New Medicare Rule to Require Notice to Beneficiaries of Their Right to File Complaints

Feb 3rd, 2011

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on February 2 that would 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. Today’s proposed 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. In all, 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
Rural health clinics and Federally Qualified Health Centers

“Today’s proposed rule would ensure that beneficiaries know they have a voice in the care they receive under the Medicare program,” said CMS Administrator Donald Berwick, M.D. “By requiring providers and suppliers to furnish QIO contact information to all beneficiaries, we are protecting beneficiaries’ rights to bring their worries about quality of care to a third party for review, which can lead to better care not only for the beneficiary, but for all patients in a given care setting.”

Since the 1970s, Medicare has contracted with private, mostly not-for-profit organizations such as QIOs to preserve beneficiaries’ access to high-quality, high-value healthcare. QIOs are located in every state as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Each QIO is staffed by professionals, mostly doctors and other healthcare professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care they receive. These professionals also work directly with providers and facilities to make improvements in quality across all care settings.

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.

“Medicare beneficiary complaints are an important source of information that QIOs use to improve the quality of care for all patients,” said Dr. Berwick. “Sometimes providers themselves are unaware of problems or the reasons for these problems until a beneficiary shows the courage to ‘speak up’ and report the issue to a QIO. By speaking up, beneficiaries can help other patients escape the same poor outcomes they have experienced.”

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. . To submit comments click here: http://www.regulations.gov/#!documentDetail;D=CMS_FRDOC_0001-0641

The proposed rule has been published today (2/2/11) at the Federal Register and can be found online at http://www.gpo.gov/fdsys/pkg/FR-2011-02-02/pdf/2011-2275.pdf

For more detailed information check out the CMS Overview webpage at http://www.cms.gov/qualityimprovementorgs It has more information about the QIO Program and how it works to improve care for Medicare beneficiaries and all Americans, including contact information for each of the 53 QIOs across the country.

Beneficiaries with questions or concerns about the quality of care they receive under Medicare can learn more about their rights by calling 1-800-MEDICARE or by reading Medicare’s fact sheet, “Quality of Care Concerns,” online at http://www.medicare.gov/Publications/Pubs/pdf/11362.pdf.

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New Medicare Rule to Require Notice to Beneficiaries of Their Right to File Complaints

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