Independent Informal Dispute Resolution (Independent IDR)
of DQA 12-003 (PDF, 68 KB)
|| April 3, 2012 -- DQA Memo 12-003
|| Federally Certified Nursing
Homes NH 03
|| Juan Flores, Director
Bureau of Nursing Home Resident Care
Otis Woods, Administrator
Division of Quality Assurance
Independent Informal Dispute Resolution (Independent IDR)
On March 23, 2010 new regulations were added at 42 CFR, Sections 488.331
and 488.431, effective January 1, 2012, resulting in the development of an
Independent Informal Dispute Resolution (Independent IDR) process for
certified nursing homes. The Independent IDR process is in addition to the
current Informal Dispute Resolution (IDR) process. The traditional and
current IDR process is virtually unaffected by the implementation of the
additional Independent IDR.
This memorandum describes the procedure under which federally certified
nursing homes may dispute certain deficiencies using the Independent IDR
process. Independent IDR will only apply to standard and/or complaint
surveys that initiate an enforcement action for which a civil money penalty
(CMP) is imposed and subject to being placed in escrow. In order to phase in
the new CMP collection and escrow provisions, CMS initially intends to
collect and escrow only those CMP which are imposed as a result of the most
serious deficiencies. CMP which are imposed for surveys in which a
deficiency or deficiencies were cited at a scope and severity level of G or
above will be subject to the combined CMP collection and escrow provisions
and be eligible for Independent IDR. For surveys in which all of the
deficiencies were cited at a scope and severity level that are less than G,
any CMP imposed for those deficiencies will continue to be collected under
the current IDR process without a requirement for Independent IDR.
The Centers for Medicare & Medicaid Services (CMS) will notify
nursing homes in the Notice of Imposition of CMP letter of their opportunity
for Independent IDR. In Wisconsin, Independent IDR is conducted by MPRO at
no cost to the nursing home.
The Independent IDR process is separate from the Informal Dispute
Resolution (IDR) process that occurs immediately after the Statement of
Deficiency (SOD) is issued. If the IDR process is completed before the
facility receives the Notice of Imposition of CMP letter from CMS, the
facility will have an opportunity to request Independent IDR for the same
deficiency citations. If the facility receives the Notice of Imposition of
CMP letter prior to the completion of the IDR, the facility will be asked to
choose either the IDR process or the Independent IDR process. The IDR
process is complete when the facility is notified in writing of the results
of the IDR by the Division of Quality Assurance (DQA).
The Independent IDR process is very similar to the IDR process. A
comparison of some of the differences between IDR and Independent IDR is
attached to the memorandum.
Timeframes and Procedures for Requesting Independent IDR
The CMS Notice of Imposition of CMP letter will inform the facility that
they may send a written request for Independent IDR to MPRO. The letter will
include information on when the request must be received by MPRO.
The written request will be expected to include:
- The type of Independent IDR requested, either telephone review or desk
- Each federal tag being disputed,
- The name of the facility contact person and the person's telephone
number including area code,
- A copy of the SOD without the Plan of Correction, and
- Supporting documentation for Independent IDR review. The supporting
documentation should include:
- The reason each federal tag is being disputed.
- The desired outcomes for each disputed federal tag, for example,
withdraw the citation, withdraw specific examples, or change the
scope/severity of the tag.
- The relevance of the documentation to the dispute. Material that
does not identify specific entries to be reviewed for each disputed
citation, or that does not explain the relevance of the documentation
to the dispute will not be considered.
This information must be sent to MPRO at:
Attention: WI Independent IDR Review Specialist
22670 Haggerty Road, Suite 100
Farmington Hills MI 48335-2611
In addition, a copy of the written request must be faxed to Gail Hansen,
Wisconsin Division of Quality Assurance, Independent IDR Intake, at FAX #
(608) 267-7119 within 10 calendar days of receipt of the CMS Notice of
Imposition of CMP letter. Do not fax a copy of the SOD or the supporting
documentation to DQA.
Questions regarding the Independent IDR process conducted by MPRO should
be directed to:
Charlene Kawchak-Belitsky, RN, BSN, NHA
MPRO, Independent IDR Project Manager
Phone: (248) 465-1038
Fax: (248) 305-7093
Independent IDR Session
Upon timely receipt by MPRO of a request for Independent IDR, MPRO will
schedule the telephone review or complete the desk review. The purpose of
the call is to allow the facility to provide a brief overview of the
material it has submitted and to answer any questions MPRO may have about
the material. The provider may explain how and why it disagrees with the
Statement of Deficiency. The call is generally limited to one hour.
DQA Regional Field Operation Directors (or their designees) and/or
attorneys representing the facility may participate in the Independent IDR.
In some cases, the Ombudsman, a representative from CMS or DQA, or an MPRO
project manager may attend an Independent IDR review. The MPRO reviewer will
inform the facility upon convening the call if additional persons are
The Independent IDR session may be taped by any party. All participants
will be notified at the start of the Independent IDR that a tape is being
made, and that a copy of the tape will be made available to those wishing a
copy. A copy of the tape and its transcription, if transcribed, will be made
a part of the permanent record.
Involved Resident/Resident Representative/Ombudsman Comments
In accordance with 42 CFR 448.431 (a) (3), DQA will notify any involved
resident or the resident's representative and the Ombudsman of the
facility's request for Independent IDR and their opportunity to submit
written comments to MPRO for review. CMS defines an involved resident as a
resident who was the subject of a complaint or who filed a complaint that
led to a deficiency that is the subject of Independent IDR. The resident
representative is defined as either the resident's legal representative or
the individual filing a complaint involving or on behalf of a resident. The
involved resident or the resident's representative will receive that portion
of the Statement of Deficiency that addresses the care the resident received
at the facility.
Post-Independent IDR Session
MPRO will submit their Independent IDR recommendations to DQA no later
than 40 calendar days following receipt of the request for Independent IDR
from the facility. As directed by CMS, DQA will review the recommendations
from MPRO. If DQA agrees with the recommendations, DQA will send written
notification of the final decision to the facility within 5 calendar days of
receipt of the Independent IDR recommendation from MPRO. If DQA disagrees
with one or more of the recommendations, final determination will be made by
the CMS Regional Office. DQA will send written notification of the final
decision to the facility within 5 calendar days of receiving the final
decision from CMS but no later than 60 calendar days following receipt of
the facility's request for Independent IDR.
When changes are made to the SOD, the facility will be sent a "clean
copy" of the original SOD. The facility is responsible for ensuring its
Plan of Correction is transferred to the "clean" SOD and returned
to the Division of Quality Assurance Regional Office.
Questions regarding this information should be directed to the Regional
Field Operations Director for the region in which your facility is located.
Regional contact information is located at: http://www.dhs.wisconsin.gov/rl_DSL/Contacts/reglmap.htm
Comparison of some of the
differences between IDR and Independent IDR
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Last Updated: April 04, 2012