealth application remains open; no evidence in the record to show that the residence is a safe and appropriate place for Appellant, nor evidence that the facility has provided sufficient preparation and orientation to Appellant to ensure a safe and orderly discharge to the residence.
Appeal 1409486
No adequate and acceptable documentation in the clinical record, from the resident’s physician, signing off on and attesting to the statement that this Appellant’s health has improved sufficiently enough to make the discharge appropriate; nursing facility has already failed twice in trying to serve Appellant with proper and appropriate notices; while the nursing facility is free to make another attempt, the nursing facility is strongly encouraged to review the applicable law and regulations quoted within this decision, and make sure that its notice, discharge planning, and paperwork prepared for hearing comply with all the regulatory law and the requirements given by the Board of Hearings.
Appeal 1405987
Nursing facility’s notice simply does not comply with many requirements of Massachusetts law; nowhere in the notice is the specific name of the contact person at the facility given; the address of an appropriate legal services offices be given with such notice; nursing facility required to say how much time the Appellant has to request an appeal.
MassHealth Appeals 