Independent Informal Dispute Resolution Requirements

7213.3 - Independent Informal Dispute Resolution Requirements (Rev. 213; Issued: 02-10-23; Effective: 02-10-23; Implementation: 02-10-23) The requirements and specific core elements that must be included in an acceptable Independent IDR process are specified in the regulations at 42 CFR 488.331 and 488.431. CMS retains ultimate authority for the survey findings and imposition of civil money penalties. However, an opportunity for an Independent IDR is provided within 30 calendar days of the notice of imposition of a civil money penalty that is subject to being collected and placed in escrow. An Independent IDR will – 1. Be completed within 60 calendar days of a facility’s request, if an Independent IDR is requested timely by the facility; NOTE: Independent IDR is completed when a final decision from the Independent IDR process has been made, a written record has been generated and the State survey agency has sent written notice of this decision to the facility. The Independent IDR process is also considered to be completed if a facility does not timely request or chooses not to participate in the Independent IDR process. 2. Generate a written record prior to the collection of the penalty; 3. Include notification to an involved resident or resident representative, as well as the State’s long term care ombudsman, to provide opportunity for written comment; NOTE: “Involved resident” is a resident 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. “Representative” means either the resident’s legal representative or an individual filing a complaint involving or on behalf of a resident. 4. Be approved by CMS and conducted by the State, or by an entity approved by the State and CMS, or by CMS or its agent in the case of surveys conducted only by Federal surveyors where the State Independent IDR process is not used, and which has no conflict of interest, such as: a. A component of an umbrella State agency provided that the component is organizationally separate from the State survey agency, or b. An independent entity with a specific understanding of Medicare and Medicaid program requirements selected by the State and approved by CMS, and, 5. Not include the survey findings that have already been the subject of an informal dispute resolution under §488.331 for the particular deficiency citations at issue in the independent process under §488.431, unless the informal dispute resolution under §488.331 was completed prior to the imposition of the civil money penalty. The Independent IDR process, as established by the State survey agency, must be approved by CMS. If an Independent IDR entity or person provides services in multiple States and/or CMS Location, each State and its CMS Location must approve the Independent IDR entity’s or person’s process and procedures for the State’s or CMS Location’s jurisdiction. In order to ensure compliance of the Independent IDR process with Federal statute and regulations, each State survey agency will submit its written process and procedures, including any subsequent changes, to the applicable CMS Location for review and prior approval. The Independent IDR process must be in writing and available for review upon request.