Informal Dispute Resolution Procedure

A facility may challenge cited deficiencies through a process called Informal Dispute Resolution (IDR).

Purpose: To offer nursing home providers the opportunity to dispute cited deficiencies with the entity that conducted the survey.


  1. Availability of informal dispute resolution. If the provider believes that a specific deficiency or any finding within a deficiency cited by a survey or complaint investigation is factually inaccurate and would like the opportunity to dispute the specific deficiency and/or finding(s), the provider will be given one opportunity to do so. IDR requests, and an explanation of why a deficiency is being disputed must be submitted in writing within the 10 days afforded the facility to submit a plan of correction. If the provider exceeds this time frame, the IDR coordinator will deny the request for IDR. If the provider desires further discussion, the IDR coordinator will refer the provider to section management.

    The request must be submitted via email to [email protected] for the Nursing Home Section or to [email protected] for the Construction Section.

  2. IDR format. The IDR may be conducted through virtual format, telephone conference call or an office review of deficiencies and material.

    a. IDR panel members may consist of two surveyors and a member of the North Carolina Health Care Facilities Association Standards and Ethics Committee, a member of the LeadingAge North Carolina, or a state-operated nursing home representative (See Guidelines for Facility Participation).

  3. Submission of additional written material. The facility may email additional written information for review to the IDR coordinator but must do so by the date specified in the letter notifying the facility of deficiencies cited so that the survey team and IDR panel can review the information prior to the IDR. The IDR may be held without submission of additional written material. The submission of additional written information at the IDR meeting is not allowed. Any written material pertaining to conduct or attitude of a surveyor(s) should be brought to the attention of Division of Health Service Regulation management and shall not be submitted with the IDR information.

  4. Scheduling IDRs. Upon receipt of a written request for IDR, the IDR coordinator will verify that the IDR has been requested in accordance with the provisions of federal regulation. When first received, additional written material submitted in accordance with the requirements in paragraph 3 above by the facility will be shared only with the survey team to determine what effect there may be on a deficiency(ies). The facility will be notified of any changes and asked to confirm that informal dispute resolution is still desired. Any changes to the CMS 2567, whether by the survey team or an IDR panel will be considered an IDR. If the facility still requests to contest a deficiency(ies), the IDR format (meeting, office review, conference call) will be confirmed and the date and time when the IDR will be held will be identified. IDR meetings are normally scheduled monthly. The IDR may be rescheduled one time only.

  5. Notification of and attendance at IDR. The IDR coordinator ensures that the IDR panel, survey team, branch and section management and State Long-Term Care Ombudsman are notified of the facilities requesting IDR, IDR format, date, time, and location of meetings. Attorneys and their employees may not attend the IDR meeting; however, the following individuals may attend the IDR meeting under the conditions stated, and are responsible to protect the confidentiality of resident information:

    1. Facility representatives and staff;
    2. Survey team members and Nursing Home Licensure and Certification Section management staff;
    3. State Long-Term Care (LTC) and Regional Ombudsman; and
    4. Resident, individual or agency who is a legal guardian or has a medical power of attorney. These individuals can stay only during discussion of information pertinent to the specific resident. The resident, legal guardian, individual or agency having medical power of attorney will be identified and signed authorization forms will be verified prior to the start of the meeting.

  6. IDR panel activity. The IDR coordinator will ensure that survey results and materials submitted by the facility to dispute deficiencies and/or findings are provided to the IDR panel for review. Only those deficiencies identified in the facility’s request will be reviewed in informal dispute resolution. IDR meetings are scheduled for a one-hour time frame with an exception in the case when the number of tags disputed cannot reasonably be reviewed and discussed within one hour. Facility staff, survey team members, ombudsman, the resident, legal guardian, or medical power of attorney, may provide verbal information pertinent to deficiencies and findings being disputed and respond to questions from panel members (as usual, survey team members are expected to keep their demeanor professional, respectful and non-confrontational when offering information which may be contrary with information the facility provides.) The resident, legal guardian, or medical power of attorney may be present and participate only for deficiencies and findings involving the specific resident. With the exception of facility staff, oral statements will be limited to five minutes.

  7. Decision. The IDR panel may decide that a deficiency or finding is to be upheld or deleted, or that a deficiency is to be upheld with deletion of a finding(s), or that scope and severity of immediate jeopardy or substandard quality of care should be decreased. The IDR panel may not decide to move a deficiency or decide that a deficiency or finding is to be rewritten. A decision will be submitted in writing to the IDR coordinator at the completion of the process. The decision will be shared with the provider and State Survey Agency. An individual objecting to the IDR decision must do so to the IDR coordinator within five working days after the IDR date. The Division of Health Service Regulation may override the decision of the IDR panel. The IDR coordinator will share the decision and reasoning for the decision with the facility no later than 10 days by letter. A copy of the letter will be sent to the State LTC Ombudsman.

  8. Actions generated by IDR. When the IDR panel decides that a deficiency or finding should not have been cited, the following actions shall occur as applicable:

    1. A new CMS-2567 will be issued.
    2. Recommend rescission of enforcement actions imposed by CMS solely because of the deficiency or finding that was deleted.

  9. Invalid use of IDR. The facility cannot use the IDR process to delay the formal imposition of remedies or to challenge any other aspect of the survey process, including the:

    1. Remedy imposed by the enforcing agency;
    2. Failure of the survey team to comply with a requirement of the survey process;
    3. Inconsistency of the survey team in citing deficiencies among facilities;
    4. Inadequacy or inaccuracy of the IDR process; or
    5. Surveyor behavior.