Failure to Complete Required PASARR Level II Referrals for Residents With Serious Mental Illness
Penalty
Summary
The facility failed to ensure that required PASARR Level II evaluations were completed and submitted to the state for three residents with serious mental illness diagnoses. One resident was admitted with schizophrenia, encephalopathy, unspecified psychosis, hallucinations, recurrent bipolar disorder, anxiety disorder, and other depressive episodes, had a BIMS score of 12 indicating moderate cognitive impairment, and was actively prescribed Risperidone and Duloxetine. The PASARR form for this resident, completed by the admissions coordinator, documented schizophrenia, major depression, bipolar disorder, and anxiety disorder, along with Duloxetine, but no Level II referral was made. A second resident was admitted with schizophrenia, anxiety disorder, and recurrent major depressive disorder, had a BIMS score of 15 indicating intact cognition, and was receiving Fluoxetine and Olanzapine; the PASARR, also signed by the admissions coordinator, documented schizophrenia, major depression, anxiety disorder, and the psychotropic medications, but again no Level II referral was submitted. A third resident was admitted with unspecified mood disorder and bipolar disorder, had an admission BIMS score of 12 indicating moderate cognitive impairment, and was prescribed Depakote with a psychiatry referral ordered. The PASARR for this resident, completed by the admissions coordinator, documented major depression, anxiety disorder, and Depakote, but no Level II PASARR referral was made. In interviews, the admissions coordinator stated she is responsible for admission, 30‑day, and change-in-condition PASARRs, acknowledged that residents with diagnoses such as bipolar disorder require a Level II PASARR referral, and confirmed that all three residents should have been referred under the facility’s policy requiring all individuals with mental disorders and intellectual disability to be referred to the state for Level II determinations. The DON and the administrator both acknowledged that PASARRs are expected to be conducted per policy when residents have qualifying mental health diagnoses.
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