Additional Elements for Federal Independent Informal

7213.10 - Additional Elements for Federal Independent Informal Dispute Resolution (Independent IDR) Process (Rev. 244; Issued: 06-26-26; Effective: 06-26-26; Implementation: 06-26-26) In the case where a Federal survey, conducted solely by Federal surveyors, or its contractors, results in the imposition of a civil money penalty (CMP) that is subject to being collected and placed in escrow, the CMS Location will offer the facility the opportunity for an Independent IDR. The CMS Location will follow the applicable elements cited in §7213. The CMS Location should advise the facility that all requests for an Independent IDR should be directed in writing to the CMS Location and an electronic copy of the request should also be sent to the CMS mailbox at QualityAssurance@cms.hhs.gov. The facility should send any and all documentation, such as facility policies and procedures, resident medical record information or other information on which it relies in disputing the survey findings directly to the entity contracted by CMS to provide the Federal Independent IDR process. The facility must also send a copy of the supporting documentation to the CMS Location with its request. The CMS Location must also inform the involved resident or resident representative as well as the State’s long term care ombudsman to submit any written comments directly to the Federal Independent IDR entity. This Independent IDR will be a paper review performed by the Federal Independent IDR entity under contract with CMS, Survey & Certification Group, Division of Nursing Homes. The Independent IDR will be completed within 60 calendar days of the facility’s timely request. Upon completion of the review the Federal Independent IDR entity will send all documents submitted by the facility and any comments submitted by the State’s long term care ombudsman and/or residents or resident representatives to the respective CMS Location along with its final written record/report. In the event that any conflict of interest exists between the facility and the contracted Federal Independent IDR entity, or in the event that the Federal Independent IDR entity is unavailable, the Independent IDR will be conducted by CMS Baltimore. In this case, the facility should be instructed to send all documentation with all PII redacted to: QualityAssurance@cms.hhs.gov . This Independent IDR will be a paper review performed by a panel of CMS Baltimore employees who meet the criteria for an Independent IDR entity. The Independent IDR will be completed within 60 calendar days of the facility’s timely request. Upon completion of the review, CMS Baltimore will send all documents submitted by the facility and any comments submitted by the State’s long term care ombudsman and/or residents or resident representatives to the respective CMS Location along with their final written record/report. Upon receipt of a facility’s request for an Independent IDR the CMS Location should enter the appropriate information into the Internet Quality Improvement and Evaluation System (IQIES). Upon receipt of the Independent IDR written record, the CMS Location, will review the Independent IDR recommendation(s) and: 1. If the CMS Location agrees with the Independent IDR recommendation(s) and no changes will be made to the disputed survey findings, the CMS Location will send written notification of the final decision to the facility within 10 calendar days of receiving the written record from the Independent IDR entity or person. 2. If the CMS Location disagrees with one or more of the recommendations of the Independent IDR entity or person, the complete written record will be sent to CMS Baltimore for review and final decision. The CMS Location should identify the Independent IDR recommendation with which it disagrees, the basis for its disagreement and any relevant survey documents to CMS Baltimore. . All documentation should be sent to QualityAssurance@cms.hhs.gov . As soon as practicable, but no later than 10 calendar days, CMS Baltimore will review the Independent IDR recommendation and corresponding records along with the CMS Location’s written disagreement of the Independent IDR’s recommendation and will provide written notification to the CMS Location of the final decision. The CMS Location will then send written notification of the final decision to the facility within 10 calendar days of receiving the final decision from CMS Baltimore. NOTE: The regulations at §488.431(a) (1) require that an Independent IDR will be completed within 60 days of a facility’s timely request. Completed means that a final decision from the Independent IDR process has been made, a written record generated AND the CMS Location has sent written notice of the Independent IDR recommendation to the facility. 3. If the CMS Location agrees with the Independent IDR recommendation(s) or has received a final decision from CMS Baltimore and changes are to be made to the disputed survey findings, the CMS Location will, within 10 calendar days of receiving the written record: a) Change deficiency (ies) citation content findings, as recommended; b) Adjust the scope and severity assessment for deficiencies, if warranted by CMS policy after taking into consideration approvable recommendations from the Independent IDR regarding the deficiency (ies); c) Annotate deficiency (ies) citations as “deleted or amended as recommended “where appropriate; d) Have a CMS Location manager or supervisor sign and date the revised CMS Form-2567; e) Ensure that any enforcement action(s) imposed solely because of deleted or altered deficiency citations will be reviewed, changed or rescinded, as appropriate; and f) Provide written notification of the final decision to the facility. NOTE: Based on a final Independent IDR recommendation and final State and CMS action, if one or more deficiencies on the Form CMS-2567 have been revised or removed, the facility has the option to request a clean (new) copy of the Form CMS-2567. However, the clean copy will be the releasable copy only when a clean (new) plan of correction is both provided and signed by the facility. The original Form CMS-2567 is disclosable when a clean plan of correction is not submitted and signed by the facility. Any Form CMS-2567 and/or plan of correction that is revised or changed as a result of IDR must be disclosed to the ombudsman in accordance with §7904. Deficiencies pending Independent IDR should be entered into the Internet Quality Improvement and Evaluation System (iQIES) and the iQIES Informal Dispute Resolution (IDR) Manager. IDR or Independent IDR requests from the facility and necessary changes should be entered in the iQIES system within 10 working days of the IDR or Independent IDR request and necessary changes should be entered in the iQIES system within 10 working days of completion of the IDR or Independent IDR process. Specific instructions are provided in the current iQIES Users Guide. The iQIES will be enabled to include the Independent IDR process for enforcement actions with survey cycles that begin on or after January 1, 2012.