|(a) The Texas Health and Human Services Commission
(HHSC) provides an informal dispute resolution (IDR) process for nursing
facilities and intermediate care facilities for individuals with an
intellectual disability or related conditions (ICF/IID) (hereinafter
referred to collectively as "facility") through which a facility may
dispute deficiencies/violations cited against that facility by the
State survey agency or its designee.
(b) HHSC must receive a facility's written request
for an IDR no later than the 10th calendar day after the facility's
receipt of the statement of deficiencies/violations from the State
survey agency or its designee. If the 10th calendar day falls on a
Saturday, Sunday, or legal holiday, the due date becomes the following
business day. The facility must submit its written request for an
IDR on the form designated for that purpose by HHSC. HHSC will make
that form publicly available, e.g., maintained on the HHSC website.
(c) Within three business days of its receipt of the
facility's written request for an IDR, HHSC will notify the facility
and the State survey agency's regional office under which the facility
operates of its receipt of the request.
(d) Within five calendar days of HHSC's receipt of
the facility's request for an IDR, HHSC must receive from the facility
two copies of the facility's rebuttal letter and attached supporting
documentation. If the 5th calendar day falls on a Saturday, Sunday,
or legal holiday, the due date becomes the following business day.
The rebuttal letter must contain:
(1) a list of the deficiencies/violations disputed
(only those deficiencies/violations listed on the IDR request form
and addressed in the rebuttal letter/supporting documentation will
(2) the reason(s) each deficiency/violation is disputed;
(3) the outcome desired by the facility for each disputed
(e) The facility submits its supporting documentation
or information in the following format:
(1) Organize the attachments by deficiency/violation
and cross-reference to the disputed deficiency/violation in the rebuttal
(2) Ensure all information is labeled and legible.
(3) Highlight information relevant to the disputed
deficiency/violation, such as a particular portion of a narrative.
(4) Describe the relevance of the documentation/information
to the disputed deficiency/violation.
(5) Do not de-identify documents that name residents
referenced in disputed deficiencies/violations.
(6) Submit supporting documentation or information
by regular mail, hand delivery, or overnight delivery. HHSC will not
review supporting documentation submitted by facsimile transmission.
(f) If the facility substantially complies with the
procedures set out in subsections (d) and (e) of this section, HHSC
will proceed with its review of the facility's IDR request.
(g) It is the facility's responsibility to present
sufficient credible information to HHSC to support the outcome requested
by the facility.
(1) Possible outcomes of an IDR for nursing facilities
and ICF/IID are:
(A) a determination that there is insufficient evidence
to sustain a deficiency/violation;
(B) a determination that there is insufficient evidence
to sustain a portion or a finding of a deficiency/violation;
(C) a determination that there is sufficient evidence
to sustain a deficiency/violation; or
(D) a determination that there is insufficient evidence
to sustain the deficiency/violation as cited but that there is sufficient
evidence to sustain a different citation.
(2) In addition to the outcomes stated in paragraph
(1) of this subsection, possible additional outcomes of an IDR for
nursing facilities only include:
(A) a determination that there is insufficient evidence
to sustain the severity and scope assessment but that there is sufficient
evidence to sustain a reduced severity and scope assessment (for Immediate
Jeopardy or Substandard Quality of Care only); or
(B) a determination that there is sufficient evidence
to sustain the severity and scope assessment as cited.
(h) HHSC will not conduct an IDR based on alleged surveyor
misconduct, alleged State survey agency failure to comply with survey
protocol, complaints about existing federal or State standards, or
attempts to clear previously corrected deficiencies/violations.
(i) Upon receipt of the facility's IDR request, the
State survey agency must submit to HHSC by means allowing confirmation
of HHSC's receipt, e.g., overnight delivery or electronic mail, the
following supporting documentation as specified in the IDR operating
(1) resident identifier list;
(2) report of contact; and
(3) Automated Survey Processing Environment (ASPEN)
event ID number.
(j) Any information related to an IDR request that
is received by HHSC from either the facility or the State survey agency
will be made available by HHSC to the opposing party. Parties have
until the end of the second business day after receipt of such shared
IDR information to respond to HHSC about that information. HHSC will
share any responses with the opposing party.
(k) HHSC may request additional information from the
facility and/or the State survey agency. Both parties will be notified
of the request for additional information and have until the end of
the second business day after notification to respond to the request.
The opposing party will be provided with copies of the response submitted
(l) Ex parte communications by the facility or by the
State survey agency with HHSC personnel conducting the IDR are prohibited.
(m) An eligible facility may receive a telephone or
face-to-face IDR conference provided that the facility requested an
IDR conference on the IDR request form.
(n) Any telephone or face-to-face IDR conference will
be scheduled on or before the 22nd calendar day after HHSC received
the IDR request. If the facility is unable to participate on the scheduled
date, the IDR conference will be cancelled, and the IDR will continue
as though no conference had been requested.
(o) The IDR conference is an opportunity for an eligible
facility to emphasize important information previously submitted in
the facility's rebuttal letter or response(s) to shared information.
The facility and the State survey agency may attend any IDR conference,
but neither party may present new information.
(p) HHSC will complete the IDR no later than the 30th
calendar day after receipt of the facility's written request. If the
30th calendar day falls on a Saturday, Sunday or legal holiday, the
due date becomes the following business day. The IDR decision shall
be in writing, address all the issues raised by the facility, and
explain the rationale for the decision.
(q) The time frames designated in the IDR process shall
be computed in accordance with §311.014, Texas Government Code.
(r) HHSC may issue and enforce operating procedures
concerning the IDR process and the conduct of IDR participants. IDR
participants must comply with any such procedures. HHSC may deny an
IDR request if the information submitted is incorrect, incomplete,
or otherwise not in compliance with applicable HHSC operating procedures.
(s) HHSC will revise an IDR decision as a result of
a review, requested by the State survey agency, and subsequent determination
that the IDR decision may violate a federal law, regulation, or the
CMS State Operations Manual.