Tips for Successful IDR/IIDR

The IDR process gives nursing homes one informal opportunity to dispute cited deficiencies after any survey of Federal requirements for participation. Facilities are also provided the opportunity to request and participate in an Independent IDR if CMS imposes civil money penalties against the facility and these penalties are subject to being collected and placed in an escrow account pending a final administrative decision. With either of these processes, facilities must understand the Federal Requirements outlined in 42 C.F.R. §488.331 and 488.431 to make sure that they adhere to these directives and understand when they can and cannot dispute cited deficiencies.

For the IDR process:

• • • The request must be submitted in writing along with an explanation of the specific deficiencies that are being disputed
    • The request must be made within the same 10-calendar day period the facility has for submitting an acceptable plan of correction to the surveying entity.

IDR is a process for facilities to dispute cited deficiencies. However, facilities may not use the

IDR process to challenge any other aspect of the survey process, including the:

• • • Scope and severity assessments of 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; or the
    • Alleged inadequacy or inaccuracy of the IDR process.

For the IIDR process:

• • • The facility must request an Independent IDR within 10 calendar days of receipt of the offer.
    • The facility should submit its request in writing to the State survey agency, or the approved Independent IDR entity or person, as appropriate.
    • The facility’s request should also include copies of any documents, such as facility policies and procedures, resident medical record information that are redacted to protect confidentiality and all patient identifiable information, or other information on which it relies in disputing the survey findings.

Like the IDR process, the Independent IDR process does not delay the imposition of any remedies, including a civil money penalty. During the Independent IDR process a facility may dispute the factual basis of the cited deficiencies for which it requested Independent IDR. However, again like the IDR process, a facility may not challenge other aspects of the survey process, such as:

• • • Scope or severity classifications, with the exception of assessments that constitute substandard quality of care or immediate jeopardy;
    • Remedy(ies) imposed;
    • 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 other facilities;
    • Alleged inadequacy or inaccuracy of the IDR or Independent IDR process.

Important tips to remember when requesting/preparing an IDR or IIDR:

1. 1. 1. Make sure the IDR/IIDR request is submitted in writing within the specified timeframe. If it is submitted late, the request will not be granted.
      2. Ensure that the IDR/IIDR address the deficiencies disputed with information to support why, and not any of the aspects that cannot be disputed.
      3. Prepare the IDR/IIDR as you would a legal case, in a logical order with the evidence to support how the facility met the regulatory requirement(s) labeled and set up as easy to follow exhibits
      4. Remember that the IDR and IIDR processes are intended to be Informal and are not intended to be a formal or evidentiary hearing. Thus, the facility should discuss with their legal counsel if they want to consider the possibility of having an attorney present during the process.

By understanding the Federal Requirements for the IDR and IIDR processes, and remembering the important tips for requesting/preparing for these, the facility will be on the road to deficiency dispute success! Contact Proactive to learn more about our survey readiness and management solutions.

Janine Lehman, RN, RAC-CT, CLNC
Director of Legal Nurse Consulting

Learn more about the rest of the Proactive team.