Information Bulletin 14-03
MHC 53

Home Health Agencies Federally Certified Informal Dispute Resolution Process

Introduction and Background

The purpose of this information bulletin is to inform federally certified home health agencies (HHA) in Minnesota of the federal informal dispute resolution (IDR) process.

The Minnesota Department of Health (MDH) has developed an IDR process consistent with the Centers for Medicare and Medicaid Services (CMS) State Operations Manual (SOM) Chapter 10, for federally certified HHA. The IDR process is explained under section 10009 of Chapter 10. The IDR process is not a substitute for formal appeal procedures.

What is a Federal HHA IDR?

A Federal HHA IDR offers a federally certified HHA, upon receipt of the official Form CMS-2567, the option to request an informal opportunity to dispute federal condition-level survey findings warranting a sanction, issued as a result of the following:

• federal or a state survey
• complaint investigation
• follow-up survey/revisit

A federal HHA IDR, including any face to face meetings, constitutes an informal administrative process that in no way is to be construed as a formal evidentiary hearing.

The Federal HHA IDR process may not be used to:
Delay the formal imposition of sanctions or to challenge any other aspect of the survey process, including:

• The severity assessment of a deficiency(ies) at the standard level that constitutes  substandard care or immediate jeopardy;
• Sanctions 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 agencies;
• Alleged inadequacy or inaccuracy of the IDR process.

How to Request an IDR

HHAs must request an IDR in writing to:

Home Health Informal Dispute Process
Minnesota Department of Health
Health Regulation Division
P.O. Box 64900
St. Paul, MN 55164-0900

health.HRD-FedLCR@state.mn.us
651-201-4101

Federally Certified HHA Responsibility

• The written request must include an explanation of the specific condition level deficiencies that are being disputed, a brief explanation of why the deficiency is considered to be 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.
• The written request must be made within the same 10 calendar day period the HHA has for submitting an acceptable plan of correction to the surveying entity;
• The federal HHA 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.

Even though an IDR is requested, the federally certified HHA must still submit an acceptable plan of correction within 10 calendar days.

Responsibilities of MDH in the IDR Process

MDH will:

• Make available to the HHA 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 Office of Health Facility Complaint investigations as information continues to be gathered after the on-site visit).
• Inform the HHA of the IDR opportunity at the time the official Form CMS-2567 is issued and include the name and address to be contacted to request IDR.
• Send a letter confirming receipt of the IDR request and provide the name and telephone number of the person who has been assigned primary responsibility for processing the IDR-(the person assigned will be someone who did not participate in issuing the disputed deficiency(ies)).
• Schedule a face to face meeting, if one is requested.
• Notify the HHA in writing, of the outcome of the IDR.

If the HHA is successful in the IDR process, MDH will:

• Mark the deficiency "deleted,” or “revised” as appropriate, and  sign and date the survey report form;  AND recommend to CMS that they rescind any enforcement action(s) imposed solely because of that deficiency
• If requested by the federally certified HHA, MDH will issue a revised statement of deficiencies within 10 days.

Questions?

Please contact our Division of Health Regulation:
Health.fpc-web@state.mn.us
651-201-4101 Phone
888-345-0823 Toll-free