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Wednesday, 31st January 2007

Two New Inspector General Reports from HHS

Two New Inspector General Reports from HHS
Source: U.S. Department of Health and Human Services, Office of Inspector General
+ Preadmission Screening and Resident Review for Younger Nursing Facility Residents With Serious Mental Illness (PDF; 665 KB):

The Omnibus Reconciliation Act of 1987 mandated preadmission screening for individuals with mental illness to ensure that only individuals needing nursing facility level of care are admitted and that these individuals receive services determined by the Preadmission Screening and Resident Review (PASRR) process. This report (1) examines the extent to which PASRR requirements were addressed for Medicaid nursing facilities residents 22 to 64 with serious mental illness within selected States and selected nursing facilities and (2) assesses Federal and State oversight of the PASRR process.

We found that almost all sampled residents with serious mental illness had a Level I screen and most screens met Federal requirements. Two-thirds of sampled residents had evidence of a Level II PASRR. However, only 5 percent of these met all Federal requirements. For sampled residents who received a Level II PASRR, 85 percent received mental health service recommendations. Thirty-three percent had all the recommended services incorporated into their nursing facility care plans. Only two of five selected States consider community-based placements during the Level II PASRR, despite Federal regulations requiring such consideration.

Lastly, we found that CMS conducted limited oversight, and that all five selected States monitor aspects of the PASRR process. We recommend that CMS hold State Medicaid agencies responsible for ensuring compliance with Federal requirements. We also recommend that CMS hold State Medicaid agencies responsible for considering community placements during the Level II PASRR process. Lastly, we recommend that CMS revise survey and certification requirements to ensure systematic oversight of the PASRR. CMS concurred with all OIG recommendations.

+ Preadmission Screening and Resident Review for Younger Nursing Facility Residents With Mental Retardation (PDF; 505 KB):

The Omnibus Budget Reconciliation Act of 1987 mandated preadmission screening and resident review (PASRR) for mental retardation to ensure that only individuals needing nursing facility level of care are admitted and that these individuals receive services determined by the PASRR process. This report (1) examines the extent to which PASRR requirements were addressed for Medicaid nursing facility residents aged 22 to 64 with mental retardation within selected States and selected nursing facilities, and (2) assesses Federal and State oversight of the PASRR process.

We found that while Level I screens were present in 88 percent of selected resident case files, one-fourth of these were completed late. Fifty-two percent of selected resident case files contained neither a Level II evaluation nor a Level II determination. Additionally, 22 percent of sampled Level II evaluations did not contain evidence that the evaluator assessed whether the individual's total needs could be met in a community setting.

Lastly, we found that the Centers for Medicare & Medicaid Services (CMS) and the survey and certification agencies in the five States we reviewed conducted limited oversight. We recommended that CMS hold State Medicaid agencies accountable for ensuring compliance with Federal requirements. We also recommended that CMS hold States accountable for considering community placements during the Level II PASRR process. Finally, we recommended that CMS revise survey and certification requirements to ensure that State surveyors sample residents with mental retardation and review the PASRR documentation for timely completion. CMS concurred with all OIG recommendations.


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