AGING AND DISABILITY SERVICES ADMINISTRATION

 

RESIDENTIAL CARE SERVICES - NURSING HOMES
INFORMAL DISPUTE RESOLUTION PROCESS

1. Active participation by the provider is encouraged during the course of the survey. Open communication is important throughout the survey process. The provider should be encouraged to provide clarifying information throughout the survey including before and after status meetings and exit conferences, and up to the point the statement of deficiencies and state survey report is completed.
2. Members of the survey team will hold at least one status meeting with the Administrator and Director of Nursing during the survey to discuss team observations including potentially significant issues that are then known. Information not covered in the one status meeting will be communicated to the Administrator and Director of Nursing prior to the formal exit report meeting.
   NOTE: Complaint/abbreviated surveys do not require status meetings.
3. If the provider has questions or concerns about how the survey was conducted, they should be discussed with the team coordinator. If questions or concerns remain after a discussion with the team coordinator, the Administrator should call the Field Manager.
4. An exit conference will be held to inform the facility of the survey team's observations, will identify failed facility practices, and will provide examples. In most cases the provider should be made aware of a deficient practice prior to the exit conference.
   NOTE: In a complaint/abbreviated survey, the actual exit meeting where the provider is notified of failed facility practice may occur by phone. However, the provider should have been made aware of the issues that were of concern before the complaint investigator left the facility.
5. The Field Manager will review the written Statement of Deficiencies (SOD) and state survey report and send the reports to the provider who must provide an acceptable Plan of Correction (POC). A notice letter, accompanying the reports will:
   1. Notify the provider of the availability of an informal dispute resolution process;
   2. Identify the informal dispute resolution options available; and
   3. Instruct the provider on how to request an IDR.
6. An IDR request must be made within 10 calendar days of the provider's receipt of the statement of deficiencies and state survey report. If the provider's IDR request clearly asks for an alternate Field Manager to handle the IDR, the original Field Manager will contact his/her designated Field Manager partner. Together the two Field Managers will decide which Field Manager will contact the provider to schedule the IDR.
7. Within five working days of the Department's receipt of an IDR request the Field Manager (or the alternate Field Manager) will call the provider to:
   1. Verify what type of IDR meeting the provider is requesting.
      1. Face-to-Face;
      2. Telephone;
      3. Record Review; or
      4. Any of the above conducted by an alternate Field Manager.
   2. Set a mutually agreeable date, time, place for the IDR meeting. An attempt should be made to schedule the IDR as soon as possible and within two weeks from the day the Field Manager contacts the provider.
   3. Confirm who will participate in the face-to-face or telephone IDR meeting. If the provider indicates that the provider's attorney will participate, the Field Manager will consult with the Enforcement Officer who will decide if an RCS attorney should also attend.
   4. Request providers who are asking for telephone IDRs or record review IDRs to submit the appropriate documents related to the disputed citations/deficiencies. The providers participating in face-to-face IDRs might present documents prior to the IDR meeting or at the time of the IDR meeting.
8. Every effort will be made to set up timely IDR meetings. However, failure to complete an IDR in a timely manner will not delay the effective date of any enforcement action against the provider. A provider may not seek a delay of any enforcement action on the grounds that the IDR has not been completed.
9. Face-to-face IDRs are encouraged. The manager has discretion to decide whether or not to grant the provider's request for an alternate type of IDR meeting.
10. Face-to-face or telephone IDR meetings should last no more than 2 hours.
11. In addition to provider participants, RCS staff, an RCS attorney, the Enforcement Officer and the Regional Administrator may attend the IDR. Other persons may ask to attend all or portions of the IDR meeting. The Field Manager should consider these requests and should consult with the Enforcement Officer for direction in handling requests from other individuals.
12. At the beginning of the IDR meeting, the Field Manager will explain that:
    1. The IDR decision will be made within 5 working days of the Field Manager receipt of all data requested;
    2. The Field Manager will call the provider to explain the IDR decisions; and
    3. The Field Manager will also send the provider a letter with the results of the IDR.
13. At the end of the IDR meeting the Field Manager will thank all attendees for their participation and remind the provider when and how the decisions will be made.
14. The Field Manager will contact the RCS staff and/or the provider as necessary for further clarification of the provider's evidence and review all documents presented by the provider.
15. The Field Manager has five working days after receipt of all IDR documents to make a decision and notify the provider of the IDR results. (This 5-day timeframe may need to be extended by the Field Manager based on amount of evidence presented and Field Manager availability.)
16. The Field Manager will call the provider with the results of the IDR and explain the rationale for the decisions.
17. If the Field Manager determines that the provider has successfully demonstrated that changes should be made to the Statement of Deficiencies report and the state survey report, the Field Manager will ask whether the provider prefers hand-written deletions, or edits to the survey reports, or an amended Statement of Deficiencies and state survey report.
18. The Field Manager will send a letter to the provider that describes the outcome of the IDR meeting.
19. If any changes made as a result of the IDR meeting affect an enforcement action, the Field Manager must notify the Enforcement Officer. If this was a nursing home survey, a facsimile will be sent to the Centers for Medicare and Medicaid Services (CMS) (formerly known as the Health Care Financing Administration, HCFA) providing notification that hat the IDR resulted in removal a citation on which a federal remedy/enforcement action was based. If an enforcement action was affected by the IDR decision, a copy of the letter notifying the provider of this change will be sent to all the individuals who received copies of the original notice of violation letter.