RFQ OHCR IDR Template FY27_FY28~2.docx

ILLINOIS DEPARTMENT OF PUBLIC HEALTH

R E Q U E S T F O R Q U O T E AGENCY: Illinois Department of Public Health Office of Health Care Regulation CONTACT NAME: Aaron Szerletich CONTACT EMAIL: aaron.szerletich@illinois.gov

SPECIFICATIONS

CONTRACT LENGTH: 7/1/2026 – 6/30/2028 / FY27 & FY28

ESTIMATED TOTAL HOURS REQUIRED: ~150 Hours per year (~300 hours over 2 years) *****Base your quote on a per hour rate*****

WORK LOCATION: Service to be completed at the Contractor’s Office

REQUIRED SERVICES Informal Dispute Resolution (IDR) The contractor will provide Federal Informal Dispute Resolution (IDR) as required under Chapter 7, section 7212 of the Centers for Medicare and Medicaid Services (CMS) State Operations Manual (SOM). The Contractor will provide a written review record for each disputed survey citation and a summary of the IDR recommendation for each deficiency.

42 CRF §488.331; Chapter 7; Section 7212 (State Operations Manual [SOM]) requires that the Centers for Medicare and Medicaid Services (CMS) and the State to provide skilled nursing facilities, nursing facilities, and dually participating facilities, an informal opportunity to dispute cited deficiencies upon the facility’s receipt of the official form CMS-2567.

The services will be paid for by the facility, not the Illinois Department of Public Health.

Must be able to:

· Review surveys (CMS 2567) with an understanding of CMS Federal regulations.

· Recommend to IDPH whether survey deficiency/deficiencies should be deleted, supported, or amended based upon the evidence provided by the Facility.

· Complete all reviews within 20 calendar days.

· Compare survey results to the Federal regulations.

· Provide written decisions and specific evidence regarding the decision.

· Accept facility requests and evidence together, whether the entity supplies a secure link upfront or accepts the facility’s secure email.

MANDATORY QUALIFICATIONS

Federal Requirements: Qualifications of an Informal Dispute Resolution Entity or Person(s) To be approved as an IDR entity or person, the entity or person must meet the following requirements:

Expertise and Training:

Knowledge and understanding related to Medicare and Medicaid program requirements, including:

· 42 CFR §488.331 (nursing homes); Chapter 7; Section 7212; (The State Operations Manual [SOM]), Definitions, and Appendix J - Appendix PP - Appendix Q - Appendix Z

· Applicable health care standards of practice, health care management, and/or life safety code knowledge and experience, as well as emergency preparedness, are relevant to the disputed issues.

· Three (3) years of experience related to nursing home facility compliant and non-compliant surveys.

Independence:

· Has no financial interest in a nursing home or any company with ownership of a nursing home.

· Must be an independent entity or person with an understanding of specific Medicare and Medicaid program requirements selected by the State.

· Cannot have acted within the past year as legal counsel for or against any long-term care facility.

· Cannot have been employed by the State survey agency or the State ombudsman program within the past year.

· Cannot have a family member who is either a resident or an employee of the facility involved in the IDR.

· Is not currently employed by the facility or organization involved in the IDR.

· Has not worked as an employee, consultant, or volunteer for the facility or a related corporation involved in the IDR within the past year.

Note to Vendor: The quote must be valid for 90 days from the date of submission and include all expenses. We reserve the right to reject all offers and individual offers that fail to meet any requirement. The selected vendor must possess all mandatory qualifications and offer the lowest price.

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