MEDICARE PROPOSES NEW RULES FOR NOTIFYING BENEFICIARIES OF THEIR RIGHT TO LODGE QUALITY OF CARE COMPLAINTS
PROVIDERS WOULD HAVE TO GIVE ALL BENEFICIARIES WRITTEN NOTICE OF THEIR RIGHTS
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule today 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
- Long-term care facilities
- Ambulatory Surgical Centers
- Portable x-ray services
- Rural health clinics and Federally Qualified Health Centers
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.
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, visit:
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.
The proposed rule has been published (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
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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