On February 2, 2011, the Centers for Medicare & Medicaid Services ("CMS") proposed new regulations requiring certain certified Medicare providers and suppliers to inform Medicare beneficiaries of their right to file a complaint with the Quality Improvement Organization ("QIO") in the state where services are being provided. These new regulations are prompted by concerns that QIOs perform very few beneficiary complaint reviews because the beneficiaries are unaware of their right to file a complaint or lack the information necessary to do so.
The certified Medicare providers and suppliers implicated by these new regulations are:
- Ambulatory Surgery Centers ("ASCs");
- Hospices;
- Hospitals;
- Long Term Care ("LTC") Facilities;
- Home Health Agencies ("HHAs");
- Comprehensive Outpatient Rehabilitation Facilities ("CORFs");
- Critical Access Hospitals ("CAHs");
- Clinics and Rehabilitation Agencies;
- Portable X-ray Services; and
- Rural Health Clinics ("RHCs") and Federally Qualified Health Centers ("FQHCs").
The new regulations would require that, upon the commencement of a course of care, all Medicare beneficiaries must receive written notice of their right to file a complaint with the QIO, the name of the QIO, and contact information for the QIO. Furthermore, the facility will need to document the Medicare beneficiary's receipt of this information.
Medicare beneficiaries who currently receive in-patient hospital care are already required to receive such notice, and CMS noted that QIO utilization rates are significantly higher amongst this population of Medicare beneficiaries. End Stage Renal Disease ("ESRD") facilities are exempt from this requirement because the ESRD Network already has a specific complaint process that is similar to the QIO process.
In addition, CMS is requiring Hospices, Hospitals, CORFs, CAHs, Clinics and Rehabilitation Agencies, Portable X-ray Services, RHCs, and FQHCs to provide all of their patients (both Medicare and non-Medicare patients) with information about filing a complaint with the applicable state survey agency. ASCs, LTC Facilities, and HHAs are exempt from this requirement because existing regulation already requires these providers and suppliers to provide notice about their applicable state survey agencies.
At this time, CMS is not mandating a specific format for the notice that must be provided, opting to give the providers and suppliers flexibility in this regard. CMS notes, however, that the providers and suppliers are responsible for ensuring that the information is communicated in an effective manner. This includes ensuring that Medicare beneficiaries with limited English proficiency and disabled individuals are provided with appropriate interpreters (free of charge).
CMS will accept comments on these proposed regulations until 5:00 p.m. EST on April 4, 2011. CMS is particularly interested in comments on when and how frequently the Medicare beneficiary should receive the notice during the course of the Medicare beneficiary's care.
Houston Harbaugh, P.C. will monitor any additional rulemaking on this topic and keep you updated on these important regulations.