Home Health & Hospice Week

Here’s what IDR will look like under updated guidelines.

Still getting a handle on the very new informal dispute resolution process for hospice survey findings — or the more established one for HHAs? New details in a Medicare guidance document may help.

The Centers for Medicare & Medicaid Services “has revised the State Operations Manual (SOM) chapter 10 to provide procedures regarding the informal dispute resolution (IDR) process for both Home Health Agencies (HHAs) and hospice programs,” CMS says in survey memo QSO-24-11-HHA & Hospice issued May 6.

Reminder: “The regulations for IDR offer HHAs and hospice programs the option to request an informal opportunity to dispute condition-level survey findings warranting an alternative sanction or enforcement remedy following a facility’s receipt of the Statement of Deficiencies (Form CMS-2567),” CMS reviews. “Effective January 1, 2024, the IDR processes for hospices follow the same existing processes for HHAs, and Chapter 10 was updated to include hospices in the guidance,” the agency says.

“These procedures were last updated for home health in 2014 when an IDR and alternative sanction process was added for home health,” recalls trade group LeadingAge on its website.

This memo outlines some new notice requirements, including notice to the provider indicating “that counsel may accompany the HHA or hospice program. If the facility chooses to be accompanied by counsel, then it must indicate that in its request for IDR, so that CMS may also have counsel present,” CMS says.

“HHAs and hospices may see that their survey entity revises its communication and instructions on the IDR process based on the … revisions,” the National Association for Home Care & Hospice says in its member newsletter. “There is no change to the process, but there is now more detailed guidance … on how the option of the IDR is to be communicated to the providers and how the IDR request is to be handled,” NAHC says in its memo analysis.

The guidance now outlines six mandatory elements of the IDR process, including what can not be challenged in the process (for example, “alleged inconsistency of the survey team in citing deficiencies among agencies”); many details of the notification process; and procedures when survey findings are overturned.

Remember: In addition to the IDR and alternative sanction-enforcement remedy changes in the memo, “the home health survey process was removed from Chapter 10 and moved to Appendix B” of the SOM, points out the Texas Department of Health and Human Services on its website.