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Nursing Home Informal Dispute Resolution Process

The Department of Health (DOH) recently issued Dear Administrator Letter (DAL) 19-11 to clarify the current Informal Dispute Resolution (IDR) process and provider options and timelines related to the current process. In addition, DOH posted a submission form and instruction sheet to be used when submitting an IDR. The DAL outlines three types of IDRs:

  • The Administrative IDR may be made for deficiencies with a Scope/Severity of B-F, excluding Substandard Quality of Care (SQC). While this IDR is heard at the regional office where the deficiency was cited, DOH has stated that the surveyor responsible for writing the deficiency is not involved in the IDR.
  • The Panel IDR reviews deficiencies involving SQC or deficiencies with a Scope/Severity of G and above (if in the same Statement of Deficiencies (SOD) deficiencies below a G level are to be disputed, they can be disputed here as well). The Panel is comprised of DOH Central Office Program staff and representatives from the New York State Board of Examiners of Nursing Home Administrators (BENHA) and the New York State Office for the Aging (NYSOFA) Office of the Long Term Care Ombudsman.
  • A Panel IIDR (Independent Informal Dispute Resolution) may be requested for a Scope/Severity of G and above, which leads to the imposition of a Civil Money Penalty (CMP). The State has a reciprocal agreement with New Jersey where each state will manage the IIDR for the other state.

The Centers for Medicare and Medicaid Services (CMS), as part of recently proposed rules for nursing homes published in the July 18, 2019 Federal Register (Part B Survey, Certification, and Enforcement Procedures), recommended changes to the IDR and IIDR process that would address, among other things, the length of time for the provider to receive the results of the IDR decision following submission and the uploading of deficiencies to the Certification and Survey Provider Enhanced Reporting (CASPER) system prior to the completion of the IDR process. These changes are not yet in effect.

Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832