CMS Broadens Qualification for Independent IDR Participation and Will Require Escrow of all CMPs

In December of 2011, the Centers for Medicare and Medicaid Services (“CMS”) implemented provisions of the Affordable Care Act that required the establishment of a Federally-funded Independent Informal Dispute Resolution process (“Independent IDR”) that facilities could take part in at no cost to the facility.  The Affordable Care Act also required Civil Money Penalties (“CMP”) issued for deficiencies to be placed into escrow by the facility on (i) the date the Independent IDR is completed or (ii) 90 days after the date of notice of imposition of CMP, whichever occurs first.  When the program was first rolled out by CMS, the Independent IDR and escrow provisions were limited to only “G” level deficiencies or higher.

Beginning on October 1, 2013, every CMP that is imposed by CMS will be subject to the escrow provisions and the nursing facility may request Independent IDR on any level deficiency.  On and after October 1, 2013, there will no longer be any restriction on what level deficiency a facility can request Independent IDR when CMP has been issued on that deficiency.  The offer of Independent IDR will be communicated in the CMP notice letter.  CMS will collect the CMP on the earlier of the two dates described above.

This change in policy will only apply to standard and complaint surveys that begin on or after October 1, 2013.  Any revisit survey conducted on or after October 1, 2013 that is associated with a standard or complaint survey completed before October 1, 2013 will not be subject to this new policy change.  To read the CMS memorandum discussing this change, click here. 

If you have additional questions on Independent IDR Participation please contact Meghan McNab at mmcnab@kdlegal.com or Zach Cattell at zcattell@kdlegal.com.