Key Elements of Independent Informal Dispute Resolution

7213.5- Key Elements of Independent Informal Dispute Resolution (Rev. 244; Issued: 06-26-26; Effective: 06-26-26; Implementation: 06-26-26) At a minimum, the Independent IDR process must provide for the following: 1. Offer of Independent IDR: The opportunity for Independent IDR must be provided within 30 calendar days of CMS’s notice of imposition of a civil money penalty that is subject to being collected and placed in an escrow account. The CMS Location will communicate the offer for an Independent IDR in its initial Notice of Imposition of a Penalty letter to a facility. In addition, the CMS notice will provide the State agency contact information, including the name, address, and telephone number of the person and/or agency or office that the facility must contact to request an Independent IDR. The Notice of Imposition of a Penalty may be sent by e-mail and/or fax. The Statement of Deficiencies (Form CMS- 2567) may be included with the Notice of Imposition of a Penalty letter. The CMS Location must confirm receipt by the facility of such notice letter. A copy of this letter will also be sent to the State agency. Upon a facility’s timely request for an Independent IDR, the State agency, or the Independent IDR entity or person (as appropriate) will provide the following information to the facility: • Information on the Independent IDR process including where, when and how the process may be accomplished, e.g., virtually, in writing, or in a face-to-face meeting, and • Contact information, i.e. the name, address, phone number and e-mail of the person(s) who will be conducting the Independent IDR, if appropriate. As with the current IDR process, the Independent IDR process will be available to a facility at no charge. Collected civil money penalty funds may not be used to cover State expenses for IDR or Independent IDR. IDR and Independent IDR are part of the survey and certification process. 2. Timing: 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 CMS offer, and, in the case of the request being mailed, the postmark verifies that it was mailed within that same 10-day time period. The facility must submit its request in writing to the State agency, or the approved Independent IDR entity or person, as appropriate. The facility’s request should also include copies of any documents, such as facility policies and procedures, resident medical record information that are redacted to protect confidentiality and all patient identifiable information, or other information on which it relies in refuting the survey findings. §488.431(a)(1) require that the Independent IDR be completed within 60 days of the facility’s request. Every effort must be made to comply with this time frame, however, failure to comply with the Independent IDR process does not invalidate any cited deficiencies or any remedies imposed. The Independent IDR process should be completed as soon as practicable but no later than 60 calendar days of receipt of the facility’s request. The Independent IDR process is considered completed if a facility does not timely request or chooses not to participate in the Independent IDR process or when a final decision has been made, a written record has been generated, AND the State agency has sent written notice of this final decision to the facility. 3. Opportunity to Comment: Once a facility requests an Independent IDR, the State must notify the involved resident or resident representative, as well as the State’s long term care ombudsman, that they have an opportunity to submit written comment. The State should request information from the long-term care ombudsman program, asking for specific information based on the ombudsman program’s direct involvement or knowledge and directly related to the deficiency (ies) being disputed by the facility. Information about the facility or provider in general but not related to the deficiency(ies) at issue, is not relevant to the Independent IDR process. This notification must be done before the Independent IDR review begins and with sufficient time for the resident or their representative to provide comment. At a minimum, this notification must include: • A brief description of the findings of noncompliance for which the facility is requesting Independent ID, a statement about the CMP imposed based on these findings, and reference to the relevant survey date; • Contact information for the State agency, or the approved Independent IDR entity or person as appropriate regarding when, where and how potential commenters must submit their comments; • A designated contact person to answer questions/concerns; • For residents and/or resident representatives, contact information for the State’s long term care ombudsman. 4. Written Record: The Independent IDR entity or person must generate a written record as soon as practicable but no later than within 10 calendar days of completing its review. The Independent IDR entity or person will forward the written record to the State agency, for retention by the surveying entity. The State agency will provide the final decision to the facility as soon as practicable but no later than 10 calendar days of its receipt of the written record. The final Independent IDR decision to the facility shall contain the result for each deficiency challenged and a brief summary of the rationale for that result. The written record from the Independent IDR entity or person shall include: • List of each deficiency or survey finding that was disputed; • A summary of the Independent IDR recommendation for each deficiency or finding at issue and the justification for that result; • Documents submitted by the facility to dispute a deficiency, to demonstrate that a deficiency should not have been cited, or to demonstrate a deficient practice should not have been cited as immediate jeopardy or substandard quality of care; and, • Any comments submitted by the State’s long-term care ombudsman and/or residents or resident representatives, as appropriate, taking care to protect confidentiality and protected health information.