Failure to Update PASRR Screenings After New Mental Illness Diagnoses
Penalty
Summary
The deficiency involves the facility’s failure to submit required PASRR Level II evaluations after new qualifying mental illness diagnoses were added for two residents. The facility’s PASRR policy dated 1/1/2024 states that all individuals seeking admission to Medicaid-certified nursing facilities must be screened for mental illness or intellectual/developmental disability, that residents will be screened prior to admission using the PASRR process, and that if the screening is positive for possible serious mental illness or intellectual/developmental disability/related condition, a Level II evaluation will be performed. Despite this policy, surveyors found that the facility did not complete or submit PASRR Level II evaluations when new mental health diagnoses were added to residents’ records. For one resident, the EHR showed admission with diagnoses including anxiety disorder, depression, and a primary diagnosis of PTSD. The resident’s MDS reflected severe cognitive impairment with a BIMS score of seven and active diagnoses of anxiety disorder, depression (other than bipolar), and PTSD, and the resident was receiving antianxiety and antidepressant medications. The medical diagnosis list showed that Major Depressive Disorder, PTSD, and anxiety disorder were added over time; however, the resident’s PASRR Level I assessment did not list other mental disorder, anxiety, or depressive disorder. Record review revealed no PASRR Level II submission after these mental illness diagnoses were added, and the resident did not appear on the facility’s list of current Level II PASRR residents. For another resident, the EHR showed admission with schizoaffective disorder, bipolar type, depression, and anxiety disorder, with additional diagnoses of schizophreniform disorder and restlessness and agitation added later. The resident’s MDS indicated they were not considered by the state Level II PASRR process to have serious mental illness or intellectual disability/related condition, showed little to no cognitive impairment with a BIMS score of 13, and listed active diagnoses of anxiety disorder, depression (other than bipolar), and schizophrenia. The resident was receiving antipsychotic, antianxiety, and antidepressant medications. The PASRR Level I assessment indicated the resident did not have a mental illness, and record review showed no PASRR Level II submission after the new mental illness diagnoses were added. The resident’s name was not on the facility’s Level II PASRR list. Staff interviews confirmed that qualifying diagnoses existed and that PASRR Level I screenings had not been accurately updated or resubmitted to trigger Level II review.
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