DAL: DRS 11-01: Revised IDR Procedure
January 10, 2011
The Department of Health (DOH) is revising the Informal Dispute Resolution (IDR) submission requirements for nursing homes effective February 1, 2011. Nursing home providers that request consideration by the IDR panel will now be required to submit the IDR request and supporting documentation directly to both the DOH Central Office and respective Regional Office. In addition, DOH is implementing an electronic IDR Form (copy enclosed) that will be submitted electronically to the DOH. This form will be available on the Health Commerce System (formerly the Health Provider Network). Minor changes are also being made to the submission requirements for administrative IDR reviews.
Effective February 1, 2011, IDR requests should be submitted as directed below:
Administrative IDR (Scope/Severity B through F, excluding Substandard Quality of Care)
- Electronic version of the IDR Form to firstname.lastname@example.org; and
- One (1) hard copy each of all relevant supporting documentation, labeled appropriately; form CMS-2567; and the Plan of Correction (POC) to the DOH Regional Office.
Panel IDR (Substandard Quality of Care, and Scope/Severity G and Above)
NOTE: If a deficiency at Substandard Quality of Care (SQC), or G level or higher is under dispute, the DOH Central Office and Regional Office should receive the following information for all deficiencies in the SOD that are disputed.
- Electronic version of the IDR Form to email@example.com;
- One (1) hard copy each of all relevant supporting documentation, labeled appropriately; form CMS-2567; and the POC to the DOH Regional Office; and
- Five (5) hard copies each of all relevant supporting documentation, labeled appropriately; and form CMS-2567 to the DOH Central Office.
A disputing provider must submit the request for an IDR at the time of POC submission. The IDR Panel review will occur no more than 45 calendar days following receipt of the facility's packet. The IDR decision will be communicated to the provider once the Centers for Medicare and Medicaid Services (CMS) concurs.
You are reminded that facilities may not use the IDR process to challenge the scope and severity assessments of deficiencies with the exception of those that constitute SQC or immediate jeopardy.
Your cooperation in implementing the new procedure is appreciated. Please do not hesitate to contact your Program Director in the DOH Regional Office if you have any questions.
Division of Residential Services
- Fillable Informal Dispute Resolution Form with Instructions - (Updated - 5/25/2011) (DOC, 44KB, 2pg.)