Failure to Submit Level II PASRR Evaluations After New Mental Health Diagnoses
Penalty
Summary
The facility failed to submit requests for Level II Preadmission Screening and Resident Review (PASRR) evaluations for three residents after new serious mental disorder diagnoses were identified, despite previous Level I PASRR determinations. For one resident, the medical record showed a Level I PASRR determination with instructions that further screening was only required if a significant change occurred. The resident was later diagnosed with generalized anxiety disorder, delusional disorder, and hallucinations, but no Level II PASRR request was submitted. The social worker acknowledged awareness of the requirement but could not provide a reason for the omission. Another resident had a Level I PASRR determination and was admitted with unspecified psychosis and anxiety disorder. The resident later exhibited increased agitation and aggression, leading to the addition of a delusional disorder diagnosis and the initiation of antipsychotic medication. Despite these changes, there was no documentation of a Level II PASRR request following the new diagnosis. The social worker confirmed responsibility for submitting such requests and noted the absence of a process to notify her of new mental health diagnoses, resulting in delays. A third resident had a Level I PASRR completed prior to admission, with recommendations to resubmit for Level II if a new mental health diagnosis was suspected. The resident was later diagnosed with bipolar disorder, but no Level II PASRR request was documented. Interviews revealed that while the MDS nurse was supposed to notify the social worker of new diagnoses, there was no consistent system in place to ensure this communication, contributing to the failure to submit timely PASRR requests.