By Jerri Lynn Ward, J.D. & Ashley Katz, Paralegal
The Informal Dispute Resolution (IDR) sets up your entire case, helps to build the defense, and organize the pertinent documents early on in the game.
When to IDR:
- Anytime you have a defense
- Old tags if the tag was cited again with new findings in the survey
- Anytime the scope and severity could be reduced
- Tags without penalties if there is a concern for the facility’s history
Possible Benefits of an IDR:
- Survey is reviewed by a third party
- 30 minute tele-conference with administrator and reviewer. Get the chance to clarify, ask questions, make sure someone actually read the IDR
- If IJ is declared, the administrator may have a face to face meeting with the reviewer
- Tags may be deleted
- Sentences, paragraphs may be deleted or changed
- Scope and severity may be reduced
- Cost Effective: prepares for future appeal
It is also possible that nothing happens and no changes are made. The reviewer may also place the deficiency under a different tag which is more suitable for the alleged findings.
The facility will get a TDHS letter acknowledging the IDR and another letter with any changes made based on the review of the IDR. If changes are made, the facility will need to request a clean copy of the 2567 to ensure changes were made. Once they receive the clean copy, they will need to resubmit their POC.
What Can You IDR?
- Any deficiency/violation cited during a survey or complaint investigation.
- A deficiency/violation that remains uncorrected from a previous visit and there is no change in the finding only if the provider has not had an IDR based on the original visit.
- A deficiency/violation that remains uncorrected and new findings are cited. (The IDR is based on new findings.)
- Scope and severity designations of deficiencies when immediate jeopardy (IJ) or substandard quality of care (SQC) exists.
What Can You Not IDR?
- Classifications of deficiencies under scope and severity rankings, except where these determinations constitute substandard quality of care or immediate jeopardy findings;
- Remedies imposed by the enforcing agency or proposed by the survey agency;
- Alleged failure of the survey team to comply with the requirements of the survey process;
- Alleged inconsistency of the survey team in citing deficiencies among facilities; and
- Alleged inadequacy or inaccuracy of the IDR process itself.
When Should the Facility IDR?
- When the facility disagrees with the citation of the deficiency.
- When the facility disagrees with the factual allegations made.
- When the facility disagrees with the scope and severity even when there is no finding of substandard quality of care.
How to Prepare an IDR
Column Method
On left side of table, put the deficiency or allegations that you dispute-on the right side, put your response.
| F 250 Social Services: The facility must provide medically-related social services to attain or maintain the highest practicable physical, mental, and psycho social well being of each resident. |
There is no regulatory basis for the citation of this tag. The surveyor’s cited it on the basis of lack of documentation in the chart, in spite of the Social Worker’s attempt to give the surveyor’s her handwritten notes verifying that these services had been provided by the facility through her. (Exhibit 1 and 1 a)… |
Narrative Method
Reiterate each deficiency and put your response under each tag or specific allegation.
Example:
F 250 Social Services:
The facility must provide medically-related social services
to attain or maintain the highest practicable physical, mental,
and psycho social well being of each resident.
There is no regulatory basis for the citation of this tag.
The surveyor’s cited it on the basis of lack of documentation
in the chart, in spite of the Social Worker’s attempt to give the
surveyor’s her handwritten notes verifying that these services
had been provided by the facility through her.
The Social Worker, _______ explained to the surveyors that she
had documented and performed the services, but had been unable
to chart with late entries. (Exhibit 1 and 1 a)…
Pointers-Presentation is Everything to Persuasiveness
- Have documentation to back up each point in your response.
- Clearly mark the documentation as an exhibit and refer to the exhibit in the body of your presentation.
- Highlight the portion of the records you want the reviewer to look at.
- Tab the exhibits for easy access to the reviewer.
All information in this article is informational only and is not legal advice. Should you have any questions or a situation requiring advice, please contact an attorney.
Copyright 2004 by Garlo Ward, P.C., all rights reserved
Austin, Texas 78752-3714 USA
Telephone: 512-302-1103
Facsimilie: 512-302-3256
Email: Info@Garloward.com
