Medicare proposes new rules for right to lodge quality-of-care complaints

March 1, 2011

Rules

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Feb. 2, 2011 that will require most Medicare-participating providers and suppliers to give Medicare beneficiaries written notice about their right to contact a Medicare quality improvement organization (QIO) with concerns about the quality of care they receive under the Medicare program.

Under current rules, only beneficiaries admitted to hospitals as inpatients are required to receive information about contacting their state QIO regarding quality-of-care issues. The new rule would require that in order to participate in the Medicare program, providers and suppliers would need to inform beneficiaries of their right to complain to a QIO about quality of care, as well as how to contact their local QIO.

One of the key tools QIOs use to improve quality of care is responding to complaints from Medicare beneficiaries regarding the care they receive from Medicare-participating providers and suppliers. QIOs investigate these complaints, gather facts from all parties involved and recommend action to help providers and suppliers improve quality of care.

The following care settings are impacted by this proposal:

•    Clinics, rehabilitation agencies and public health agencies that provide outpatient physical therapy and speech-language-pathology services;
•    Comprehensive outpatient rehabilitation facilities;
•    Critical access hospitals;
•    Home health agencies;
•    Hospices;
•    Hospitals;
•    Long-term care facilities;
•    Ambulatory surgical centers;
•    Portable X-ray services; and
•    Rural health clinics and federally qualified health centers.

CMS will accept comments on the proposed rule until April 3, 2011 and will respond to comments in a final rule to be issued in the coming months. See the CMS overview Web page for more detailed information:
www.cms.gov/qualityimprovementorgs.

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