Definitions--contracting with third parties--department to establishIDR process, procedures--rulemaking authority.
198.545. 1. This section shall be known and may be cited as the"Missouri Informal Dispute Resolution Act".
2. As used in this section, the following terms shall mean:
(1) "Deficiency", a facility's failure to meet a participationrequirement or standard, whether state or federal, supported by evidencegathered from observation, interview, or record review;
(2) "Department", the department of health and senior services;
(3) "Facility", a long-term care facility licensed under thischapter;
(4) "IDR", informal dispute resolution as provided for in thissection;
(5) "Independent third party", the federally designated MedicareQuality Improvement Organization in this state;
(6) "Plan of correction", a facility's response to deficiencies whichexplains how corrective action will be accomplished, how the facility willidentify other residents who may be affected by the deficiency practice,what measures will be used or systemic changes made to ensure that thedeficient practice will not reoccur, and how the facility will monitor toensure that solutions are sustained;
(7) "QIO", the federally designated Medicare Quality ImprovementOrganization in this state.
3. The department of health and senior services shall contract withan independent third party to conduct informal dispute resolution (IDR) forfacilities licensed under this chapter. The IDR process, includingconferences, shall constitute an informal administrative process and shallnot be construed to be a formal evidentiary hearing. Use of IDR under thissection shall not waive the facility's right to pursue further oradditional legal actions.
4. The department shall establish an IDR process to determine whethera cited deficiency as evidenced by a statement of deficiencies against afacility shall be upheld. The department shall promulgate rules toincorporate by reference the provisions of 42 CFR 488.331 regarding the IDRprocess and to include the following minimum requirements for the IDRprocess:
(1) Within ten working days of the end of the survey, the departmentshall by certified mail transmit to the facility a statement ofdeficiencies committed by the facility. Notification of the availabilityof an IDR and IDR process shall be included in the transmittal;
(2) Within ten calendar days of receipt of the statement ofdeficiencies, the facility shall return a plan of correction to thedepartment. Within such ten-day period, the facility may request inwriting an IDR conference to refute the deficiencies cited in the statementof deficiencies;
(3) Within ten working days of receipt for an IDR conference made bya facility, the QIO shall hold an IDR conference unless otherwise requestedby the facility. The IDR conference shall provide the facility with anopportunity to provide additional information or clarification in supportof the facility's contention that the deficiencies were erroneously cited.The facility may be accompanied by counsel during the IDR conference. Thetype of IDR held shall be at the discretion of the facility, but shall belimited to:
(a) A desk review of written information submitted by the facility;or
(b) A telephonic conference; or
(c) A face-to-face conference held at the headquarters of the QIO orat the facility at the request of the facility.
If the QIO determines the need for additional information, clarification,or discussion after conclusion of the IDR conference, the department andthe facility shall be present.
5. Within ten days of the IDR conference described in subsection 4 ofthis section, the QIO shall make a determination, based upon the facts andfindings presented, and shall transmit the decision and rationale for theoutcome in writing to the facility and the department.
6. If the department disagrees with such determination, thedepartment shall transmit the department's decision and rationale for thereversal of the QIO's decision to the facility within ten calendar days ofreceiving the QIO's decision.
7. If the QIO determines that the original statement of deficienciesshould be changed as a result of the IDR conference, the department shalltransmit a revised statement of deficiencies to the facility with thenotification of the determination within ten calendar days of the decisionto change the statement of deficiencies.
8. Within ten calendar days of receipt of the determination made bythe QIO and the revised statement of deficiencies, the facility shallsubmit a plan of correction to the department.
9. The department shall not post on its web site or enter into theCenters for Medicare & Medicaid Services Online Survey, Certification andReporting System, or report to any other agency, any information about thedeficiencies which are in dispute unless the dispute determination is madeand the facility has responded with a revised plan of correction, ifneeded.
10. Any rule or portion of a rule, as that term is defined in section536.010, RSMo, that is created under the authority delegated in thissection shall become effective only if it complies with and is subject toall of the provisions of chapter 536, RSMo, and, if applicable, section536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and ifany of the powers vested with the general assembly pursuant to chapter 536,RSMo, to review, to delay the effective date, or to disapprove and annul arule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2009, shall beinvalid and void.
