Ostrander Care And Rehab

Based on a phone interview on 04/15/2026 9:26 a.m., FM-A stated had visited more often than other family members but was not POA. FM -A did not recall any specific conversation with the facility DON in reference to the possibility of appeal and stated, we were just told therapy was going to stop.

Facility was unable to provide a signed copy of the CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) for review.

During an interview with on 04/15/2026 10:08 a.m., DON stated, had not presented R30's family a copy of the CMS-10055 Skilled Nursing Facility Advance Beneficiary Notice of Non-coverage (SNF ABN) for review and signature. A facility policy titled [NAME] care and Rehab Administration policy Rates and Charges/Medicare Policy reviewed on 2/2025 states,1. OCR must inform the resident or the resident agent/guardian before any changes in charges for services not covered under Medicare or Medicaid or by nursing home per diem rate. 5.

Residents admitted under Medicare A will be informed within 48 hours of the need for denial of benefits pending change.

• The Medicare denial will be explained to the resident or their responsible person and the reason of

denial prior to obtaining the signature on the form.

Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.

For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.

LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE