IDR and IIDR Processes

This page is designed to help nursing homes understand the Informal Dispute Resolution (IDR) and Independent Informal Dispute Resolution (IIDR) rules and processes. 

Regulations at 42 CFR §488.331 require that the Centers for Medicare and Medicaid Services (CMS) and the States, offer skilled nursing facilities, nursing facilities, and dually participating facilities an informal opportunity to dispute cited deficiencies upon the facility/agency’s receipt of the official Form CMS-2567.  Nursing home administrators may contact the survey team manager prior to submitting a request for an IDR, if needed, to discuss the official written statement of deficiencies.

iMPROve Health (a peer review organization), contracted by the Bureau of Survey and Certification (BSC), will conduct the IDR/IIDR reviews.  Submissions for IDR’s must be received by iMPROve Health within ten calendar days from the date of issuance of CMS’s 2567 by the State Agency. Submission for IIDR’s must be received by iMPROve Health within 10 calendar days of CMS’ offer. You will waive the right to an IDR request if the required information is not received timely.

Per CMS, facilities may not use the IDR process to delay the formal imposition of remedies or to challenge any other aspect of the survey process. An ineligible/inappropriate request for a dispute that will be denied includes:

• Scope and severity assessments of deficiencies with the exception of scope and severity assessments that constitute substandard quality of care (SQoC) or immediate jeopardy (IJ)
• 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

CMS offers nursing home providers the opportunity to an IIDR when a Civil Money Penalty (CMP)is imposed, and that penalty is subject to being collected and placed in escrow under 42 CFR 488.431(b).  Upon notification from CMS of their opportunity to an IIDR, a nursing home provider must complete the LTC IIDR Request Form and upload all supporting documents to iMPROve Health’s portal at www.improve.health/idr. When appropriately requested, the written request must include the specific deficiency being disputed and a brief explanation of why you dispute those deficiencies or why you dispute scope and severity assessments for deficiencies which resulted in a finding of SQoC or IJ. 

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. 

Telephonic = IIDR Conference Call

In addition to a desk review, nursing home providers may also request a conference call with iMPROve to discuss the case and answer any questions about the submitted information in support of the facility’s position.  Because the conference call is not required by CMS, the nursing home provider will incur all costs associated with this option.

If requested, the call will be scheduled in advance and the nursing home provider will be invoiced a fee to cover the cost.  The iMPROve Reviewer will host and lead the call.  BSC will designate one representative to join in listen-only mode.

iMPROve Health will respond to BSC within 20 days of their findings. The Bureau will review iMPROve Health's recommendations and provide any comments to CMS, who will make the final decision. The timeframe for completion of the IIDR process is 60 calendar days from the nursing home provider’s request, which is strictly enforced by CMS.