SMQT - Surveyor Minimum Qualifications Resident Assessment and PASRR Questions and Answers — Questions and Answers
Question 1: An individual with a known history of serious mental illness is admitted to a Medicaid-certified nursing facility. The PASRR Level I screen is positive. What is the immediate next step the facility must ensure is completed *before* this individual can be admitted for a long-term stay?
- A comprehensive resident assessment using the MDS within 14 days.
- A full PASRR Level II evaluation and determination. (Correct answer)
- A baseline care plan within 48 hours of admission.
- Notification to the state's long-term care ombudsman.
Correct answer: A full PASRR Level II evaluation and determination.
Federal regulations at 42 CFR 483.100-138 mandate that all individuals seeking admission to a Medicaid-certified nursing facility be screened for mental illness or intellectual disability (Level I). If the Level I screen is positive, a more in-depth Level II evaluation must be completed *prior* to admission to determine if the nursing facility is the appropriate setting and if specialized services are required. The other options are required steps in the admission and care process, but they follow the pre-admission PASRR determination.
Question 2: A resident experiences a major decline in their cognitive and functional abilities after a stroke. The facility determines this is a 'significant change in status.' According to federal regulations, within how many days must the facility complete a comprehensive resident assessment?
- Within 7 days of the stroke.
- At the next scheduled quarterly review.
- Within 14 days of determining the change is significant. (Correct answer)
- Within 48 hours of the physician's order.
Correct answer: Within 14 days of determining the change is significant.
According to 42 CFR §483.20, a comprehensive assessment must be completed within 14 calendar days after the facility determines that a significant change in the resident's physical or mental condition has occurred. This timeline is distinct from quarterly reviews and is triggered by the determination of the change, not necessarily the event itself.
Question 3: What is the primary purpose of the Care Area Assessments (CAAs) within the Resident Assessment Instrument (RAI) process?
- To guide the interdisciplinary team in a deeper review of specific areas triggered by MDS responses. (Correct answer)
- To calculate the daily Medicare reimbursement rate for the resident.
- To replace the need for daily nursing progress notes.
- To serve as the final, comprehensive care plan document.
Correct answer: To guide the interdisciplinary team in a deeper review of specific areas triggered by MDS responses.
The CAA process is designed to assist the interdisciplinary team in systematically interpreting information recorded on the MDS. When specific MDS responses trigger a Care Area, the CAAs guide the team to conduct a more in-depth assessment of that potential problem, which then informs care planning decisions.
Question 4: A surveyor reviews the record of a new resident admitted from an acute care hospital for a 21-day stay for rehabilitation. The resident has a known intellectual disability, and the PASRR Level I was positive, but no Level II evaluation was performed. This is compliant if the admission meets the criteria for a(n):
- Categorical determination for terminal illness.
- Significant change in status.
- Annual resident review.
- Exempted hospital discharge. (Correct answer)
Correct answer: Exempted hospital discharge.
Federal regulations allow for an 'exempted hospital discharge' from the PASRR Level II requirement. This applies when an individual is admitted to a nursing facility directly from a hospital for the same condition they were treated for, and the stay is not expected to exceed 30 days. The other options are not applicable exemptions in this scenario.
Question 5: The Resident Assessment Instrument (RAI) process is mandated by CMS to ensure a comprehensive and standardized assessment. Which of the following lists the three required components of the RAI?
- The Baseline Care Plan, the Comprehensive Care Plan, and the Discharge Summary.
- The Physician's Orders, Nursing Notes, and the Medication Administration Record.
- The Minimum Data Set (MDS), the Care Area Assessments (CAAs), and the RAI Utilization Guidelines. (Correct answer)
- The PASRR Level I, the PASRR Level II, and the Specialized Services Plan.
Correct answer: The Minimum Data Set (MDS), the Care Area Assessments (CAAs), and the RAI Utilization Guidelines.
The RAI process consists of three core components: The Minimum Data Set (MDS) as the assessment tool, the Care Area Assessment (CAA) process to further investigate triggered areas, and the RAI Utilization Guidelines which provide instructions for using the instrument.
Question 6: A surveyor observes that a resident's MDS assessment is inconsistent with direct observations and staff interviews, indicating the resident is more capable than assessed. This discrepancy in the assessment process most directly compromises the facility's ability to:
- Develop an accurate, person-centered care plan. (Correct answer)
- Comply with PASRR Level I screening timelines.
- Notify the resident's physician of a change in condition.
- Ensure proper financial guardianship.
Correct answer: Develop an accurate, person-centered care plan.
The accuracy of the MDS assessment is foundational to the entire care planning process. If the assessment does not accurately reflect the resident's status and abilities, the resulting care plan cannot be truly individualized or effective in meeting the resident's needs and promoting their highest practicable well-being.
SMQT - Surveyor Minimum Qualifications Resident Assessment and PASRR Questions and Answers
An individual with a known history of serious mental illness is admitted to a Medicaid-certified nursing facility.
The PASRR Level I screen is positive.
What is the immediate next step the facility must ensure is completed *before* this individual can be admitted for a long-term stay?