04/30/2026

Survey Tip of the Week: Informal Dispute Resolution

Regulations at 42 CFR 488.331 require nursing facilities to be given an informal opportunity to dispute cited deficiencies upon the facility’s receipt of the official Form CMS-2567. In the April update to Centers for Medicare & Medicaid Services memo QSO-26-03-NH, CMS clarified key expectations for both facilities and State Agencies. Notably, once a facility submits a timely IDR request, the State must complete the process within 60 calendar days. The final IDR determination must clearly outline the result for each challenged deficiency and include a brief rationale supporting the decision.

CMS also outlines what is not appropriate for inclusion in the Informal Dispute Resolution (IDR) process. IDR is not intended to delay the imposition of remedies or to address broader concerns about the survey process. Specifically, IDR cannot be used to challenge:

• Scope and severity assessments of deficiencies with the exception of scope and severity assessments that constitute substandard quality of care or immediate jeopardy;
• Remedy(ies) imposed by the enforcing agency;
• Alleged failure of the survey team to comply with a requirement of the survey process;
• Alleged inconsistency of the survey team in citing deficiencies among facilities;
• Alleged inadequacy or inaccuracy of the informal dispute resolution process.

Additional details are outlined in the QSO-26-03-NH memo, and these clarifications will be incorporated into updates to the State Operations Manual, chapter 5 and chapter 7, which can be found on the CMS State Operations Manual webpage.