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IDR and IIDR Processes
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
- Applicable request form AND
- 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 Charlene Kawchak-Belitsky (248) 465-1038