Skilled Nursing: IDR vs. IIDR
Understanding IDR and IIDR: What Colorado Nursing Facilities Need to Know
When a nursing facility receives a Statement of Deficiencies, one of the most important questions is: how do we challenge survey findings we believe are inaccurate?
Colorado providers have two avenues for review: the Informal Dispute Resolution (IDR) process and, in certain cases, the Independent Informal Dispute Resolution (IIDR) process. While they sound similar, these procedures are different in scope, timing, and authority. Understanding how and when to use each process is critical for protecting your facility’s compliance record and minimizing enforcement actions.
The Relationship Between IDR and IIDR
- IDR is the standard process available to dispute deficiencies under state or federal regulations. It is administered by the Colorado Department of Public Health and Environment (CDPHE) through a seven-member review committee.
- IIDR is available only when CMS imposes a Civil Money Penalty (CMP). Unlike IDR, it is overseen federally, and the final decision rests with CMS, not the state.
- Facilities must choose between IDR or IIDR when challenging CMP-related deficiencies—but if you pursued IDR before the CMP was imposed, you may still request IIDR on the same citations.
How the IDR Process Works
- Committee Review: Seven members (three long-term care providers, two uninvolved state surveyors, one outside agency representative, and one ombudsman).
- Scope: A desk review of your written arguments, supporting documents, and the surveyor’s response.
- Deadline: The request must be submitted by the due date of your Plan of Correction (POC), usually 30 days after survey exit. One short extension (up to seven days) may be granted.
- Limitations: IDR cannot be used to challenge the survey process itself, the remedy imposed, or severity/scope—except in cases of immediate jeopardy or substandard quality of care.
- Outcome: If successful, the deficiency is amended or removed, and a revised CMS-2567 is issued.
How the IIDR Process Works
- When Available: Only when a CMP has been imposed. CMS’ penalty notice will offer the IIDR option.
- Committee Review: Three members (one provider representative, one ombudsman, and one healthcare policy researcher).
- Scope: Broader than IDR. The committee reviews facility documentation, surveyor comments, ombudsman input, and resident or representative statements. Both the merits of the deficiency and the severity/scope level may be addressed.
- Deadline: The facility must submit the IIDR request within 10 calendar days of receiving CMS’ CMP notice.
- Timing: The IIDR must be completed within 60 days of CMS’ offer. CMS issues the final decision and provides it to the facility, usually within 10 days of receipt.
- Outcome: CMS’ decision is final. If deficiencies are deleted or amended, a corrected CMS-2567 is reposted.
Timing Considerations
- IDR: Due with your POC (30 days after survey exit, unless an extension is approved). Does not delay enforcement actions.
- IIDR: Due within 10 days of the CMP notice. Process concludes within 60 days.
Bottom Line
Think of IDR as your first line of defense for most deficiencies, and IIDR as a federal-level review triggered only by CMPs. Many facilities pursue IDR immediately after survey to preserve their record. If CMS later imposes a CMP, IIDR may provide a second opportunity—even on the same deficiencies.
Navigating these processes is highly technical, and success depends on how well the facility documents compliance and prepares its arguments. A clear strategy, with supporting evidence, can make the difference between an amended CMS-2567 and a deficiency that stays on your record.
The information provided here is intended for educational purposes and serves as a general guide. It is not tailored legal advice for specific circumstances. For detailed guidance on this or other topics, please consult with a qualified legal professional or reach out to our firm.
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