SNF/NF survey tip—The IIDR process
By Doug Beardsley | January 13, 2023 | SNF/NF providers
If you disagree with a survey finding, one route to challenge the deficiency is to use the independent informal dispute resolution process (IIDR). This process, as used in Minnesota, is outlined in Minnesota Department of Health’s (MDH’s)
Information Bulletin 04-07, released in May 2004 (last updated 10/04/22). In short, the process provides the opportunity for the facility to provide an administrative law judge (ALJ), from the Office of Administrative Hearings (OAH) information to support its dispute of the deficiency or deficiencies issued. The ALJ listens to the facility’s arguments (frequently made by an attorney representing the facility), as well as arguments from MDH. The ALJ then issues an opinion regarding the deficiency or deficiencies in question. That opinion is then reviewed by MDH and accepted, altered, or denied. It is then sent to the Centers for Medicare & Medicaid Services (CMS) for the final determination.
The ALJ can make any of the following determinations:
- Supported in full. The citation is supported in full, with no deletion of findings and no change in the scope or severity assigned to the deficiency citation.
- Supported by substance. The citation is supported, but one or more findings are deleted without any change in the scope or severity assigned to the deficiency.
- Deficient practice cited under wrong requirement of participation. The citation is amended by moving it to the correct requirement of participation.
- Scope not supported. The citation is amended through a change in the scope assigned to the citation.
- Severity not supported. The citation is amended through a change in the severity assigned to the citation.
- Not deficient practice. The citation is deleted because the findings did support the citation, or the negative resident outcome was unavoidable.
During the pandemic, MDH ran way behind in processing IIDRs. They are now starting to get caught up. New IIDR data, provided by MDH, from the past year indicates the following:
Current status of IIDRs:
- Scheduled, pending hearing: 11
- Received, to be scheduled: 14 (meaning contact has been made with the requestor/their representative about scheduling, but the case is not ready to be/has not been scheduled for hearing yet.)
Total IIDR requests received in 2022:
- 26 (this is in line with annual averages over the past 4 years)
- Completed/resolved in 2022: 52 (includes a backlog from 2020 and 2021)
IIDR Outcome details:
- Requests withdrawn: 23
- Matter settled/resolved prior to hearing: 14 (meaning MDH reviewed the case and amended the 2567 to the satisfaction of the appellant)
- Hearings completed: 15
Hearing outcome details:
- Fully supported tags: 8
- IJ upheld, but length of IJ reduced: 1
- Tag modified, but IJ upheld: 2
- Scope and Severity reduced: 4
- Tags rescinded: 6
- Pending final outcome: 1 (at CMS for review—ALJ recommended rescind, MDH disagreed and recommended full support of the tag)
MDH has disagreed with the ALJ on a total of six deficiencies. CMS agreed with MDH on three, disagreed with MDH on two, and MDH is awaiting final decision on the final disagreement. One MDH disagreement was in favor of the facility—MDH felt the IJ period should be reduced, where the ALJ had recommended full support. CMS disagreed with the MDH recommendation.
The other dispute process, the Informal Dispute Resolution (IDR) process, is outlined in MDH
Information Bulletin 04-06, issued in May, 2024 (last updated 10/04/22). Care Providers of Minnesota has requested similar data regarding IDR outcomes in 2022 to assist providers in deciding which process they would prefer to use.
Doug Beardsley | Vice President of Member Services |
dbeardsl@careproviders.org | 952-851-2489