With the re-initiation of full surveys, facilities are needing to contemplate whether to dispute citations. The decision of whether to do an IDR is not as easy as it may appear and takes a clear head to understand the requirement, review the citation findings, and decide whether the facts warrant the time, energy, and resources necessary to IDR.

These steps are best done by taking emotion out of the equation and looking specifically at what the state agency identified as failed practice and the fact pattern of what may have or may not have occurred. This often takes a facility investigation of the issue. If there are errors in resident identification numbers, diagnoses, typos, inflammatory language or simply errors in the citation that do not necessarily change the failed practice, a first step would be to reach out to the RCS Field Manager to discuss the situation and request the CMS 2567 (for skilled nursing) or Statement of Deficiencies (for assisted living) be corrected. Often the Field Manager can simply amend the wording in the citation and resend the document. If this is not possible, the facility may choose to move forward with an IDR.

According to WAC 388-97-4420 (for skilled nursing), an Informal Department Review, commonly known as an IDR, is for skilled nursing facilities (SNF) and is the only opportunity for the facility to dispute the federal deficiency citation report (CMS 2567), unless a federal sanction is imposed. The SNF licensee has the right to an IDR of disputed state and/or federal citations. WAC 388-78A-3210 offers assisted living facilities the right to IDR.
A licensee (or their representative) must make a written request for an IDR within ten calendar days of receipt of the department's written deficiency citation(s) report. The request must be directed to the department's designated IDR Program Manager and must identify the deficiencies that are being disputed. Do not miss this deadline--if missed, facility will lose their opportunity for the IDR. A facility may request an IDR so as not to miss the deadline and withdraw their request later. There is no punitive action to do so.
The IDR process provided by the department includes, but is not necessarily limited to, an opportunity for review by a department employee who did not participate in, or oversee, the determination of the violation or enforcement remedy under dispute. The department convenes a meeting, when possible, within ten working days of receipt of the request for IDR, unless by mutual agreement a later date is agreed upon. The facility may include anyone deemed necessary to participate in the IDR meeting. The facility typically provides documentation and verbal explanations related to the disputed federal and/or state deficiencies.
If the department determines that a violation or enforcement remedy should not be cited or imposed, the department deletes the violation or immediately rescinds or modifies the enforcement remedy.
The purpose of the IDR process is to provide an opportunity for an exchange of information that may lead to the following:
  • Modification
  • Deletion
  • Removal of parts of a violation
Keep in mind that modification may mean that the citation may move to a different regulation or F-tag (for skilled nursing), or while rare, can result in identification of an additional citation. When modifications or deletions are made to the disputed federal and/or state deficiency citations, a skilled nursing facility must modify or delete the relevant portions of the plan of correction within five days of receipt of the modified or deleted deficiency(ies). Assisted living providers should amend their plan of correction and file it in their survey binder; there is no need to submit plans of correction for assisted living facilities.
The facility may request a clean copy of the revised deficiency citation report. Keep in mind, if the skilled nursing facility is unwilling to provide the modified plan of correction, the department may impose a per-day civil fine for failure to return the modified deficiency citation report to the department in accordance with this subsection.
The request for IDR does not delay the effective date of any state enforcement remedy imposed by the department, except that civil monetary fines are not payable until the exhaustion of any formal hearing and appeal rights. The facility must still correct and look at its systems, even if there is an IDR pending. The department can do a follow-up inspection at any time. They do not have to wait until after a credible date, IDR, or appeal.

IDRs can be confusing processes and timelines involved can easily be missed. If you have questions, please email Elena Madrid or call her at (800) 562-6170, extension 105, or email Vicki McNealley or call her at (800) 562-6170, extension 107.

In an upcoming WHCA Survey and Regulatory Update, watch for:
  • Skilled Nursing Facilities: An overview of IIDRS
  • Assisted Living Facilities: Best Practice for Creating and Implementing a Survey-Readiness Binder
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Tel (800) 562-6170