Failure to Submit and Follow Up on PASARR NFSS Request
Penalty
Summary
The facility failed to refer a resident with newly evident or possible serious mental disorder, intellectual disability, or a related condition for a Level II PASARR review upon a significant change in status assessment. Specifically, the facility did not submit a complete and accurate request for nursing facility specialized services (NFSS) in the required LTC Online Portal within the mandated 20 business days after the Interdisciplinary Team (IDT) meeting. The NFSS request was submitted electronically but not through the required SIMPLELTC web portal, resulting in a denial, and there was no evidence of follow-up by the facility to ensure the request was approved. The resident involved was an older adult female admitted with multiple diagnoses, including acute kidney failure, major depressive disorder, anxiety disorder, brief psychotic disorder, and generalized anxiety disorder. Her comprehensive MDS assessment indicated she was considered by the state Level II PASARR process to have a serious mental illness, with an intact cognitive status. Her care plan reflected the need for specialized services as recommended by the local authority, and her most recent PASARR Level 1 screening was positive for both a primary diagnosis of mental illness and intellectual disability. Interviews with facility staff revealed that the MDS Coordinator was responsible for completing PASARRs and submitting NFSS requests through the SIMPLELTC portal. However, the submission was not completed as required, and there was a lack of monitoring and follow-up to ensure acceptance of the NFSS request. The facility's policy required timely and accurate submission of NFSS forms, but this process was not followed, resulting in the resident not receiving the necessary specialized services.