Home Health & Hospice Week

Informal dispute resolution for home health agencies will debut this summer.

The new informal dispute resolution for surveys may not help you unless you know the ropes.

Background: In the 2013 home health prospective payment system final rule published in the Nov. 8, 2012 Federal Register, the Centers for Medicare & Medicaid Services finalized its proposal to offer an informal dispute resolution (IDR) process for home care surveys (see Eli’s HCW, Vol. XXI, No. 41). CMS will require states to implement the process in July 2014, along with alternative sanctions such as civil money penalties and payment suspensions.

Other alternative sanctions became effective July 2013, but surveyors have yet to use them, reported CMS’s Pat Sevast at the National Association for Home Care & Hospice’s annual meeting in Wash-ington, D.C. CMS is hoping to soon issue official regulations and surveyor protocols for sanctions, Sevast acknowledged in a Nov. 1 session. Those documents are in final clearance and CMS will issue them in a survey and cert letter when approved.

Six states already have IDR for home health agencies, Sevast noted. In July, "all states will be required to have an IDR process," she confirmed.

Important: HHAs can use IDR only for condition-level deficiencies, Sevast stressed in the meeting. Standard-level deficiencies are not eligible for the process.

And you must realize what you can not address in IDR. Neither alternative sanctions nor the survey process are subject to the process — just the survey findings, Sevast explained.

"The IDR process is provided primarily as an opportunity for the provider to provide additional information and to dispute condition-level deficiencies," CMS notes in the final rule.

"Whenever possible, we want to provide every opportunity to settle disagreements at the earliest stage, prior to a formal hearing, conserving time and money potentially spent by the HHA, the State agency, and CMS," the rule says. "An IDR … will allow the HHA an opportunity to provide an explanation of any material submitted to the SA and respond to the reviewer’s questions."

Look To Nursing Homes For Clues

Some states may choose to also implement an IIDR — independent informal dispute resolution — process as well, Sevast noted. "They don’t have to, but they may."

Starting in January 2012, CMS required states to provide IIDR for nursing homes, notes law firm Hall Render on its website. "The purpose of the Independent IDR process is to provide a nursing facility, under certain circumstances, an opportunity to dispute cited deficiencies through a process that is unrelated to the State survey agency," the Indianapolis-based firm says. IIDR applies when a provider receives CMPs.

You can expect HHAs’ IDR process to look a lot like the one for nursing homes. States’ IDR will "probably be very consistent with the nursing home process," Sevast predicts.

Note: The final rule is at-www.gpo.gov/fdsys/pkg/FR-2012-11-08/pdf/2012-26904.pdf.