Failure to Initiate PASRR Specialized Services and Submit Required Documentation
Penalty
Summary
The facility failed to incorporate recommendations from the PASRR Level II determination and evaluation reports for four residents reviewed for PASRR. 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) meetings for these residents. This was confirmed through interviews and record reviews, which showed that the required NFSS forms were either outdated or missing, and no recent submissions had been made as required by regulation. For one male resident with diagnoses including unspecified intellectual disabilities, mental disorder, functional quadriplegia, legal blindness, and mood disorder, records indicated that the most recent NFSS form was submitted several years prior, and no current or recent forms were available. The care plan and progress notes documented ongoing needs for specialized services such as independent living skills training and customized durable medical equipment, but there was no evidence that these services were initiated within the required timeframe. Similar findings were noted for a female resident with cerebral palsy, epilepsy, and intellectual disabilities, whose records also lacked current NFSS documentation despite recommendations for continued habilitation and specialized therapies. Interviews with facility staff, including the PASRR Program Specialist, DON, and MDS nurse, revealed that the facility had not submitted any NFSS forms since a change in facility ownership, which resulted in the loss of their NPI number and inability to upload required forms. Despite ongoing IDT PASRR meetings and continued care planning, the absence of current NFSS submissions meant that residents did not receive timely specialized services as recommended. The facility's policy required specialized rehabilitative services to be provided according to assessment and care plan, but this was not followed for the residents reviewed.