Failure to Timely Initiate PASRR Specialized Services
Penalty
Summary
The facility failed to incorporate the recommendations from the PASRR Level II determination and the PASRR evaluation report for one resident with intellectual and developmental disabilities. Specifically, the facility did not initiate Nursing Facility Specialized Services (NFSS) within 20 business days following the date the services were agreed upon in the Interdisciplinary Team (IDT) meeting, as required by state regulations. The PASRR evaluation had recommended specialized services such as self-monitoring, assistance with ADLs, and independent living skills, but the facility did not ensure timely initiation of these services. Record review showed that the resident had significant medical conditions, including cerebral palsy, muscle weakness, diabetes mellitus, and hypertension, and was dependent on a wheelchair and required substantial assistance with daily activities. The care plan and PASRR documentation indicated ongoing needs for specialized equipment and services, such as a customized manual wheelchair and habilitative therapies. Despite these documented needs and recommendations, the facility did not submit the required NFSS request within the mandated timeframe after the IDT meeting. Interviews with facility staff revealed confusion and lack of clarity regarding responsibility for submitting the NFSS request and monitoring the PASRR process. The Director of Rehabilitation (DOR) and MDS staff each believed the other was responsible for initiating the request, and there was a lack of awareness about the 20-day requirement. The administrator acknowledged that the process was not completed within the required timeframe and that oversight of the PASRR process was ultimately his responsibility.