Definitions--contracting with third parties--department to establishIDR process, procedures--rulemaking authority.
198.545. 1. This section shall be known and may be cited as the"Missouri Informal Dispute Resolution Act".
2. As used in this section, the following terms shall mean:
(1) "Deficiency", a facility's failure to meet a participationrequirement or standard, whether state or federal, supported by evidencegathered from observation, interview, or record review;
(2) "Department", the department of health and senior services;
(3) "Facility", a long-term care facility licensed under thischapter;
(4) "IDR", informal dispute resolution as provided for in thissection;
(5) "Independent third party", the federally designated MedicareQuality Improvement Organization in this state;
(6) "Plan of correction", a facility's response to deficiencies whichexplains how corrective action will be accomplished, how the facility willidentify other residents who may be affected by the deficiency practice,what measures will be used or systemic changes made to ensure that thedeficient practice will not reoccur, and how the facility will monitor toensure that solutions are sustained;
(7) "QIO", the federally designated Medicare Quality ImprovementOrganization in this state.
3. The department of health and senior services shall contract withan independent third party to conduct informal dispute resolution (IDR) forfacilities licensed under this chapter. The IDR process, includingconferences, shall constitute an informal administrative process and shallnot be construed to be a formal evidentiary hearing. Use of IDR under thissection shall not waive the facility's right to pursue further oradditional legal actions.
4. The department shall establish an IDR process to determine whethera cited deficiency as evidenced by a statement of deficiencies against afacility shall be upheld. The department shall promulgate rules toincorporate by reference the provisions of 42 CFR 488.331 regarding the IDRprocess and to include the following minimum requirements for the IDRprocess:
(1) Within ten working days of the end of the survey, the departmentshall by certified mail transmit to the facility a statement ofdeficiencies committed by the facility. Notification of the availabilityof an IDR and IDR process shall be included in the transmittal;
(2) Within ten calendar days of receipt of the statement ofdeficiencies, the facility shall return a plan of correction to thedepartment. Within such ten-day period, the facility may request inwriting an IDR conference to refute the deficiencies cited in the statementof deficiencies;
(3) Within ten working days of receipt for an IDR conference made bya facility, the QIO shall hold an IDR conference unless otherwise requestedby the facility. The IDR conference shall provide the facility with anopportunity to provide additional information or clarification in supportof the facility's contention that the deficiencies were erroneously cited.The facility may be accompanied by counsel during the IDR conference. Thetype of IDR held shall be at the discretion of the facility, but shall belimited to:
(a) A desk review of written information submitted by the facility;or
(b) A telephonic conference; or
(c) A face-to-face conference held at the headquarters of the QIO orat the facility at the request of the facility.
If the QIO determines the need for additional information, clarification,or discussion after conclusion of the IDR conference, the department andthe facility shall be present.
5. Within ten days of the IDR conference described in subsection 4 ofthis section, the QIO shall make a determination, based upon the facts andfindings presented, and shall transmit the decision and rationale for theoutcome in writing to the facility and the department.
6. If the department disagrees with such determination, thedepartment shall transmit the department's decision and rationale for thereversal of the QIO's decision to the facility within ten calendar days ofreceiving the QIO's decision.
7. If the QIO determines that the original statement of deficienciesshould be changed as a result of the IDR conference, the department shalltransmit a revised statement of deficiencies to the facility with thenotification of the determination within ten calendar days of the decisionto change the statement of deficiencies.
8. Within ten calendar days of receipt of the determination made bythe QIO and the revised statement of deficiencies, the facility shallsubmit a plan of correction to the department.
9. The department shall not post on its web site or enter into theCenters for Medicare & Medicaid Services Online Survey, Certification andReporting System, or report to any other agency, any information about thedeficiencies which are in dispute unless the dispute determination is madeand the facility has responded with a revised plan of correction, ifneeded.
10. Any rule or portion of a rule, as that term is defined in section536.010, RSMo, that is created under the authority delegated in thissection shall become effective only if it complies with and is subject toall of the provisions of chapter 536, RSMo, and, if applicable, section536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and ifany of the powers vested with the general assembly pursuant to chapter 536,RSMo, to review, to delay the effective date, or to disapprove and annul arule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2009, shall beinvalid and void.
Definitions--contracting with third parties--department to establishIDR process, procedures--rulemaking authority.
