Beginning this fall, Residential Care Services (RCS) will launch an Adult Family Home (AFH) IDR (Informal Dispute Resolution) pilot project using a 5 person panel with expertise/familiarity with AFH operations in lieu of RCS staff.

RCS chose to initiate an alternative IDR process beginning with AFH as a trial before broadening it to Assisted Living and Skilled Nursing.  Application of a panel IDR process in SNF is more complicated given the regulatory and compliance oversight of the federal government which is delegates to the state agency.  As such, CMS has stated:

• The State Agency (SA) cannot delegate the final IDR decision.  The SA is solely responsible for the decision.
• While CMS does give states latitude to develop a review panel for IDRs, they would only be able to make recommendations to the SA.

Despite the governing CMS and applicable SNF survey procedures, LeadingAge continues to believe there are ways in which a panel review could be beneficial as long as the basis for their findings and conclusions are transparent and as long as the state maintains its final authority while granting the panel deference.  Further conversations on the use of a panel IDR for assisted living and SNFs will follow as the department learns from the AFH experiences.

Pilot Overview

The purpose of the panel is to conduct Informal Dispute Resolution meetings for Adult Family Home Providers.  The panel will hear opinions and review documents from AFH provider’s as well as the RCS staff responsible for issuing the citations and/or enforcement actions in dispute.

The panel will make recommendations to the RCS panel chair regarding the citation(s) in dispute. This panel will include two AFH providers, one RCS staff, one service consumer (for example, a resident, resident representative, ombudsman etc.) and an RCS panel chair.  RCS will begin evaluating the effectiveness of the panel after three months and report outcomes in the months that follow.  They expect the IDR panel project to last for six months before making any decisions about whether or not it will expand to other programs.