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The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Health Facility Dispute Resolution Process
All health facilities have the right the dispute the findings of a survey which results in intermediate sanctions. The type of dispute resolution process available depends on the type of health facility.
Intermediate Sanctions
Measures imposed on a facility for violations of applicable licensing laws and regulations other than license revocation, suspension, denial of license renewal, or loss of certification.
A list of intermediate sanctions include the following.
- Directed Plan of Correction
- Facility Monitors
- Temporary Management
- Restricted Admissions or Provision of Services
- Reduction of Licensed Capacity
- Civil Monetary Penalty
Hearing Requests
Informal Dispute Resolution
Any assisted living facility, nursing home, or home health agency may request an Informal Dispute Resolution (IDR).
The health facility shall be notified at the same time they receive a statement of deficiencies of their right to request informal review of specific deficiencies.
The written request for the IDR and supporting documentation must be postmarked within 10 calendar days (or the next day if the 10th calendar day falls on a holiday or a weekend) of receipt of the statement of deficiencies.
Please read the Informal Dispute Resolution Committee Operating Rules for Nursing Homes or Informal Dispute Resolution Committee Operating Rules for Home Health Agencies or Informal Dispute Resolution Committee Operating Rules for Assisted Living Facilities for complete details on how to get the process started.
NOTE: The request for Informal Review does not relieve the facility from providing an acceptable plan of correction within ten calendar days of receipt of the statement of deficiencies.
Independent Informal Dispute Resolution
The Independent Informal Dispute Resolution (IIDR) process applies to Medicare funded skilled nursing facilities or a dually (Medicare and Medicaid) participating Skilled Nursing Facility/Nursing Facility (SNF/NF).
The New Mexico State survey agency, in accordance with sections 1819(h)(2)(B)(ii)(IV) and 1919(h)(2)(B)(ii)(IV) of the Social Security Act (the Act), regulations at 42 CFR §488.331 and §488.431 and the State Operations Manual section 7213, will provide the opportunity to participate in an IIDR when the Centers for Medicare and Medicaid Services imposes a civil money penalty against a Medicare-participating SNF or a dually (Medicare and Medicaid) participating SNF/NF and the penalty will be collected and placed in an escrow account pending a final administrative decision.
The IIDR Process only applies to Medicare funded Nursing Facilities and Skilled Nursing facilities which have had a Federal Civil Monetary Penalty imposed.
Please read our Independent Informal Dispute Resolution Policy & Procedures for full details on the process. You’ll then need to fill out the Independent Informal Dispute Resolution Request Form to get the process started.