Resulting from the Patient Protection and Affordable Care Act (PPACA), CMS recently provided guidance to state survey agencies regarding independent informal dispute resolution (IIDR). As part of the Act, states will be required to provide independent informal dispute resolution to nursing homes as part of the certification process. 

The ISDH has had an independent informal dispute resolution process since 2004.  The current process allows for providers to request independent informal dispute resolution. The ISDH approved MPRO to conduct the independent reviews.  Under the existing system, the providers pay for the costs of the independent informal dispute resolution.  

Effective January 1, 2012, state survey agencies will be required to provide the option of an independent informal dispute resolution. The primary change will be that the cost of the independent informal dispute resolution will be paid by the state survey agencies through its CMS budget.

In preparation for this transition, the ISDH is terminating its existing independent informal dispute resolution option through MPRO effective immediately.  Any requests for the providerpaid MPRO review already in process will be completed through that process. No new requests for independent informal dispute resolution will be accepted until a new system is in place.  During this interim period, the only available informal dispute resolution process available to nursing homes will be the traditional ISDH IDR process with ISDH staff.

The ISDH is developing a new independent informal dispute resolution system consistent with the federal guidance. Details on the new process will be provided once they are completed.  Because of the payment component, the ISDH will need to contract with a qualified entity to provide the independent process. The ISDH expects the contract process to take a couple of months. The ISDH hopes to have a new independent informal dispute resolution process in place early in 2012.