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LTC IDR

LTC Informal Dispute Resolution (SOM 7212)

TermDefinition
Informal Dispute Resolution (IDR)- SOM 7212 Is the single opportunity to refute deficiencies or correction orders. An IDR is for deficiencies or correction orders that result from the following : a Federal or State survey. or a complaint investigation.
42 CFR 488.331 Require CMS & the State to offer SNF, NF & dually SNF/NF an informal opportunity to dispute cited deficiencies upon the facility's receipt of the official Form CMS-2567.
Mandatory Element of Informal Dispute Resolution #1 Facilities must be offered an informal opportunity to dispute deficiencies with the entity that conducted the survey.
Mandatory Element of Informal Dispute Resolution #2 Facilities may not use the IDR process to delay the formal imposition or remedies or to challenge any other aspect of the survey process.
Mandatory Element of Informal Dispute Resolution #3 Facilities must be notified of the availability of IDR, in a letter transmitting the official Form CMS-2567.
Mandatory Element of Informal Dispute Resolution #4 Failure to complete IDR will not delay the effective date of any enforcement action against the facility.
Mandatory Element of Informal Dispute Resolution #5 When a facility is unsuccessful during the process at demonstrating that a deficiency should not have been cited, the surveying entity must notify the facility in writing that it was unsuccessful.
Mandatory Element of Informal Dispute Resolution #6 When a facility is successful during the IDR at demonstrating that a deficiency should not have been cited: 1) Citation "deleted", 2) Adjust S/S per CMS policy, 3) Facility has option to request a clean copy of Form CMS-2567.
Mandatory Element of Informal Dispute Resolution #7 Facility may request IDR for each survey that cites deficiencies. A facility may not challenge finding from previous surveys for which they an IDR or the opportunity for one.
Eligibility for IDR 1) Same deficiency at revisit? YES 2) New deficiency at revisit or as result of IDR? YES 3) New instance (i.e., new facts, same tag) at revisit or IDR? YES 4) New tag but same facts at revisit or IDR? NO unless new tag constitutes substandard QoC.
Mandatory Element of Informal Dispute Resolution #8 Written description of the surveying entity's IDR process must be made available to a facility upon facility's request.
Mandatory Element of Informal Dispute Resolution #9 Sates are encouraged to include in the IDR process at least one person as part of the decision making process who was not directly involved in the survey. May include another surveyor, ombudsman, or a member of another survey team.
7212.4- There are three additional elements for Federal IDR CMS has adopted the following elements to be incorporated in all cases involving deficiencies cited as a result of Federal surveys.
Additional element #1 Notice to the facility will indicate that he informal dispute resolution, including any fact-to-face meeting, constitutes an informal administrative process.
Additional element #2 Notice to the facility will indicate that counsel may accompany facility. If the facility chooses to have counsel, then it must indicate that in request for IDR, so CMS may also have counsel present.
Additional element #3 CMS will verbally advise the facility of CMS's decision to the informal dispute, with written confirmation to follow.
7213.3- Independent Informal Dispute Resolution Requirements The requirements & specific core elements that must be included in an acceptable independent IDR process are specified in the regulations at 42 CFR 488.331 & 488.431
A "Involved Resident" is... One who was the subject of a complaint or who filed a complaint that led to a deficiency finding that is the subject of Independent IDR.
A "Representitive" is... Either the resident's legal representative or an individual filing a complain involving or on behalf of a resident.
Independent IDR process... Does not delay the imposition of any remedies, including a civil money penalty.
During the Independent IDR process the facility may not challenge other aspects of the survey process, such as: -Scope or severity classifications, with the exception of assessments that constitute substandard quality of care or IJ. -Remedy(ies) imposed; Alleged failure of survey team to comply with requirement of survey process;
During the Independent IDR process the facility may not challenge other aspects of the survey process, such as (continued)... Alleged inconsistency of survey team in citing deficiencies among other facilities. Alleged inadequacy or inaccuracy of the IDR or Independent IDR process.
While State have discretion to limit participation in the Independent IDR process by attorneys or other parties,... notice to the facility should indicate that the Independent IDR, including face-to-face meetings, constitutes an informal administrative process that is not to be construed as a formal evidentiary hearing.
Independent IDR is not intended to be a formal or evidentiary hearing not are the results of the Independent IDR process and initial determination... that gives rise to appeal rights. The Independent IDR results are recommendations to the State & CMS & are not subject to a formal appeal.
Created by: Debra Bernier 1
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