(a)The health facilities commission shall establish an independent informal dispute resolution (IIDR) program that conforms to the requirements of this section.
(b)If a nursing home is entitled to an informal dispute under 42 C.F.R. § 488.331 or 42 C.F.R. § 488.431 , or pursuant to state law if cited for a licensure deficiency, then the nursing home may request an opportunity for IIDR. (c)The IIDR program must contain, at a minimum, the following elements:
(1)The commission shall contract with an independent review organization to conduct the IIDR process for nursing homes; and (2) Any independent review organization contracted with must:
(A)Have an understanding of medicare and medicaid program requirements;
(B)Have no conflict of interest; and (C) Be acceptable to the federal cente
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(a) The health facilities commission shall establish an independent informal dispute resolution (IIDR) program that conforms to the requirements of this section. (b) If a nursing home is entitled to an informal dispute under 42 C.F.R. § 488.331 or 42 C.F.R. § 488.431 , or pursuant to state law if cited for a licensure deficiency, then the nursing home may request an opportunity for IIDR. (c) The IIDR program must contain, at a minimum, the following elements: (1) The commission shall contract with an independent review organization to conduct the IIDR process for nursing homes; and (2) Any independent review organization contracted with must: (A) Have an understanding of medicare and medicaid program requirements; (B) Have no conflict of interest; and (C) Be acceptable to the federal centers for medicare and medicaid services (CMS) and meet the requirements of any federal rules regarding IIDR entities. (d) The IIDR process must consist of the following steps: (1) A statement of deficiencies issued by the commission that must include or be accompanied by notification of the availability of and an explanation of the IIDR process; (2) Within ten (10) working days of the notification of civil monetary penalties imposed by CMS that will be placed in a CMS escrow account, or the notification of the imposition of any other remedy for which IIDR is provided under federal or state law or rule, the nursing home may request in writing an IIDR conference; (3) The commission may only require that the nursing home's request: (A) Be in writing and transmitted either by U.S. mail, common carrier, or by electronic means; (B) Identify the deficiencies that are being contested through IIDR; (C) Explain why the nursing home believes the deficiencies are not correctly cited; (D) Identify any involved resident and that resident's representative, if any; and (E) Explain the manner in which the nursing home wishes to conduct the IIDR conference, which is limited to the following options: (i) A desk review of written information submitted by the nursing home; (ii) A telephonic conference; or (iii) An internet-facilitated meeting or videoconference, if the nursing home can facilitate the availability of technology for such meeting; (4) Within five (5) working days of receipt of the written request for the IIDR process made by a nursing home, the commission shall refer the request to the independent review organization contracted with the commission; (5) The commission shall acknowledge in writing to the nursing home that the request for independent review has been received and forwarded to the independent review organization for review. The notice must include the name, address, and contact information of the independent review organization; (6) The nursing home may submit any additional nursing home records, information, exhibits, or other documentation to support its argument without a page limitation. All documentation must be received by the independent review organization no later than two (2) working days prior to the IIDR conference, and may be transmitted in electronic format; (7) The independent review organization shall hold an IIDR conference no later than fifteen (15) working days after receipt of the written request for the IIDR process made by a nursing home, unless the nursing home requests additional time to schedule the conference; (8) If the independent review organization determines the need for additional information, clarification, or discussion after conclusion of the IIDR conference, then the nursing home shall present the requested information as soon as possible, but no later than five (5) working days of receipt of the request; (9) Within ten (10) calendar days of the IIDR conference, the independent review organization shall provide and make an IIDR recommendation, based upon the facts and information presented, and shall transmit a written decision to the commission; (10) If additional information was requested and submitted after conclusion of the IIDR conference, the independent review organization has an additional five (5) calendar days to make a determination; and (11) The IIDR recommendation must include, at a minimum: (A) A list of each disputed deficiency or survey finding; (B) A summary of the IIDR recommendation for each deficiency or finding and the rationale for the recommendation; (C) Any documents submitted by the nursing home; and (D) Any comments submitted. (e) The commission shall provide a final decision to the facility as soon as practicable, but no later than ten (10) calendar days after its receipt of the written record. The final IIDR decision to the facility must contain the result for each deficiency challenged and a brief summary of the rationale for that result. (f) If the independent review organization or the commission upon review of a written decision, determines that the original statement of deficiencies should be changed as a result of the IIDR process, then the commission shall transmit a revised statement of deficiencies to the nursing home within ten (10) calendar days of the independent review organization's determination. The nursing home shall have an additional ten (10) calendar days from the receipt of the revised statement of deficiencies to submit a revised plan to correct any remaining deficiencies. (g) Use of the IIDR process by a nursing home does not waive the nursing home's right to any formal hearing or other appeal process afforded by law or rule. The IIDR is not a formal evidentiary proceeding. (h) No later than December 1st of each year, the commission shall submit a report on the IIDR process to the chair of the health and welfare committee of the senate, the health committee of the house of representatives, and the legislative librarian, and publish the report on its website in a manner accessible to the public. The report must contain, at a minimum: (1) The number of IIDR conferences requested and conducted; (2) The number of deficiencies contested through the IIDR process; (3) The number of deficiencies sustained in IIDR conferences; (4) The number of deficiencies overturned in IIDR conferences; (5) The number of deficiencies modified or changed in IIDR conferences; and (6) To the extent possible, the number of civil monetary penalties reduced by IIDR results where the facility overturned one or more deficiencies.