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§ 446.4. Informal dispute resolution process

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 35 P.S. Health and SafetyEffective: April 20, 2012

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 35 P.S. Health and Safety (Refs & Annos)
Chapter 1A-1. Long-Term Care Nursing Facility Independent Informal Dispute Resolution Act
Effective: April 20, 2012
35 P.S. § 446.4
§ 446.4. Informal dispute resolution process
Currentness
(a) Establishment of an independent IDR process.--
(1) The department shall establish an IDR process to determine whether a cited deficiency contained in a statement of deficiencies against a facility should be upheld.
(2)(i) The department shall designate Pennsylvania's QIO as the independent IDR agent.
(ii) In the event that Pennsylvania's QIO is unable to serve as the independent IDR agent, the department, in consultation with the Health Policy Board, shall designate the QIO of another state that has experience in conducting informal dispute resolutions for a state survey agency as the independent IDR agent.
(iii) If no other QIO is available to serve as the independent IDR agent, the department, in consultation with the Health Policy Board, shall designate as the independent IDR agent an independent review organization that is accredited by the Utilization Review Accreditation Commission.
(iv) Notwithstanding any other provision of the law to the contrary, the department shall enter into a sole source contract with the independent IDR agent as necessary to implement the provisions of this act.
(3) The department shall obtain all necessary approvals from the Centers for Medicare and Medicaid Services to contract with the independent IDR process.
(4) The independent IDR agent shall offer facilities that provide the independent IDR process a choice of the following levels of review:
(i) desk review;
(ii) telephone review; or
(iii) in-person review, including the utilization of video conferencing.
(5) The independent IDR process may not replace or be a substitute for the existing informal dispute resolution process conducted by the department, but shall be an optional process that can be selected by facilities on a fee-for-service basis.
(6) The fee for the independent IDR process shall be established by the independent IDR agent, provided that the fees are approved by the department and consistent with law.
(7) Independent IDR recommendations made by the independent IDR agent shall be subject to final review and approval by the department.
(b) Minimum requirements of the independent IDR process.--The department shall establish written policies and procedures governing the independent IDR process that comply with the provisions of 42 CFR 488.331 (relating to informal dispute resolution) and the State Operations Manual regarding the informal dispute resolution process. The independent IDR procedures shall include, but are not limited to, the following:
(1) Within ten business days of the end of the survey, the department shall, by certified mail or by the intranet of the department, if the facility is connected to the intranet, transmit to the facility a statement of alleged deficiencies.
(2) A facility that may request an informal dispute resolution review be conducted by either department staff not associated with the survey at no charge or an independent IDR by the independent IDR agent designated by the department on a fee-for-service basis. A facility may select only one method of review. A facility must submit its request for an independent IDR review and indicate its selection of the type of review and level of review in writing within the same ten-day period applicable to the facility for submission of the plan of correction.
(3)(i) Within 45 days of receipt of the request for an independent IDR by a facility, the independent IDR agent shall issue a written decision to the facility based upon its review of the facts, survey findings, State Operations Manual and applicable law.
(ii) If the independent IDR agent sustains the deficiency, the independent IDR agent's written determination shall include the rationale for its decision and provide recommended action that the facility can implement to achieve compliance.
(iii) If the department disagrees with an independent IDR agent's determination that reverses a deficiency, the department shall provide a written explanation for its decision to nullify the independent IDR agent's report to the independent IDR agent and to the facility.

Credits

2011, Dec. 22, P.L. 592, No. 128, § 4, effective in 120 days [April 20, 2012].
35 P.S. § 446.4, PA ST 35 P.S. § 446.4
Current through Act 92 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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