Failure to Request PASRR Level II Evaluation and Integrate Level II Recommendations Into Care Planning
Penalty
Summary
The facility failed to comply with PASRR requirements for residents with serious mental illness. For one resident with an existing Level I PASRR determination, subsequent psychiatric progress notes documented new diagnoses of chronic, stable major depressive disorder and PTSD, along with treatment with sertraline and ongoing monitoring. The resident’s MDS assessments reflected active diagnoses of anxiety disorder, depression, and PTSD, as well as use of antianxiety and antidepressant medications and moderate cognitive impairment. Despite the PASRR Determination Notification specifying that no further screening was required unless a significant change occurred suggesting a mental illness diagnosis or change in treatment needs, the facility did not submit a request for a Level II PASRR evaluation after these new mental illness diagnoses were identified. The social worker, who was responsible for submitting Level II requests, stated she was not always notified of new mental illness diagnoses and acknowledged that no Level II request was submitted for this resident following the new diagnoses. For another resident with a documented Level II PASRR determination, the facility failed to incorporate the PASRR recommendations into the resident’s care plan. This resident had cumulative diagnoses including major depressive disorder, anxiety disorder, borderline personality disorder, hallucinations, and unspecified psychosis, with MDS findings of severe cognitive impairment, delusions, and frequent behavioral symptoms. A Level II PASRR Determination Notification indicated that nursing placement was appropriate and specified specialized services of psychological testing and psychiatric evaluation. However, review of the comprehensive care plan showed no care plan addressing the Level II PASRR specialized services determination. The MDS Coordinator, who was responsible for developing care plans, confirmed the resident had a Level II PASRR and that a care plan should have been developed, but it was not, which was described as an oversight.
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