Every finding on record at Care Alternatives of Massachusetts, LLC

The patient has the right to receive information about the services covered under the hospice benefit. This standard was not met as evidenced by clinical record review and interview. In 1 of 2 (50%) discharged patient records where Medicare was the primary payor, the agency did not ensure that the Notice of Medicare Non-Coverage was provided to the patient as outlined in the "Notice Instructions for the Notice of Medicare Non-Coverage (NOMNC)" instructions (form CMS-10123). CLINICAL RECORD 15: A review of the clinical record revealed that the patient elected the hospice benefit and was admitted to hospice care on 01/11/2024. Medicare was the payor source for the hospice admission. The patient was recertified four (4) times. The Interdisciplinary Team (IDT) documented in the IDT team meeting note dated 10/17/24 that the patient had stabilized and that hospice services were no longer required. The patient was discharged from hospice care on 10/28/2024. A documented and signed Notice of Medicare Non-Coverage (NOMNC) was present in the record dated 10/28/2024. The agency did not ensure that the NOMNC was provided to the patient at least two calendar days before Medicare-covered services ended. The Administrator (Personnel Record 1) was interviewed on 09/19/2025 and stated, "The Notice of Non-Coverage should not have been signed and given to the patient on the date of discharge,"

It is required that hospice volunteers provide day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. The hospice documents the cost savings achieved through volunteers. This standard was not met as evidenced by document review and interview. A review of the agency's Volunteer Program documents revealed that the agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. DOCUMENT: The Volunteer Coordinator (VC) (Personnel Record 9) provided documentation of the agency's Volunteer program. The agency-maintained documentation of volunteer hours and overall cost savings; however, the utilization did not equal, at minimum, five percent (5%) of the total patient care hours of all paid hospice employees and contract staff. In 2024, the agency documented a percentage of volunteer use of 0.31%. The Volunteer Coordinator (VC) (Personnel Record 9) was interviewed on 09/19/2025. The current VC is new to the role (started 07/2025) and stated, "We know we have work to do with the volunteer program to get up to five percent." A review of the agency's Volunteer Program documents revealed that the agency did not ensure that hospice volunteers provided day-to-day administrative or direct patient care services in an amount that, at a minimum, equals five percent (5%) of the total patient care hours of all paid hospice employees and contract staff.