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May, 2004
Information Bulletin 04-6
NH-97
Informal Dispute Resolution Process For
Nursing Facilities
and Skilled Nursing Facilities
Introduction and Background
Federal law requires the Centers for Medicare & Medicaid Services
(CMS) and each state to develop an Informal Dispute Resolution (IDR)
Process (42 CFR 488.331). The purpose of this Information Bulletin
is to communicate the process for informally disputing deficiencies
and licensing orders issued as a result of a complaint investigation
or survey conducted by the Minnesota Department of Health (MDH).
Information Bulletin 00-6 is obsolete. MDH Information Bulletins 04-6,
04-7, and 04-8 explain the processes for submission of an IDR.
This IDR process has been developed consistent with Minnesota Statutes
144A.10 and CMS IDR Process under section 7212 of the federal nursing
home standards and certification. The IDR process is not a substitute
for formal appeal procedures.
It is the goal of the MDH to have an IDR process that is fair, straightforward,
and efficiently conducted. MDH takes seriously and is aware that some
providers fear retribution or retaliation if they use the IDR process.
If you have concerns that retribution or retaliation may be occurring,
please submit specific examples to division supervisory or management
staff.
What Is An IDR?
An Informal Dispute Resolution (IDR) Process is the single opportunity
to refute deficiencies or correction orders. The department will
accept for an IDR, deficiencies or correction orders that
result from the following:
- a federal or a state survey
- a complaint investigation
- a follow-up survey/revisit
- a Vulnerable Adult Act investigation (note: the IDR process will
be the reconsideration process specified in Minnesota Statutes 626.557,
Subd. 9d.)
The IDR process may not be used to:
- delay the formal imposition of remedies;
- to challenge revised deficiencies or licensing orders that result
from the IDR process;
- to challenge any other aspect of the survey process, including:
scope and severity assessments or deficiencies with the exception
of scope and severity assessments that constitute substandard quality
of care or immediate jeopardy;
remedy(ies) imposed by the enforcing agency;
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
facilities;
alleged inadequacy or inaccuracy of the informal dispute resolution
process.
How To Request An IDR:
All requests for an IDR of federal deficiencies must also
be submitted via the web: http://www.health.state.mn.us/divs/fpc/profinfo/ltc/ltc_idr.cfm
You must notify MDH at the website above of your request for an IDR
within the 10 calendar day period allotted for submitting an acceptable
plan of correction.
Supporting documentation for the IDR process must be mailed within
10 calendar days to:
Nursing Home Informal Dispute Process
Minnesota Department of Health
Compliance Monitoring Division
P.O. Box 64900
St. Paul, MN 55164-0900
Facility Responsibility in the IDR Process:
- Request for IDR must be made in writing and within the 10 calendar
day period allotted for submitting an acceptable plan of correction
or within 10 calendar days after receipt of state licensing orders.
The IDR process can be conducted in writing, by telephone, or in
person. Please let us know which method you wish to use. Please let
us know if your attorney will participate in a face to face meeting
or in a telephone conference call. If a face to face meeting is requested,
please tell us how many persons will be attending from your facility.
Please note that there is a one (1) hour time limit on all IDR meetings,
whether by telephone or in person. All face to face meetings will
be held in St. Paul, MN.
- Explain in your written request for IDR the specific deficiencies
being disputed, a brief explanation of why the deficiency is considered
to be invalid, documentation supporting why deficiency is considered
invalid, and why this information was not available at the time of
survey or investigation. A sole statement of disagreement is not
sufficient to remove a deficiency.
- If the facility is aware of information that could negate or modify
a deficiency after the exit, this information must be sent to the
survey team supervisor within 48 hours of the exit (In the case of
deficiencies or orders issued by OHFC, the exit is the date on which the investigator notifies the facility administration that a deficiency will be issued. Please contact the assigned investigator of OHFC within 48 hours of receipt of an OHFC report if you have additional information.
- Even though IDR is requested, the facility must still submit an
acceptable plan of correction within 10 calendar days.
Responsibilities of the MDH in the IDR Process
The MDH will:
- make available to facilities the written description of IDR Process
(as outlined in this bulletin).
- at time of exit, discuss preliminary deficiency determinations
and information sufficient to support deficiency determinations (this
may not be possible in OHFC investigations as information continues
to be gathered after the on-site visit).
- inform the facility of the IDR opportunity at the time the official
Form HCFA-2567 is issued and include the name and address to be contacted
to request IDR.
- inform the Ombudsman of the facility's request for IDR.
- send a letter confirming receipt of your IDR request and provide
the name and telephone number of the person who has been assigned
primary responsibility for processing your IDR-(the person assigned
will be someone who did not participate in issuing the disputed deficiencies
and/or licensing orders).
- schedule a face to face meeting, if one is requested.
- deficiencies pending IDR will be entered in the Automated Survey Processing Environment (ASPEN) but will not be posted to the Nursing Home Compare website until the IDR process has been completed. In addition, the MDH will include a notice on the MDH website indicating the deficiencies are being disputed by the facility
- notify the facility and the ombudsman, in writing, of the outcome
of IDR.
If the facility is successful in the IDR process, MDH will:
- mark the deficiency "deleted", sign and date the survey
report form; AND rescind any enforcement action(s)
imposed solely because of that deficiency or correction order citation; OR
- adjust the scope and severity assessment, if necessary, to reflect
outcome of IDR; AND
- if requested, issue a revised statement of deficiencies within
10 days.
Questions?
You may submit questions in writing to:
Nursing Home Informal Dispute Process
Minnesota Department of Health
Compliance Monitoring Division
P.O. Box 64900
St. Paul, MN 55164-0900
For questions about this page, please contact Compliance Monitoring Division: health.fpc-web@state.mn.us
Updated July 2009
For questions about this page, please contact our Minnesota Health Care Facilities Programs: health.fpc-web@state.mn.us
See also > Division of Compliance Monitoring Home Page
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