Nursing Homes: How to Request and Prepare for an IDR?

IDR reviewers listening to the presentation of the facility.

When a nursing home in Colorado receives deficiency citations from the Colorado Department of Public Health and Environment (CDPHE), one important option is the Informal Dispute Resolution (IDR) process. IDR allows facilities to challenge survey findings without the expense and delay of a formal appeal. Here’s what you need to know to request and prepare for an IDR.

Step 1: Understand What IDR Is—and Isn’t

What it is: A desk review where your written arguments and supporting documents are reviewed against the citation and the surveyor’s response.

What it isn’t: A court hearing or formal appeal. IDR decisions don’t create new appeal rights, but they can correct the record and sometimes remove costly deficiencies.

Step 2: Know Who Oversees the Process

- Federal deficiencies: Oversight by the Centers for Medicare and Medicaid Services (CMS).
- State licensure deficiencies: Oversight by CDPHE.
- Authority: Federal law (42 CFR §488.331) and Colorado statute (§25-27-106, C.R.S.) guarantee this right to nursing homes.

Step 3: Request IDR on Time

- You must request IDR within 10 calendar days of receiving your Statement of Deficiencies.
- The request must identify the deficiencies you are disputing, explain why the facts are incorrect, and include supporting evidence.
- Submit a redacted copy with resident identifiers removed.

Step 4: Prepare Your Documentation

The strength of your IDR request comes down to the quality and clarity of your supporting evidence. Since IDR is a desk review with no live testimony, the reviewers will rely entirely on what you submit.

To prepare effectively:

1. Draft a clear written argument.

·       Identify the exact statement in the citation you are disputing.

·       Explain why the statement is incorrect, incomplete, or misleading.

·       Keep your language factual and professional—avoid speculation or emotion.

2. Include relevant supporting records.
Examples may include:

·       Resident care notes showing staff followed proper procedures.

·       Policies and procedures that were in place at the time of the survey.

·       Training logs or attendance sheets demonstrating staff were educated on the issue cited.

·       Maintenance logs or inspection reports if the citation relates to physical plant or safety issues.

·       Correspondence or internal reports that verify compliance.

3. Cross-reference everything.

·       Label each document (e.g., “Exhibit A – Policy on Medication Administration”).

·       In your written argument, cite the exhibit by name. For example: “See Exhibit C, Resident #5 care notes dated June 10–12, which show staff followed two-person transfer protocol.”

·       Make it easy for the reviewer to connect your evidence to the deficiency.

4. Redact resident identifiers.

·       Replace resident names with sample numbers or initials, as listed in the Statement of Deficiencies.

·       Submit both a full version (for CDPHE review) and a redacted version for committee distribution.

5. Be comprehensive but concise.

·       Submit all relevant documents at once—new material cannot be added later.

·       Don’t overwhelm reviewers with unnecessary records. Focus on documents that directly support your argument.

Step 5: Know What IDR Can—and Cannot—Do

IDR can:
- Correct factual errors,
- Remove or amend citations not supported by documentation.

IDR cannot:
- Challenge the survey process itself,
- Question surveyor judgment or consistency,

Step 6: Prepare for Outcomes

The IDR committee or reviewer may:
- Sustain the citation,
- Delete it entirely,
- Amend it by narrowing scope/severity, or
- Reclassify it under another regulation.

If changes are made, CDPHE will issue a corrected Statement of Deficiencies and allow you to revise your Plan of Correction.

Why This Matters

The IDR process provides nursing homes with a structured, timely, and lower-stakes path to correct survey records. A well-prepared IDR submission can protect your facility’s compliance record and reputation, while avoiding unnecessary enforcement actions.

This guide is for informational purposes only and not legal advice. For detailed support, consult a qualified legal professional or contact our office at Brian@Pinkowskilaw.com.