441—81.32 (249A) General provisions.
	   81.32(1) Purpose of remedies. The purpose of remedies is to ensure prompt compliance with program requirements.
	   81.32(2) Basis for imposition and duration of remedies. The department of inspections and appeals, as the state survey agency under contract with the department, determines the remedy to be applied for noncompliance with program requirements. When the department of inspections and appeals chooses to apply one or more remedies specified in rule 441—81.34(249A), the remedies are applied on the basis of noncompliance found during surveys conducted by the department of inspections and appeals.
	   81.32(3) Number of remedies. The department of inspections and appeals may apply one or more remedies for each deficiency constituting noncompliance or for all deficiencies constituting noncompliance.
	   81.32(4) Plan of correction requirement.
	      a.    	 Except as specified in paragraph “b,” regardless of which remedy is applied, each facility that has deficiencies with respect to program requirements shall submit a plan of correction for approval by the department of inspections and appeals.
	      b.    	 A facility is not required to submit a plan of correction when the department of inspections and appeals determines the facility has deficiencies that are isolated and have a potential for minimal harm, but no actual harm has occurred.
	   81.32(5) Disagreement regarding remedies. If the department of inspections and appeals and CMS disagree on the decision to impose a remedy, the disagreement shall be resolved in accordance with rule 441—81.55(249A).
	   81.32(6) Notification requirements.
	      a.    	 The department of inspections and appeals shall give the provider written notice of remedy, including the:
	       (1)  	 Nature of the noncompliance.
	       (2)  	 Which remedy is imposed.
	       (3)  	 Effective date of the remedy.
	       (4)  	 Right to appeal the determination leading to the remedy.
	      b.    	 Except for civil money penalties and state monitoring imposed when there is immediate jeopardy, for all remedies specified in rule 441—81.34(249A) imposed when there is immediate jeopardy, the notice shall be given at least two calendar days before the effective date of the enforcement action.
	      c.    	 Except for civil money penalties and state monitoring, notice shall be given at least 15 calendar days before the effective date of the enforcement action in situations where there is no immediate jeopardy.
	      d.    	 The 2- and 15-day notice periods begin when the facility receives the notice, but in no event will the effective date of the enforcement action be later than 20 calendar days after the notice is sent.
	      e.    	 For civil money penalties, the notices shall be given in accordance with rules 441—81.48(249A) and 441—81.51(249A).
	      f.    	 For state monitoring imposed when there is immediate jeopardy, no prior notice is required.
	   81.32(7) Informal dispute resolution.
	      a.    	 Opportunity to refute survey findings.
	       (1)  	 For nonfederal surveys, the department of inspections and appeals (DIA) shall offer a facility an informal opportunity, at the facility’s request, to dispute survey findings upon the facility’s receipt of the official statement of deficiencies.
	       (2)  	 For a federal survey, the Centers for Medicare and Medicaid Services (CMS) offers a facility an informal opportunity, at the facility’s request, to dispute survey findings upon the facility’s receipt of the official statement of deficiencies.
	      b.    	 Delay of enforcement action.
	       (1)  	 Failure of DIA or CMS, as appropriate, to complete informal dispute resolution timely cannot delay the effective date of any enforcement action against the facility.
	       (2)  	 A facility may not seek a delay of any enforcement action against it on the grounds that informal dispute resolution has not been completed before the effective date of the enforcement action.
	      c.    	 If a provider is subsequently successful, during the informal dispute resolution process, at demonstrating that deficiencies should not have been cited, the deficiencies are removed from the statement of deficiencies and any enforcement actions imposed solely as a result of those cited deficiencies are rescinded.
	      d.    	 Notification. DIA shall provide the facility with written notification of the informal dispute resolution process.