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IDR and IIDR Processes

IDR and IIDR Processes

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LTC IDR Request Form

LTC IIDR Request Form

Submit a Case | iMPROve Health

Basics

iMPROve Health (a peer review organization), contracted by the Bureau of Survey and Certification (BSC), conducts the IDR/IIDR reviews. The State Agency conducts the final review and notifies the facility of the outcome.

  • Acceptable and expected written case submission into the iMPROve Portal includes:
    • Applicable request form AND
    • A list of deficiency/ies being disputed and why AND
    • Documentation supporting your rebuttal
  • IDRs: Case must be submitted into the iMPROve portal within 10 calendar days of the date on the CMS-2567.
  • IIDRs: Case must be submitted into the iMPROve portal within 10 calendar days of CMS' offer.
  • You waive the right to an IDR/IIDR request if the above required information is not received timely.

iMPROve Health Suggestions for Case Submission

  • Provide a list of all attachments/exhibits.
  • Identify each attachment/exhibit to match list in your narrative.
  • Separate narrative/files/exhibits by citation if applicable.
  • Review that your submission is legible.
  • Only use resident and staff identifiers from the 2567/identifier lists in your narrative (do not use proper names)

Informal Dispute Resolution (IDR)

  • Provides facilities an opportunity to informally dispute cited deficiencies after a survey.
  • Per CMS, the IDR process cannot be used to delay remedies or challenge the survey process. The IDR process does not delay the implementation of any enforcement actions, including penalties.

 

  • Surveys aspects NOT subject to IDR:
    • Scope and severity assessments (except for substandard quality of care or immediate jeopardy deficiencies)
    • Imposed remedies
    • Survey team compliance issues
    • Inconsistencies in deficiency citations
    • Inadequacies in the IDR process.
    • Approval of Past-Noncompliance (PNC)

     

    • Your submission cannot include:
      • Copies of the federal standards
      • De-identified documents
      • Information dated after the survey exit date or information on actions that took place after the survey exit date
      • Legal arguments or briefs

       

      • IDR Conference Calls:
        • Facilities can request a conference call with iMPROve to discuss their case, in addition to a desk review
        • Since this call is optional and not required by CMS, the facility will cover all associated costs
        • The call, hosted by the iMPROve reviewer, will be scheduled in advance, and the Facility will be invoiced a fee. A BSC representative will join the call in a listen-only capacity.

         

        • Pursuant to MCL 333.22115(1), BSC will adopt the recommendations to support, amend (if applicable), or delete the disputed citation.
        • The facility will be notified of the State Agency’s decision in a letter that will accompany the final CMS-2567.

Independent Informal Dispute Resolution (IIDR)

  • Provides facilities facing Civil Monetary Penalties (CMPs) an avenue to dispute deficiencies through an independent review process.
  • Constitutes an informal administrative process that is not be construed as a formal evidentiary hearing.
  • Notification of eligibility comes from CMS.
  • An IIDR is conducted only upon a facility's timely request.
  • As mentioned previously, the facility must make a full case submission for an IIDR within 10 days of CMS' eligibility offer.
  • IDR and IIDR requests for the same deficiency citation(s) arising from the same survey are not permitted unless the IDR process was completed prior to the imposition of the CMP.
  • The IIDR process does not postpone any enforcement actions or penalties.

 

  • Process:
    • An external entity (iMPROve Health), not involved in the original survey or enforcement process, conducts the review to ensure impartiality.
    • Like IDR, facilities can present additional evidence, documentation, or arguments.
    • Also, like IDR, a conference call may be requested for an additional fee.
    • iMPROve Health provides their findings to BSC within 20 days of the request.
    • BSC will review iMPROve Health's recommendations. If necessary, BSC will provide comments to CMS. CMS has the authority to make a final decision.
    • The facility will be notified of the State Agency's decision in a letter that will accompany the final CMS-2567.
    • The IIDR process is completed as soon as practicable but no later than 60 calendar days of receipt of the facility's request.

Contact

iMPROve Health
IDR/IIDR Section, Bureau of Survey and Certification

Questions? LARA-BSC-IDR@michigan.gov

iMPROve Contacts: Aris Rhodes-Bond (248) 465-7405 or Bailey Brokmeyer (248) 465-1035