February 7, 2012_NH "Dear Administrator" Letters

February 7, 2012

ADSA: NH #2012-001
S&C 12-08:  Federal Requirements for the Independent Informal Dispute Resolution (IIDR) Process

Dear Nursing Facility/Home Administrator:

The purpose of this letter is to let you know that the Centers for Medicare & Medicaid Services (CMS) has issued a survey and certification (S&C) memorandum on the independent informal dispute resolution (IIDR) process for nursing homes.  New regulations were added at 42 CFR, Sections 488.331 and 488.431 as required under section 6111 of the Patient Protection and Affordable Care Act of 2010.  This included federal requirements for the IIDR process for nursing homes.

PLEASE NOTE: This requirement only applies if CMS imposes a civil monetary penalty (CMP) against the facility and the CMP amounts are subject to being collected and placed in an escrow account.

Highlights from S&C 12-08-NH Memorandum:

  • The IIDR opportunity will begin on January 1, 2012, for any CMP imposed by CMS that meets the above criteria.
  • CMS will begin collecting and escrow only those CMPs which are imposed as a result of the most serious deficiencies, actual harm or immediate jeopardy to resident health or safety including from life safety code surveys (i.e., at a scope and severity (S/S) level of G or above).
  • An IIDR will not include the survey findings that already have been the subject of an informal dispute resolution for the particular deficiency citations at issue, unless the informal dispute resolution was completed prior to the imposition of the civil money penalty.
  • After receiving the imposition of CMP notice from CMS, if you want an IIDR, you must request it by the date indicated in the notice.  The IIDR form request can be found online at:  http://www.adsa.dshs.wa.gov/professional/nh.htm  under IIDR request form.  You may also find the state agency IIDR process and procedures at that link under IIDR state process.
  • The IIDR will be document review only; you must submit a form for each deficiency disputed along with the documents relevant to only that deficiency.
  • Submission of documents not relevant to the deficiency may result in the IIDR person being unable to find pertinent information or they may not find it within the timeframe required for completion.

To read the details of the memorandum online, please use the following link:  Federal Requirements for the Independent Informal Dispute Resolution (Independent IDR) Process

Please contact your local RCS Field Manager if you have any questions.


Joyce Pashley Stockwell, Director
Residential Care Services