April, 2000

Information Bulletin 00-6
NH-39

Informal Dispute Resolution Process For Nursing Facilities And Skilled Nursing Facilities

Introduction and Background

Federal law requires the Health Care Financing Administration (HCFA) 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).

This bulletin replaces and supersedes all prior Informal Dispute Resolution policies and procedures of the department.

This IDR process has been developed consistent with Minnesota Statutes 144A.10 and HCFA 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 which is fair, straightforward, and efficiently conducted. The 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. Our staff is aware that conduct by them leading to fear of retribution or retaliation is not acceptable and will subject individuals to disciplinary action.

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 IDR must be made in writing and submitted to:

Nursing Home Informal Dispute Process
Minnesota Department of Health
Health Regulation 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 completion of the written report. Please contact the director 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.

• while IDR is pending, cited deficiencies will not be entered into OSCAR.

• 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
Health Regulation Division
P.O. Box 64900
St. Paul, MN 55164-0900