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INFORMAL DISPUTE RESOLUTION (IDR) PROCESS

You may find the following resources and information useful:

Requesting an IDR

A Long-Term Care Facility’s (Facility) request for an Informal Dispute Resolution (IDR) must be:

  • Made in writing.  It can be in the form of a memo or letter.
  • Faxed or mailed to the Montana Department of Public Health and Human Services, Office of Fair Hearings.

The mailing address is:

                        Office of Fair Hearings
                        Department of Public Health and Human Services
                        2401 Colonial Drive, Third Floor
                        PO Box 202953
                        Helena  MT  59620-2953

The Facsimile number is: (406) 444-3980.

The Office of Fair Hearings will assign a Presiding Official for the IDR.

  • Submitted within 10 calendar days from the receipt of the statement of deficiencies, i.e. FORM CMS-2567.

The written request should contain the following information:

  • The name of the Facility.
  • The date of the survey.
  • The specific deficiency citation or citations being disputed.
  • A brief summary of the objections to each citation.
  • Whether a record review, a telephone conference or an in-person conference is desired.
  • The name, address and phone number of the person coordinating the IDR for the Facility.
  • Whether or not legal counsel will represent the Facility.
  • Whether or not the Facility desires documentation from the Department of Public Health and Human Services’ Certification Bureau (Department) that the Department used in reaching the deficiency citation.   The Department may charge the facility $.20 per page to the cover the cost of retrieving, copying and mailing the information unless fewer than 20 pages are produced.

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Presenting Objections and Desired Outcomes for an IDR

 A Long-Term Care Facility’s (Facility) objections that can be presented for an Informal Dispute Resolution (IDR) include:

  • There is insufficient evidence to sustain a deficiency.
  • There is insufficient evidence to sustain a portion or a finding of a deficiency.
  • There is insufficient evidence to sustain the deficiency as cited but there is sufficient evidence to sustain the deficiency at a different citation.
  • There is insufficient evidence to sustain the scope and severity at the Immediate Jeopardy or Substandard Quality of Care level but that there is sufficient evidence to sustain the deficiency at a reduced (lower) scope and severity.

Objections that cannot be presented for an IDR include:

  • Complaints about a surveyor.
  • Complaints about the survey process.
  • Deficiencies cited at prior surveys.

Desired outcomes requested can include:

  • Deletion of a deficiency.
  • Removal of a specific example or finding.
  • Rewording of a specific example or finding.
  • Movement of a deficiency to another tag.
  • Reduction of the scope and severity for either Immediate Jeopardy or Substandard Quality of Care.

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Submitting Material for an IDR

A Long-Term Care Facility (Facility) may submit materials supporting its objections for an Informal Dispute Resolution (IDR).

Materials may be organized using the following format:

  • Group all materials by deficiency into separate sections.
  • Place the sections in the same order that the deficiencies are cited on the statement of deficiencies, i.e. Form CMS-2567.
  • Separate each section with tabbed or labeled dividers.
  • Number all pages of the materials consecutively.
  • Bind the materials together in some manner.  Binding can be done by stapling, placement in a 3 ring binder or report cover.

Sections may be organized using the following format:

  • A written rebuttal stating the disputed position factually and succinctly.  The rebuttal may contain: the reasons why the deficiency is disputed; the desired outcome for the disputed deficiency; and references to the documentation following.  The rebuttal should not include complaints about a surveyor or the survey process.
  • Substantiating documentation that directly demonstrates that the deficiency is not sustainable.

Substantiating Documentation may include:

  • A Long-Term Care Facility form that is specific to the disputed survey findings.  Blank forms should only be submitted to prove that a form existed at the time of the survey.
  • A document from the appropriate Facility records.  For example, if the dispute regards a care plan that a surveyor found deficient, submit that care plan.  Documentation may also include such items as nurse’s notes, physician’s notes, prescription orders, or assessments.
  • Applicable policy and procedures.
  • Curricula or curriculum summaries and attendee signatures lists to indicate the training context and attendance for in-service training programs and sessions.
  • A copy of the portion of a professional source or standard cited.
  • Minimum Data Set.
  • Signed testimonials from Resident family members or Facility Staff.

Inappropriate Documentation includes:

  • The Plan of Correction.
  • The Statement of Deficiencies.

The condition of the Substantiating Documentation should be:

  • In its original form and content as of the survey date.  Do not de-identify documents that name the residents referenced in the deficiency.
  • The wording on the documents must be legible.  If the document or portions are illegible, provide a typed version or a neatly written transcription of the section of the document.
  • Highlight appropriate narrative, text or information relevant to the deficiency.

Materials must be submitted 7 days prior to the IDR.  They must be mailed to:
 
Presiding Official
Office of Fair Hearings
Department of Public Health and Human Services
2401 Colonial Drive, Third Floor
PO Box 202953
Helena  MT  59620-2953

and copied to:

Certification Bureau
Department of Public Health and Human Services
2401 Colonial Drive, Second Floor
PO Box 202953
59620-2953

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How is an IDR Decision Issued?

The Montana Department of Public Health and Human Services (Department) designates an individual who is not directly involved in the certification survey to serve as the Presiding Official for the Informal Dispute Resolution (IDR).

The Presiding Official will issue the decision no later than 60 calendar days following the IDR conference or review.  If the Presiding Official allows the submission of additional materials after the IDR conference or review, then the decision will be issued 60 days after the additional materials are submitted.

The IDR decision will be issued in writing  and address the issues raised by the Long-Term Care Facility (Facility).  The decision will be in the form of an Opinion and Recommendation.  The Opinion portion will address the Presiding Official’s rationale for the recommendations made.  The Recommendation will address the statement of deficiencies, i.e. Form CMS-2567. 

The following are possible outcomes of the Informal Dispute Resolution (IDR) process:

  • A determination that there is sufficient evidence to sustain a deficiency.
  • A determination that there is insufficient evidence to sustain a deficiency and the deficiency should not have been cited and should be deleted.
  • A determination that there is insufficient evidence to sustain a portion or a finding of a deficiency and the deficiency should be amended or modified.
  • A determination that there is sufficient evidence to sustain a deficiency but the deficiency should be cited under a different tag.
  • A determination that there is insufficient evidence to sustain the scope and severity at the level cited but that there is sufficient evidence to sustain the deficiency at a reduced (lower) scope and severity.
  • A determination that there is sufficient evidence to sustain the deficiency and there is sufficient evidence to sustain the deficiency at an increased (higher) scope and or severity level.

A copy of the IDR Opinion and Recommendation will be mailed to both the Department and the Facility.

The IDR Opinion and Recommendation is not precedential.  The U.S. Department of Health and Human Services’ Center for Medicare and Medicaid Services is not bound by the Presiding Official’s recommendations. 

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Page last updated: 07/30/2013