Section He-E 807.13 - Informal Dispute Resolution Process(a) A NF may request an informal dispute resolution (IDR) for the opportunity to dispute a cited deficiency upon the facility's receipt of the CMS-2567 in accordance with 42 CFR 488.331.(b) The IDR shall be held to consider new or additional information presented by the NF to dispute a cited deficiency and to review the accuracy of the facts obtained during the compliance survey.(c) If a NF requests an IDR, the request shall: (1) Be submitted in writing to the bureau chief of the survey agency within 10 calendar days of the receipt of the CMS-2567;(2) Identify the NF's preference for how the IDR will be held as described in (g) below:(3) Identify the deficiency(ies) in dispute;(4) Include a brief statement as to why the deficiency(ies) should not have been cited; and(5) Indicate whether the NF provider will be accompanied by or include legal counsel at the IDR.(d) An IDR shall not: (1) Delay the imposition of a remedy;(2) Delay the submission of a POC as described in He-E 807.06; or(3) Be requested to challenge the remedy to be imposed in accordance with 42 CFR 488.408(g) (2) .(e) When a NF requests an IDR, the bureau chief of the survey agency shall assign a staff person to be the IDR coordinator to act as the liaison between the survey agency and the NF provider.(f) The IDR coordinator shall coordinate the IDR process by:(1) Notifying all parties listed in (h) or (k) of the date and time of the IDR, and, if the IDR is to be held as a meeting as referenced in (g) (1) or (g) (4) below, the location of the IDR; and(2) Facilitating the IDR meeting or teleconference by: a. Explaining that the IDR is an informal process and the purpose of it as described in (b) above;b. Explaining that a decision will not be made at that time but notification of the decision shall be made in accordance with (v) or (w) below;c. Restating the deficiency(ies) in dispute;d. Coordinating the presentation of evidence and statements of all parties so that: 1. The NF, the survey team, and any other interested party has an opportunity to present all documentary evidence and statements regarding the deficiency(ies) in dispute; and2. Questions can be raised to clarify any of the information presented, if necessary, to ensure that all information required to reach a decision has been received; ande. Ending the meeting or teleconference when all statements and evidence have been presented.(g) An IDR shall be held by one of the following methods, at the request of the NF provider: (1) A meeting between the individuals listed in (h) below;(3) By written correspondence between the NF provider and the IDR coordinator; or(4) A meeting of an advisory panel as described in (j) - (p) below.(h) The following individuals shall be required to attend the IDR if held in accordance with (g) (1) or (2) above: (2) The field supervisor or team leader who conducted the survey which cited the deficiency;(3) The NF provider or a member of his/her staff; and(4) Any other interested party(ies) who may have information to present for consideration or whom the NF or the survey agency chooses to have attend.(i) If the IDR is to be held by written correspondence between the NF provider and the IDR coordinator, then the parties listed in (g) above shall submit written evidence to the IDR coordinator by the date set by the IDR coordinator in accordance with He-E 807.13(f) (1) .(j) At the request of a NF, an advisory panel shall convene to discuss the evidence and statements in the case of a dispute of a cited deficiency as referenced in (f) (2) d.1. and 2. above.(k) The advisory panel shall consist of the following members: (1) Individuals who are either: a. A nursing home administrator licensed in New Hampshire under RSA 151-A;b. A director of nursing in a NF licensed by the board of nursing under RSA 326-B; orc. A medical director in a NF licensed by the board of medicine under RSA 329;(2) Of the members listed in (1) above: a. There shall be 3 members appointed by the NH Health Care Association; andb. There shall be 1 member appointed by the County Nursing Home Association; and(l) If an advisory panel is requested by an NF, the parties who will present evidence shall be the same as listed in (f) (2) d. (m) An individual shall recuse him/herself and shall not participate as a member on an advisory panel for a specific IDR process if any of the following apply: (1) The individual or any of his/her immediate family, is currently, or within the past 2 years has been, employed as a staff member, officer, consultant or agent by the NF that requested the IDR;(2) The individual or any of his/her immediate family, has any financial interest or any ownership interest in the facility that requested the IDR; or(3) The individual has an immediate family member who is a resident of the NF that requested the IDR.(n) Training for appointed advisory panel members shall be coordinated by the survey agency and the state medicaid agency prior to a member serving on the advisory panel.(o) The training referenced in (n) above shall:(1) Consist of a review of state and federal regulations regarding the survey process; and(2) Be conducted as follows: a. An initial training of a minimum of 8 hours; andb. A minimum of 3 hours of update training held annually.(p) All members on the advisory panel shall participate in the development of the recommendation to be presented to the bureau chief as described in (t) below.(q) If questions arise at the time of the presentation of evidence at the IDR, or as a result of the review of written evidence, the NF shall be given an additional 10 calendar days to present written clarifying information to the IDR coordinator for consideration by him/her or the advisory panel. When this occurs, the evaluation described in (s) below shall be postponed until all information has been received or the 10 calendar days have passed.(r) The IDR coordinator shall consult with other survey agency and state medicaid agency staff as needed to determine whether the NF was successful in disputing the deficiency(ies) under consideration.(s) The evidence shall be evaluated by the IDR coordinator or the advisory panel to determine whether to rescind or revise the citing of a deficiency by considering the following: (1) Whether the evidence presented at the IDR existed at the time the survey was conducted, as any evidence created after a survey will not result in a rescission or revision of the citing of a deficiency;(2) Whether there is a preponderance of evidence that the deficient practice did or did not occur; or(3) Whether the evidence presented creates a change in material fact that lead to the citing of the deficiency and if that change of material fact would result in a rescission or revision of the citing of the deficiency.(t) After evaluating the evidence and considering the factors listed in (s) above, the IDR coordinator shall present his/her recommendation, or the recommendation of the advisory panel, to the bureau chief of the survey agency for his/her final decision.(u) The bureau chief shall: (1) Review all material related to the survey and the IDR process;(2) Determine if the IDR process was conducted in accordance with He-E 807.13;(3) Ensure that the NF was provided the opportunity to respond to the IDR's or advisory panel's request for further information;(4) Ensure that the recommendation made to him/her as a result of the IDR process is supported by the evidence presented at the IDR in accordance with He-E 807.13(s) (1) - (3) and is consistent with all applicable federal regulations; and(5) Based on the review of all factors in (1) - (4) above, decide whether to uphold or overturn the deficiency(ies) findings at issue.(v) If the NF was successful in disputing the deficiency(ies), then: (1) The citing of a deficiency(ies) shall be rescinded;(2) A decision letter shall be sent to the NF which contains the following: a. An attendance roster of all parties at the IDR;b. The decision of the bureau chief that the deficiency is successfully refuted and the reason(s) why; andc. The signature of the bureau chief of the survey agency; and(3) A corrected CMS Form 2567 shall be sent to the NF.(w) If the NF was not successful in disputing the deficiency(ies), then a decision letter shall be sent to the NF which contains the following: (1) An attendance roster of all parties at the IDR;(2) The decision of the bureau chief that the deficiency was not successfully refuted and the reason(s) why; and(3) The signature of the bureau chief of the survey agency.(x) The decision of the bureau chief shall be final for any deficiency not resulting in the termination of the provider agreement or the imposition of a remedy specified in 42 CFR 488.406.N.H. Code Admin. R. He-E 807.13