Failure to Obtain Level II PASARR After New Schizoaffective Disorder Diagnosis
Penalty
Summary
The deficiency involves the facility’s failure to obtain a Level II PASARR evaluation for a resident who was later identified as having a serious mental disorder. The resident’s Level I PASARR, completed at the hospital prior to admission on 7/17/2024, documented that no Level II was required because there was no known or suspected severe mental illness, intellectual disability, or related condition, and no mental health medications at that time. The resident was admitted on 7/25/2024. Subsequently, the admission record reflected a diagnosis of schizoaffective disorder with an onset date of 1/17/2025. A psychiatrist’s progress note dated 8/08/2024 documented a diagnosis of schizoaffective disorder, depressed type, with a past psychiatric history of schizoaffective disorder and historical use of lithium, and included an order to add Seroquel 50 mg at night. Interviews and record review showed that, despite the new or previously unreported diagnosis of schizoaffective disorder and the initiation of antipsychotic medication, the facility did not request or obtain a Level II PASARR for this resident. The nurse consultant confirmed that the resident did not have the schizoaffective diagnosis at the time of admission based on hospital and referral paperwork and acknowledged that the facility did not resubmit for a Level II PASARR. The admissions director stated that the initial Level I PASARR was done at the hospital and acknowledged that if a new schizoaffective diagnosis was made or missed during the first assessment, a new PASARR should have been obtained. The facility’s own PASARR policy, adopted 7/16/2025, states that when a new psychiatric diagnosis under mental disability or intellectual disability is added by a physician, or when the facility suspects such a condition, the facility will notify the appropriate state-designated authority by requesting a PASARR screening via AssessmentPro, which was not done in this case.
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