Independent Informal Dispute Resolution Recommendation

7213.9 - Independent Informal Dispute Resolution Recommendation and Final Decision (Rev. 244; Issued: 06-26-26; Effective: 06-26-26; Implementation: 06-26-26) 1. Upon receipt of the Independent IDR written record, the State agency, will review the Independent IDR recommendation(s) and: (a) If the State agency, agrees with the Independent IDR recommendation(s) and no changes will be made to the disputed survey findings, the State agency 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. (b) If the State agency disagrees with one or more of the recommendations of the Independent IDR entity or person, the complete written record will be sent to the applicable CMS Location for review and final decision. The State agency should identify the portion(s) of the Independent IDR recommendation with which it disagrees, the basis for its disagreement including any relevant survey documents that support its recommendation to the CMS Location. As soon as practicable, but no later than 10 calendar days, the CMS Location will review the Independent IDR recommendation and records along with the State’s written disagreement of the Independent IDR’s recommendation and will provide written notification to the State agency of the final decision. The CMS review will be conducted by persons familiar with LTC requirements but who have not had any input or activity with respect to the survey or deficiencies at issue. The agency will then send written notification of the final decision to the facility within 10 calendar days of receiving the final decision from the CMS Location. NOTE: 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 State agency has sent written notice of the Independent IDR recommendation to the facility. The Independent IDR process is also considered completed if a facility does not timely request or chooses not to participate in the Independent IDR process. 2. If the State agency agrees with the Independent IDR recommendation(s) or has received a final decision from the CMS Location and changes will need to be made to the disputed survey findings, the State agency will complete the following 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 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 State agency manager or supervisor sign and date the revised CMS Form-2567; e) Promptly recommend to CMS that any enforcement action(s) imposed solely because of deleted or altered deficiency citations 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 changed, deleted or altered, 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 informal dispute resolution must be disclosed to the ombudsman in accordance with §7904. Deficiencies pending Independent IDR should be entered into iQIES within ten (10) calendar days of receiving the request for an independent informal dispute resolution. IDR or Independent IDR requests from the facility should be entered in iQIES within 10 working days of the IDR or Independent IDR request and necessary changes should be entered in iQIES within 10 working days of completion of the IDR or Independent IDR process. Specific instructions are provided in the current iQIES Survey & Certification User Manuals