APPLY FOR BENEFITS

Kevin S. Settlement

New Federal Changes

new mexico human services department logo

LOOKING FOR ASSISTANCE

hrSwirlsHeader

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.

Home » Informal Reconsideration of Findings

Informal Reconsideration of Findings

There are two different processes for initiating an Informal Reconsideration of Findings (IRF) based on whether you are disputing Abuse, Neglect & Exploitation (ANE) or a survey report findings. Please continue reading to determine the correct process for each respective situation.

Skip to:

Abuse, Neglect & Exploitation

Providers who wish to dispute the findings of a specific investigation report of ANE may do so by requesting an IRF for Incident Management Bureau (IMB).

The request must be submitted within 10 calendar days of being notified of the substantiated ANE. The request must be submitted using the Informal Reconsideration of Findings for Abuse, Neglect & Exploitation Request Form and should include supporting evidence.

Survey Report Findings

Providers who wish to dispute the specific finding(s) of a Quality Management Bureau (QMB) survey may do so by requesting an IRF for QMB. The request must be submitted using the Informal Reconsideration of Findings for Survey Reports Request Form.

Please see our Informal Reconsideration of Finding Process (Attachment C) document for more information about how the IRF process for QMB works.

 

REQUEST FOR INFORMAL RECONSIDERATION OF FINDINGS (IRF) - IMB

Instructions for completing the Request for Informal Reconsideration of Findings (IRF) Form

Instructions for Completing the
IMB Request for Informal Reconsideration of Findings (IRF) Form

  1. Complete Part A, including the IMB case number.
  2. Complete Part B. Provide a detailed explanation about why the
    substantiated finding should be overturned.
    • Provide any documentation or evidence that supports your request.
    • Provide the name(s) of any additional witnesses who were not interviewed by IMB.
  3. Please make sure to read and check the “Consent Acknowledgement” section to finalize your submission, as this constitutes your electronic signature. The form must be electronically signed by the Accused Person or Agency Director.
  4. The form must be received with all supporting documentation within
    10 calendar days of receipt of the “closure letter.”
  5. If you have questions about the IRF process, email the
    DHI Deputy Director at
    Teri.Cotter@hca.nm.gov for assistance.
  6. Please submit your IRF application using the form below. Make sure to attach any supporting evidence using the “file upload” option within the form.

Note Regarding the IRF Process

Provider IRF Process

The IRF process is informal and is provided as a courtesy to Providers.
During the IRF process, providers must continue to implement their
“Immediate Action and Safety Plan” and
“Corrective Preventative Action Plan.”

The IRF review is a desk review and does not include a provision
for a face-to-face meeting between the provider and the IMB Bureau Chief.

When the IRF request is received, it will be processed and, if approved,
forwarded to the IMB Bureau Chief for review of the case.

Providers will be notified of the IRF outcome.

Failure to comply with requirements for filing an IRF (1 through 4 above)
may stop the IRF from occurring.

Accused Person IRF Process

The IRF process is informal and is provided as a courtesy to an
accused person or provider agency substantiated for
abuse, neglect, or exploitation as the result of an IMB investigation.

The IRF review is a desk review and does not include a provision
for a face-to-face meeting between the Accused Person/Agency and the Reviewer.

The person conducting the review shall be neutral and have no direct involvement
with the investigation or substantiation.

The reviewer shall issue a written decision within 30 days, explaining why the
substantiation, by preponderance of evidence, is
modified, affirmed, or reversed.

The decision by the person conducting the IRF is final and non-appealable,
except as otherwise provided by law.

IRF Form (IMB)

INCIDENT MANAGEMENT BUREAU REQUEST OF INFORMAL RECONSIDERATION OF FINDINGS (IRF)

Part A:

MM slash DD slash YYYY

Part B:

Please upload any additional evidence or documentation.
Drop files here or
Max. file size: 500 MB, Max. files: 10.
    Consent(Required)
    MM slash DD slash YYYY

     

     

    REQUEST FOR INFORMAL RECONSIDERATION OF FINDINGS (IRF) - QMB

    Instructions for Completing the Request for Informal Reconsideration of Findings (IRF) Form
    1. Complete Part A, including agency information and QMB survey information.
    2. Complete Part B (Only use one form per disputed tag. If needed, use additional forms.)
      • Include the TAG NUMBER.
      • Include the standard or regulation cited and the finding.
      • Include the rationale for disputing the finding.
      • Include all supporting evidence to verify compliance with the required standard or regulation.
    3. The Executive Director or Designee must sign and date the request form (electronic signatures are acceptable).
    4. The form must be received with all supporting evidence within 10 working days of receipt of the QMB Final Report of Findings.
      Please note: No extension is granted for this process.
    5. If you have questions about the IRF process, email the IRF Chairperson, Valerie V. Valdez, at valerie.valdez@hca.nm.gov for assistance.
    6. Please submit your IRF forms and supporting evidence via mail to:
      ATTN: DHI QMB Bureau Chief
      Request for Informal Reconsideration of Findings
      3900 Masthead, Suite 200
      Albuquerque, NM 87109
      Attention: DHI QMB IRF Request

    Note Regarding the IRF Process

    The IRF process is informal and is provided as a courtesy to Providers. During the IRF process, providers must continue to implement their Plan of Correction. The IRF review is a desk review and does not include a provision for a face-to-face meeting between the provider and the IRF Committee.

    When the IRF request is received, it will be processed and, if approved, forwarded to the IRF Committee for review of the case.

    The IRF Committee is comprised of one member from DHI and one member from DDSD. The Committee reviews each disputed tag/deficiency and will make a recommendation of Removal, Modification, or may Uphold the disputed tag/deficiency.

    Providers will be notified of the IRF outcome.

    Failure to comply with requirements for filing an IRF (1 through 4 above) may stop the IRF from occurring.

    IRF Form (QMB)

    REQUEST FOR INFORMAL RECONSIDERATION OF FINDINGS (IRF) - QMB

    Part A:

    MM slash DD slash YYYY
    Select Waiver Type(Required)

    Part B:

    Dispute of Findings Information (click the plus sign to add additinoal rows)(Required)
    Tag #
    Title of Standard / Regulation and Finding in Question
    Rational for Dispute of Findings: (attachments must include all supporting evidence to be reviewed)
     
    Please include any supporting documentation here.
    Drop files here or
    Accepted file types: pdf, jpg, doc, docx, png, csv, Max. file size: 500 MB, Max. files: 10.
      Executive Director or Designee
      MM slash DD slash YYYY
      Consent(Required)