Medicare Wants to
be Sure Senior Citizens Know Where to File Health Care Complaints
CMS proposes rule
requiring providers to give seniors and other beneficiaries written
notice of their rights
2, 2011 – Medicare thinks senior citizens and other beneficiaries should
be informed about their right to have their beef heard, when they have
concerns about the quality of care they receive from health care
providers in the Medicare program.
The Centers for
Medicare & Medicaid Services (CMS) today issued a proposed rule 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 their care.
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
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
● Rural health clinics and
Federally Qualified Health Centers
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
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.
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
rule has been published today (2/2/11) at the Federal Register and can
be found online –
detailed information check out the CMS Overview webpage –
click here. 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
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 –
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