Medicare Proposes Written Notice for All Quality of Care Complaints
The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule requiring 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.
“Right now the only Medicare beneficiaries who have to receive information about QIO are those who are admitted to hospitals as inpatients,” notes Alan Weinstock, insurance broker at MedicareSupplementPlans.com. “This new rule would mean the very act of participating in the Medicare program would require providers and suppliers to inform Medicare beneficiaries of their right to complain and how to contact their local QIO.”
Overview of Quality Improvement Organizations (QIO)
CMS contracts with a Quality Improvement Organization (QIO) in all 50 states, U.S. territories and the District of Columbia, whose purpose is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries.
QIOs are private, generally non-profit organizations staffed by doctors and health care professionals who are trained to review medical care and help Medicare beneficiaries with complaints about the quality of their care. The term of contract lasts three years.
Currently the QIO Program is administered through 53 performance-based, cost-reimbursement contracts with 41 independent organizations. A single organization can have more than one QIO contract.
CMS publishes a Report to Congress every fiscal year which outlines the administration, cost and impact of the QIO Program.
Health Care Settings Impacted by Medicare Proposal
With the proposed change by CMS, the following care settings now would be impacted by this proposal:
a. Clinics, rehabilitation agencies, and public health agencies that provide outpatient physical therapy and speech-language-pathology services
b. Comprehensive outpatient rehabilitation facilities
c. Critical access hospitals
d. Home health agencies
e. Hospices
f. Hospitals
g. Long-term care facilities
h. Ambulatory Surgical Centers
i. Portable x-ray services
j. Rural health clinics and Federally Qualified Health Centers
Comments are currently being accepted by the CMS regarding the proposed rule until April 3, 2011 and the CMS will respond to comments in a final rule to be issued in the coming months. Anyone who wishes to submit a comment can do so by visiting the regulations.gov link “Medicare and Medicaid Programs: Patient Notification of Right to Access State Survey Agencies; Medicare Beneficiary Notification of Right to Access Quality Improvement Organizations.”
The proposed rule has been published at the Federal Register. 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.”
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