Proposed Rule Expands Patient Rights to Quality Care

The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule that would add to the existing requirements providers and suppliers must meet  to participate in Medicare and Medicaid. The new Condition of Participation (CoP) for providers or Condition for Coverage (CfC) for suppliers would require most providers and suppliers to give their Medicare patients the information they need to file a complaint if they are dissatisfied with the care they are receiving. Presently, only hospitals are required to provide this information to inpatients.

Medicare-participating providers and suppliers would be required to:

  1. Provide Medicare patients with a written notice of their right to contact a Medicare Quality Improvement Organization (QIO) with complaints about the quality of care they are receiving.
  2. Document in the patient’s record that the written notice was furnished prior to providing care.

At this time, providers and suppliers would be permitted to design their own notice and documentation process; however, the written notice would need to include contact information for the patient’s local QIO. QIOs investigate patient complaints, gather facts from all parties involved in the dispute, and recommend ways the provider or supplier might improve quality of care.

Providers and suppliers affected by this proposed rule include the following:

  • Clinics, rehabilitation agencies, and public health agencies providing outpatient physical therapy and speech-language-pathology services
  • Comprehensive outpatient rehabilitation facilities
  • Critical access hospitals (CAHs)
  • Home health agencies (HHAs)
  • Hospices
  • Hospitals
  • Long-term care facilities (LTCFs)
  • Ambulatory surgical centers (ASCs)
  • Portable X-ray services
  • Rural health clinics and Federally Qualified Health Centers

CMS proposes to require seven out of the 10 providers and suppliers named above to provide all patients with state survey agency contact information in the event patients wish to file a grievance. Existing regulations already require ASCs, LTCFs, and HHAs to supply this information to patients.

CMS published the proposed rule Feb. 2 in the Federal Register and is accepting comments until April 4.


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11 Responses to “Proposed Rule Expands Patient Rights to Quality Care”

  1. Lynn Berry says:

    This rule, which would affect outpatient physical therapists among others on the list, would only be meaningful if the provider would actually verbally explain this to the patient. If they are only adding to the current paperwork that patients are required to sign (that most of them do not read), it loses its purpose and is just extra paperwork in the system. The intent is good (patients will know where to voice their complaints and get resolution of their problems), but the way in which it will be ultimately implemented by most providers negates that intent.

  2. Kristin R. says:

    Why not include this information with the patient’s enrollment to the Medicare program? That way they aren’t getting multiple pieces of paperwork all pointing them to the same Medicare QIO. I’m not understanding why the burden of informing patients how to contact Medicare regarding quality care issues should be put on physicians and clinics.

  3. Donna says:

    I have to agree with Kristin’s comment. Whatever happened to the idea of paperwork simplification? Medical providers should be able to focus on improved quality of care for their patients without the added burden of more government paperwork. If this becomes necessary, could it be incorporated into HIPAA Notice of Privacy Practices?

  4. John B. says:

    Have a national QIO number printed on the back of the Medicare/Medicaid card in case a patient has a complaint about any care issue or other complaint for that matter. If a form must be presented to the patient to inform them of their rights then a second form must be filed for proof that the patient was informed. Then this second form will need to be scanned into the EHR for future retrieval under audit. This is two pieces of paper and a scan, at a minimum, for every medicare patient seeking care for every visit they make. Then I read about how inefficient hospitals, physician and other providers are when caring for Medicare patients. I wonder why?

  5. Barbara says:

    It seems like the provider’s staff is doing more and more work that Medicare should be…You can’t get most patients to read, understand and sign and ABN…I agree patients need the QIO number but why must it be the provider giving it to them Why not Medicare???? More paperwork in the providers office to make patients mad …That is what we need.

  6. Diana says:

    As a caregiver and daughter, I am finally impressed with our government for seeing quality of care being an issue and addressing it responsibly. I would even go a step further and make supplier payments partially depend on quality of care! Thank you.

  7. Dale says:

    Wait a minute, you have to have a “rule” for patients complaints? I’ve never really known a patient to have a problem with complaining and they didn’t even have to know there was a “rule”. It is almost laughable how our politicians waste their time on trivial “rules”. And at the same time increase the costs to providers. And this is supposed to control healthcare cost? There will be a whole new industry develop to handle the volumous amount of printing forms to meet these guidelines. And the cost will be handed down to patients. This will do nothing to improve quality of care. What it will do is become a time-consuming process that takes away from patient care.

  8. Nadine says:

    I agree with Kristen, if this paperwork is signed with the packet of annual Mediare requirements, the patient would have it available if they feel the care is not up to par. Would this be a seperate form for hospitals and the other disciplinaries?? .

  9. Lynn says:

    The reason that this information cannot be included with Medicare enrollment and why the patient cannot be provided with a national QIO number, is that there are QIOs assigned to different areas of the country. You should be familiar with the one for your area. The type of form utilized or if you want to include with other forms is not regulated. You can design one of your choosing and provide it with the others. My point was to inform the patient verbally so that they know it is available in case of a problem. It is true that this does not directly improve the quality of care. But it alerts the practitioner to the fact that the patient has another avenue for venting problems and may help direct CMS to problematic practitioners. The patients cuirrently complaint to their contractor when they have a problem, but if involves quality of care, the QIO is a better arbitor of such areas. As Medicare tries to move from fee for service to pay for performance and quality improvement, this is just another avenue to do this.

  10. amal n tosson says:

    what about if the provider does a good quality and the patient denied that. what would be the final decision?

  11. Ginger P says:

    I agree with Lynn and Kristen. The burden should not be put on providers. Medicare should include this information with the “Welcome to Medicare” information that is provided during enrollment process. This way the patient gets this information one time, instead of from EVERY provider they see. This is just more paperwork that the patients are not going to read. The copies will be left all over the lobby, just like the copies of HIPAA privacy notice.

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