Failure to Timely Initiate PASRR-Recommended Services
Penalty
Summary
The facility failed to incorporate the recommendations from the PASRR Level II determination and evaluation report for a resident with severe intellectual disabilities and dementia. The resident, who had significant cognitive and physical impairments, was identified as PASRR positive and required specialized services, including occupational and physical therapy. The care plan indicated the need for service coordination with behavioral health and the involvement of relevant parties in care planning meetings, as well as the submission of necessary forms to request habilitative services. Despite these documented needs and agreements made during the annual interdisciplinary team (IDT) meeting, the facility did not initiate the Nursing Facility Specialized Services (NFSS) request within the required 20 business days following the IDT meeting. Interviews with facility staff revealed confusion and lack of clarity regarding responsibilities for submitting the NFSS in the LTC Online Portal. The DON, who had recently assumed responsibility for this task, acknowledged that the NFSS for the resident was submitted incorrectly and subsequently denied, resulting in the resident not receiving PASRR-authorized services through the appropriate process, although therapy services were provided outside of PASRR. Record reviews and staff interviews further indicated that the facility's process for coordinating PASRR-related services was inconsistent, with unclear delegation of duties between the MDS nurse, DON, and other staff. The facility's admission policy required coordination with the PASRR program for residents with mental disorders or intellectual disabilities, but the failure to timely and correctly submit the NFSS resulted in noncompliance with these requirements for the resident in question.