Summary: The Arkansas State Medicaid Agency has implemented a proactive approach towards identifying nursing facility deficiencies related to PASRR and referring them to the State Survey Agency.
42 CFR requires that State Survey Agencies (SSA) perform initial surveys and periodic resurveys of all providers and certain kinds of suppliers, including Medicaid-certified nursing facilities. These surveys are conducted to ascertain whether a provider/supplier meets applicable requirements for participation in Medicaid programs, and to evaluate performance and effectiveness in rendering a safe and acceptable quality of care.
The current CMS survey process for PASRR activities can be found in the State Operations Manual (attached) Appendix P, Survey Protocol for Long-Term Care Facilities. The specific regulatory requirements and guidance to determine a facility’s compliance with PASRR are found in Appendix PP, Interpretive Guidance for Long-Term Care Facilities. Within Appendix PP, F285 §483.20(e) asserts that surveyors are to review the records of selected sample residents with MI/ID to ensure that the nursing facility complies with PASRR requirements. This includes requirements related to pre-admission screens, resident reviews, determinations for specialized services, and the provision of care and services in accordance with individuals’ plans of care.
Surveyors commonly admit that it is difficult to cite deficiencies in facilities’ adherence to PASRR requirements during a standard facility survey (tag F285). As a result, states typically know little about PASRR-related deficiencies in nursing facilities.
Arkansas has implemented a system in which the State Medicaid Agency notifies the State Survey Agency (SSA) any time state staff involved in PASRR notice a deficiency in a nursing facility. For example, the Arkansas State Medicaid Agency receives a Level I screen from a nursing facility. The Level I indicates that the individual seeking admission into the nursing facility has an intellectual disability, and that a Level II evaluation and determination is required. Contrary to regulations, the nursing facility admitted this resident before the Level II evaluation and determination report had been made. At this point, the State Medicaid Agency notifies the SSA of a potential deficiency and the SSA follows the lead and investigates the situation.
The proactive process for identifying nursing facility deficiencies in Arkansas lessens the dependency on SSA periodic investigations to reveal PASRR-related nursing facility deficiencies. It’s likely that this process reveals deficiencies that would otherwise go unnoticed.
 Centers for Medicare and Medicaid Services (CMS). Certification Process. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/CertandComplianceProcess.pdf