Grievances and Complaints 2021: Ensuring Hospitals Compliance with the CMS CoPs, Joint Commission, DNV Standards, and OCR

The CMS grievance requirements have been a frequent source of investigation. The grievance standards for acute hospitals are in the patient rights section.  Many hospitals are surprised at the number of regulations and the detailed requirements on what they need to do to comply with this problematic standard.

Hospitals that accept Medicare or Medicaid reimbursement must comply with the CMS Conditions of Participation (CoPs). This program will cover in detail the CMS requirements for hospitals to help prevent the hospital from being found out of compliance with the grievance regulations.

This program will talk about a federal law that is enforced by the Office of Civil Rights requirements under Section 1557 of the Affordable Care Act. This law previously required many specific things and was revised in June 2020. The hospital must still have a grievance procedure and compliance coordinator to investigate any grievances alleging noncompliance with this law including discrimination.

This program will also discuss the Joint Commission standards on complaints and DNV Healthcare on grievances and how their standards crosswalk to the CMS grievance interpretive guidelines. This is a must-attend for any hospital. Staff should be aware and follow the hospital grievance and complaint policy. The policy should be approved by the board. Staff should be educated on the policy. This program will cover what is now required to be documented in the medical record.

Objectives:-

• Discuss that any hospital that receives reimbursement for Medicare patients must follow the CMS Conditions of Participation on grievances.    
• Recall that the CMS regulations under grievances include the requirement to have a grievance committee.
• Discuss that the Joint Commission has complaint standards in the patient’s right (RI) chapter and DNV grievance standard in the patient rights chapter.
• Recall that patients must be provided with a written notice that includes steps taken to investigate the grievance, the results, and the date of completion.
• Describe that the Office of Civil Rights requires hospitals to have a process to handle grievances related to discrimination under Section 1557.

Agenda:-

This program will cover the following:

• Background on CMS CoPs
• How to find a current copy
• CMS deficiency memo
• How to find changes in the hospital CoPs
• Issuance of final interpretive guidelines
• OCR grievance requirements under Section 1557 and significant changes June 19, 2020
• TJC standards
• Recent standing order memo
• Preprinted order sheet changes
• Federal Register, interpretive guidelines, survey procedure
• P&P requires to ensure patients have information on rights
• Prompt resolution of grievances
• CMS definition of grievance
• Definition of staff present
• TJC definition and six elements of performance on complaints
• P&P with all the required elements
• Form to collect information
• HIPAA requirements if request, not from the patient
• Need to determine the person is authorized, representative
• Billing issues and information on patient satisfaction
• Telephone complaints after discharge
• Customer service and complaints
• Audits and PI required
• Policy to encourage staff
• Process for prompt resolution
• The requirement to inform each patient on how to file grievances
• Board’s responsibility in the grievance process
• Grievance committee required
• Referral to QIO and State Department of Health
• Changes to QIOs process
• P&P on grievances
• Written notice to patient requirements
• The time frame for responding to grievances
• 7-day rule
• System analysis approach
• What should critical access hospitals do?
• DNV Health NIAHO standards on grievances
• OCR Section 1557 on complaint process and recent changes
  • Policy required
  • Grievance process
  • Appeal to CEO or board changed
  • Timelines for filing a grievance on discrimination revised

Who Should Attend:-

• Consumer Advocates or Patient Advocate
• Chief Operating Officer (COO)
• All nurses with direct patient care
• All nurse managers
• Joint Commission Coordinator
• All department directors
• Chief Executive Officer (CEO)
• Chief Nursing Officer (CNO)
• Chief Medical Officer (CMO)
• Chief Financial Officer (CFO)
• Board Members
• Quality Improvement Coordinator
• Risk Managers
• Legal Counsel
• Nurse Educator
• Patient Safety Officer
• Emergency Department Manager
• Compliance Officer
• Outpatient Director
• HIPAA privacy and security officer
• Director of Business Office
• Lab director
• Policy and procedure committee
• Ethicist
• Anyone involved in the implementation of the CMS grievance, DNV, OCR, or Joint Commission compliant standards