10.12.04.08

.08 Compliance Monitoring.

A. The Department shall monitor or inspect a center at least once every 2 years to ensure compliance with the requirements of this chapter.

B. The Department may conduct unannounced or announced licensure or complaint investigation visits as frequently as necessary to ensure compliance with this chapter or for the purpose of investigating a complaint.

C. In accordance with a written agreement, the Department may delegate certain aspects of its monitoring or inspection responsibilities to a local health department.

D. Notice of Violations. If a complaint investigation or survey inspection identifies a regulatory violation, the Department shall issue a notice:

(1) Citing the violation;

(2) Requiring the center to submit an acceptable plan of correction within 10 calendar days of receipt of the notice of violation or deficiency;

(3) Notifying the center of sanctions or that failure to correct the violation may result in sanctions; and

(4) Offering the center the opportunity for informal dispute resolution (IDR).

E. The plan of correction referred to in §D(2) of this regulation shall include the date by which the licensee shall complete the correction of each deficiency. Failure to return an acceptable plan of correction within the allotted time frame may result in a sanction.

F. When a licensee requests an IDR as provided in §G of this regulation, the licensee shall file a plan of correction within the required time, except to the extent that the licensee contests specific findings, in which case absent the Department's specific directive, a licensee may delay submitting its plan of correction with respect to those specific findings until 5 days after the licensee is provided oral or written notice of the outcome of the IDR.

G. Informal Dispute Resolution.

(1) A licensee may request an IDR to question violations or deficiencies within 10 calendar days of receiving the statement of deficiencies. The written request for an IDR shall fully describe the disagreement with the statement of deficiencies and be accompanied by any supporting documentation.

(2) At the discretion of the Office of Health Care Quality, the IDR may be held in-person, by telephone, or in writing. In-person IDRs are informal in nature and are not attended by counsel.

(3) The IDR process may not delay the effective date of any enforcement action.

(4) In the event a licensee requests an IDR of a violation written by a designee of the Department, the Department shall request the designee to participate in the IDR process.