37.5.603 OPPORTUNITY FOR INFORMAL DISPUTE RESOLUTION
(1) A facility may request an informal dispute resolution to refute a deficiency citation made by the state survey agency.
(2) An informal dispute resolution is a different and separate form of procedure from an administrative review and/or fair hearing. A facility is not entitled to an administrative review, fair hearing or other process in addition to an informal dispute resolution unless specifically provided for by department rule or otherwise required by law.
(3) Informal dispute resolution is an informal opportunity for the facility to dispute deficiency citations. Informal dispute resolutions conducted under this chapter are subject to neither the provisions of the Montana Administrative Procedure Act, Title 2, chapter 4, MCA, nor to statutory rules or provisions regarding civil procedure or evidence.
(4) This rule does not require that the informal dispute resolution be conducted prior to the state survey agency making a recommendation to the CMS.
(5) Nothing in this chapter shall be construed to impede, prevent or delay any enforcement action or proceedings by the CMS or the department, acting as the State Medicaid Agency.
(6) The determination of the presiding official who conducts the informal dispute resolution is not binding upon CMS nor does it affect any right the facility may have to pursue any available federal administrative hearings or appeals processes.
(7) Only one informal dispute resolution to dispute deficiencies cited is available for either a standard survey or a complaint investigation survey.
(8) Regardless of whether a facility has used the opportunity for informal dispute resolution at the standard or complaint investigation survey, a facility may request an additional informal dispute resolution under the following circumstances:
(a) if a deficiency cited as a result of a standard or complaint survey continues at a survey revisit (that is, the facility has failed to correct a deficiency cited as a result of the standard or complaint survey prior to the revisit), the facility may request informal dispute resolution to dispute citation of the deficiency at the survey revisit;
(b) if a new deficiency is cited as a result of a survey revisit or as the result of an informal dispute resolution, the facility may request informal dispute resolution to dispute citation of the deficiency at the survey revisit or following informal dispute resolution; or
(c) if, on the basis of new facts discovered at the survey revisit, or as the result of an informal dispute resolution, a new example of a deficiency cited as a result of a standard or complaint survey is added following the survey revisit, or following informal dispute resolution, the facility may request informal dispute resolution to dispute the new example of the deficiency citation.
(9) A second informal dispute resolution is not available if a different deficiency is cited at the survey revisit or as a result of an informal dispute resolution but the factual basis for the deficiency is the same as the factual basis for a deficiency cited in the original standard or complaint investigation.
(10) Scope and severity classification of the deficiency citation(s) shall not be the sole basis of a facility's dispute of a state survey agency deficiency citation unless the scope and severity assessment constitutes substandard quality of care or immediate jeopardy. The informal dispute resolution process may, however, result in a change in the scope and severity classification.
History: 53-6-109, 53-6-113, MCA; IMP, 53-6-109, 53-6-113, MCA; NEW, 2004 MAR p. 736, Eff. 4/9/04.