Applicability of the Independent Informal Dispute Resolution

7213.4 - Applicability of the Independent Informal Dispute Resolution Process (Rev. 118, Issued: 06-12-14, Effective: 01-01-12, Implementation: 01-01-12) The Independent IDR process must be offered to a facility when a civil money penalty is imposed and that penalty is subject to being collected and placed in escrow under 42 CFR 488.431(b). Beginning on January 1, 2012, CMS may collect and place imposed civil money penalties in an escrow account on whichever of the following occurs first: • The date on which the Independent IDR process is completed, or • The date which is 90 calendar days after the date of the notice of imposition of the civil money penalty. The Independent IDR is conducted only upon the facility’s timely request. The facility must request an Independent IDR within 10 calendar days of receipt of the offer. The facility’s request will be considered timely if the request is dated within 10 calendar days of the receipt of the offer, and, in the case of the request being mailed, the postmark verifies that it was mailed within that same 10 day time period. 1. A facility may request an Independent IDR for each survey that cites deficiencies for which a civil money penalty has been imposed that is subject to collection and placement in an escrow account. However, when a facility requests an Independent IDR for a survey, the facility cannot raise questions or issues regarding a previous survey, and consideration of such previous survey results is beyond the scope of the independent IDR. The following table indicates when independent informal dispute resolution may be requested based on the results of a revisit or as a result of the previous independent informal dispute resolution outcome. Situation Eligibility for Independent Informal Dispute Resolution Continuation of same deficiency at revisit which results in the continuation of the imposed civil money penalty Yes New deficiency resulting in the imposition of a civil money penalty(i.e., new or changed facts, new tag) at revisit or as a result of an independent informal dispute resolution Yes New instance of deficiency resulting in the imposition of a civil money penalty (i.e., new facts, same tag) at revisit or as a result of an informal dispute resolution. Yes Different tag but same facts at revisit or as a result of an informal dispute resolution No, unless the new tag constitutes substandard quality of care and results in the imposition of a civil money penalty The Independent IDR process does not delay the imposition of any remedies, including a civil money penalty. During the Independent IDR process a facility may dispute the factual basis of the cited deficiencies for which it requested Independent IDR. During the Independent IDR process, a facility may not challenge other aspects of the survey process, such as: • Scope or severity classifications, with the exception of assessments that constitute substandard quality of care or immediate jeopardy; • Remedy(ies) imposed; • Alleged failure of the survey team to comply with a requirement of the survey process; • Alleged inconsistency of the survey team in citing deficiencies among other facilities; • Alleged inadequacy or inaccuracy of the IDR or Independent IDR process. The focus of the Independent IDR process is the deficiency or deficiencies from a survey that led to the imposition of a civil money penalty that is subject to being collected and placed in escrow under §488.431(b). However, while such factors as the scope and severity classification, and the amount of the penalty, are not the subjects of the Independent IDR, State survey agencies and CMS, will take into consideration any changes in deficiency findings that result pursuant to State or CMS review of the completed Independent IDR process. Based on such review, States and CMS will assess whether any changes to scope and severity or civil money penalty amount are warranted. While States have discretion to limit participation in the Independent IDR process by attorneys or other parties, notice to the facility should indicate that the Independent IDR, including face-to-face meetings, constitutes an informal administrative process that is not to be construed as a formal evidentiary hearing. Independent IDR is not intended to be a formal or evidentiary hearing nor are the results of the Independent IDR process an initial determination that gives rise to appeal rights pursuant to 42 CFR 498.3(b). The Independent IDR results are recommendations to the State and CMS and are not subject to a formal appeal.