AGING AND DISABILITY SERVICES ADMINISTRATION

2007 NH "Dear Administrator" Letters

September 17, 2007

ADSA: NH #2007-025
TIMEFRAME FOR REQUESTING AN INFORMAL DISPUTE RESOLUTION (IDR)

Dear Nursing Facility/Home Administrator:

The department has seen an increase in the number of informal dispute resolution (IDR) requests that fall outside of the legal timeframe for making this request.

To meet the legal requirements, the following applies:

• As a licensed nursing home (NH), you must remain in substantial compliance with state licensing and federal certification requirements.
• If the department finds that the nursing home is out of compliance, the department will notify you in writing through statement of deficiencies and/or Nursing Home Survey Report.
• If you disagree with the department findings, you may ask for an IDR with the department.
• The regulation requires you to request the IDR within ten calendar days from the receipt of the department’s deficiency citation(s) report.

We encourage you to continue to take part in the IDR process in a timely manner. Thank you for your commitment to the nursing home residents of Washington.

A copy of the law and regulation regarding Nursing Home Informal Dispute Resolution is provided with this letter.

Sincerely,

Joyce Pashley Stockwell, Director
Residential Care Services

Enclosure

Nursing Home Informal Dispute Resolution

The law:

Subpart E--Survey and Certification of Long-Term Care Facilities Sec. 488.331 Informal dispute resolution.

(a) Opportunity to refute survey findings. (1) For non-Federal surveys, the State must offer a facility an informal opportunity, at the facility's request, to dispute survey findings upon the facility's receipt of the official statement of deficiencies.

(2) For Federal surveys, CMS offers a facility an informal opportunity, at the facility's request, to dispute survey findings upon the facility's receipt of the official statement of deficiencies.

(b)(1) Failure of the State or CMS, as appropriate, to complete informal dispute resolution timely cannot delay the effective date of any enforcement action against the facility.

(2) A facility may not seek a delay of any enforcement action against it on the grounds that informal dispute resolution has not been completed before the effective date of the enforcement action.

(c) If a provider is subsequently successful, during the informal dispute resolution process, at demonstrating that deficiencies should not have been cited, the deficiencies are removed from the statement of deficiencies and any enforcement actions imposed solely as a result of those cited deficiencies are rescinded.

(d) Notification. Upon request, CMS does and the State must provide the facility with written notification of the informal dispute resolution process.

The regulation:

388-97-620
Informal department review.(1) For Medicare or Medicaid certified nursing homes, the informal department review process described in this section is the only opportunity for the nursing home to dispute the federal deficiency citation report, unless a federal sanction is imposed.

(2) The nursing home licensee has the right to an informal department review of disputed state or federal citations, or both.

(3) A licensee must make a written request for an informal department review within ten calendar days of receipt of the department's written deficiency citation(s) report. The request must be directed to the department's designated local aging and adult services administration (AASA) office and must identify the deficiencies that are being disputed.

(4) At the informal department review, the licensee or nursing home may provide documentation and verbal explanations related to the disputed federal or state deficiencies, or both.

(5) When modifications or deletions are made to the disputed federal or state deficiency citations, or both, the licensee or nursing home must modify or delete the relevant portions of the plan of correction within five days of receipt of the modified or deleted deficiency(ies). The licensee or nursing home may request from the department a clean copy of the revised deficiency citation report.

(6) If the licensee or nursing home is unwilling to provide the modified plan of correction, the department may impose a per day civil fine for failure to return the modified deficiency citation report to the department in accordance with this subsection.