Failure to Submit Level II PASRR Evaluations for Residents with Serious Mental Health Disorders
Penalty
Summary
The facility failed to submit requests for Level II Preadmission Screening and Resident Review (PASRR) evaluations for four residents who had serious mental health disorders. Each of these residents had a Level I PASRR determination with no expiration date and were admitted with diagnoses such as PTSD, major depressive disorder, bipolar disorder, delusional disorder, and anxiety. Despite having active psychiatric diagnoses and receiving psychotropic medications, there was no documentation in their medical records that a Level II PASRR evaluation had been requested or completed for any of these residents. For each resident, medical records and care plans indicated ongoing mental health concerns and the use of medications such as antidepressants, anticonvulsants, and antianxiety agents. Psychiatric and physician progress notes documented the presence and management of these mental health conditions, including follow-up visits and medication adjustments. However, the facility was unable to provide evidence that the required Level II PASRR evaluations had been initiated, even when new or ongoing mental health diagnoses were identified after admission. Interviews with the Social Worker (SW) and Administrator revealed a lack of knowledge and training regarding the PASRR process. The SW, who took over the PASRR responsibilities in April, stated she had not been shown what to do or what to look for regarding Level II PASRR referrals and had not submitted any requests for evaluations. The Administrator, who also started in April, confirmed uncertainty about whether any Level II PASRR requests had been made and was unable to locate any documentation to that effect. Both indicated an expectation that referrals should be made when residents are admitted with mental health diagnoses or when new diagnoses are identified, but this was not occurring in practice.