Failure to Submit Timely PASRR NFSS Request for Specialized Services
Penalty
Summary
The facility failed to submit a complete and accurate request for Nursing Facility Specialized Services (NFSS) in the LTC Online Portal for one resident who required a PASRR assessment. Specifically, the required NFSS form for occupational therapy (OT) assessment and services was not submitted within 20 business days following the interdisciplinary team (IDT) meeting, as mandated. This omission resulted in the resident not receiving the Medicaid service for OT as identified in the PASRR Comprehensive Service Plan. Record reviews indicated that the resident had multiple diagnoses, including unspecified intellectual disabilities, anxiety disorder, and major depressive disorder. The resident's care plan did not include OT services, despite the PASRR Comprehensive Service Plan identifying a need for specialized OT assessment and services. Documentation also showed that the resident was receiving other IDD habilitative specialized services, such as habilitation coordination and independent living skills, but the required NFSS request for OT was not completed or submitted in a timely manner. Interviews with facility staff revealed confusion and lack of clarity regarding roles and responsibilities for PASRR processes. The MDS Coordinator, who was new to the position, was unaware of the timelines for submitting the NFSS form and did not have the necessary documentation for the resident's OT services. The Social Worker, who started after the relevant events, had not previously completed or submitted an NFSS form and believed it was the MDS Coordinator's responsibility. The DON confirmed that PASRR responsibilities were split between the Social Worker and MDS Coordinator, which contributed to the failure to submit the required documentation.