198.545. 1. This section shall be known and may be cited as the"Missouri Informal Dispute Resolution Act".
2. As used in this section, the following terms shall mean:
(1) "Deficiency", a facility's failure to meet a participationrequirement or standard, whether state or federal, supported by evidencegathered from observation, interview, or record review;
(2) "Department", the department of health and senior services;
(3) "Facility", a long-term care facility licensed under thischapter;
(4) "IDR", informal dispute resolution as provided for in thissection;
(5) "Independent third party", the federally designated MedicareQuality Improvement Organization in this state;
(6) "Plan of correction", a facility's response to deficiencies whichexplains how corrective action will be accomplished, how the facility willidentify other residents who may be affected by the deficiency practice,what measures will be used or systemic changes made to ensure that thedeficient practice will not reoccur, and how the facility will monitor toensure that solutions are sustained;
(7) "QIO", the federally designated Medicare Quality ImprovementOrganization in this state.
3. The department of health and senior services shall contract withan independent third party to conduct informal dispute resolution (IDR) forfacilities licensed under this chapter. The IDR process, includingconferences, shall constitute an informal administrative process and shallnot be construed to be a formal evidentiary hearing. Use of IDR under thissection shall not waive the facility's right to pursue further oradditional legal actions.
4. The department shall establish an IDR process to determine whethera cited deficiency as evidenced by a statement of deficiencies against afacility shall be upheld. The department shall promulgate rules toincorporate by reference the provisions of 42 CFR 488.331 regarding the IDRprocess and to include the following minimum requirements for the IDRprocess:
(1) Within ten working days of the end of the survey, the departmentshall by certified mail transmit to the facility a statement ofdeficiencies committed by the facility. Notification of the availabilityof an IDR and IDR process shall be included in the transmittal;
(2) Within ten calendar days of receipt of the statement ofdeficiencies, the facility shall return a plan of correction to thedepartment. Within such ten-day period, the facility may request inwriting an IDR conference to refute the deficiencies cited in the statementof deficiencies;
(3) Within ten working days of receipt for an IDR conference made bya facility, the QIO shall hold an IDR conference unless otherwise requestedby the facility. The IDR conference shall provide the facility with anopportunity to provide additional information or clarification in supportof the facility's contention that the deficiencies were erroneously cited.The facility may be accompanied by counsel during the IDR conference. Thetype of IDR held shall be at the discretion of the facility, but shall belimited to:
(a) A desk review of written information submitted by the facility;or
(b) A telephonic conference; or
(c) A face-to-face conference held at the headquarters of the QIO orat the facility at the request of the facility.
If the QIO determines the need for additional information, clarification,or discussion after conclusion of the IDR conference, the department andthe facility shall be present.
5. Within ten days of the IDR conference described in subsection 4 ofthis section, the QIO shall make a determination, based upon the facts andfindings presented, and shall transmit the decision and rationale for theoutcome in writing to the facility and the department.
6. If the department disagrees with such determination, thedepartment shall transmit the department's decision and rationale for thereversal of the QIO's decision to the facility within ten calendar days ofreceiving the QIO's decision.
7. If the QIO determines that the original statement of deficienciesshould be changed as a result of the IDR conference, the department shalltransmit a revised statement of deficiencies to the facility with thenotification of the determination within ten calendar days of the decisionto change the statement of deficiencies.
8. Within ten calendar days of receipt of the determination made bythe QIO and the revised statement of deficiencies, the facility shallsubmit a plan of correction to the department.
9. The department shall not post on its web site or enter into theCenters for Medicare & Medicaid Services Online Survey, Certification andReporting System, or report to any other agency, any information about thedeficiencies which are in dispute unless the dispute determination is madeand the facility has responded with a revised plan of correction, ifneeded.
10. Any rule or portion of a rule, as that term is defined in section536.010, RSMo, that is created under the authority delegated in thissection shall become effective only if it complies with and is subject toall of the provisions of chapter 536, RSMo, and, if applicable, section536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and ifany of the powers vested with the general assembly pursuant to chapter 536,RSMo, to review, to delay the effective date, or to disapprove and annul arule are subsequently held unconstitutional, then the grant of rulemakingauthority and any rule proposed or adopted after August 28, 2009, shall beinvalid and void.
