Failure to Timely Initiate PASARR-Recommended Specialized Services
Penalty
Summary
The facility failed to incorporate recommendations from the PASARR Level II determination and evaluation report into a resident's assessment, care planning, and transitions of care. Specifically, after an IDT/PCSP meeting, a customized manual wheelchair was recommended for a resident with major depressive disorder, anxiety, and severe cognitive impairment. The facility did not initiate the request for specialized services (NFSS) within the required 20 business days following the meeting, as outlined in facility policy. Record reviews and staff interviews revealed confusion and miscommunication regarding the process for obtaining the wheelchair. The MDS Coordinator stated that she entered the recommendation into the portal but later claimed it was entered in error, asserting that neither the resident nor the family requested a wheelchair. The DOR and Habilitation Coordinator, however, confirmed that a wheelchair was recommended and that the family initially agreed to pursue it through PASRR, but the facility ultimately sought to obtain it through a DME company and the resident's insurance instead. The Habilitation Coordinator documented multiple follow-ups to remind staff of the need to initiate the request, but the process was not completed within the required timeframe. Interviews with facility leadership, including the DON, Administrator, and Regional Clinical Reimbursement Specialist, indicated a lack of clarity regarding responsibility and timelines for completing the NFSS after the IDT meeting. The facility's own policy required initiation of the request for specialized services within 20 business days, but this was not adhered to, resulting in a delay in the resident receiving the recommended customized wheelchair.