November 3, 2005 - Medicare to auto-enroll eligible Medicaid patients in Medicare drug plan
Medicare will mail people with Medicare and full Medicaid coverage an auto-enrollment notice by Nov. 5 to inform them about the change in their drug coverage from Medicaid to Medicare, the Centers for Medicare & Medicaid Services announced. The notice explains to the recipient that will be enrolled in a Medicare prescription drug plan if they don’t join one by the end of the year, what plan Medicare will enroll them in, their costs in the plan, and that starting Jan. 1, 2006, Medicare will help pay for their prescription drugs instead of Medicaid. The notice includes a one-page letter, and two pages of questions and answers about Medicare prescription drug coverage. A fact sheet describing the mailing is available at the CMS Web site.
August 22, 2005 - AHA News Now
The Centers for Medicare & Medicaid Services has issued revisions to its interpretive guidelines for the hospital conditions of participation in Medicare, including changes suggested earlier this year by the Society for Healthcare Consumer Advocacy to clarify the definition of a patient grievance and the patient grievance process. The clarifications to the grievance conditions of participation are contained in section 482.13 of the guidelines, for state survey agency directors. Among other issues, the section addresses who can handle patient complaints and when complaints should be categorized as grievances, the requirements for responding to patient grievances, and when a grievance is considered resolved. SHCA is an AHA personal membership group for health care consumer advocate professionals
August 22, 2005 - CMS Announces Revisions to Interpretive Guidelines for Hospital CoP
I am proud to announce that a Memorandum from the Centers for Medicare & Medicaid Services was recently distributed containing revisions to four (4) Interpretive Guideliens for Hospital Conditions of Participation (CoP), including Patients' Rights -§482.13 - grievance process, grievance definition, and grievance responses.
For your convenience, SHCA staff is hard at work completing the construction of a special section on SHCA's Web site, dedicated to these important CMS revisions, and will include all the critical information you will need to transition to the new guidelines, both from CMS and SHCA/AHA. The Memorandum states an effective date of September 19, 2005 .
Within 24 hours, we will announce (via E-mail and FAX) the specific location on SHCA's Web site where all this information will be stored.
In the meantime members are encouraged to download the 12-page Memorandum.
Much Thanks
A big THANK YOU to Brenda Radford , SHCA Past President, for her expertise and perseverance. Her ongoing communication with Captain Eddinger kept us informed and provided a tremendous resource for CMS.
Thanks to Nancy Foster , Senior Associate Director, AHA Policy/Center for Public Affairs, and the entire AHA Washington, DC staff, for their assistance to SHCA all along the way.
And thanks to you, our members, for reminding us how important our work on this issue was, and for lending your voice on behalf of all healthcare patient advocates.
Remember, we are here to serve you, so feel free to contact any one of your SHCA Board of Directors should you have any questions about these Guideline updates.
July 26, 2005 - Second Quarter Newsletter Article -CMS Grievance Guidelines Continue to Change
In May, 2004 Captain David Eddinger attended the SHCA conference to clarify the grievance guidelines. A patient grievance was described as any written or verbal complaint by a patient, or the patient's representative, regarding the patient's care, abuse or neglect, or the hospital's compliance with the CMS Hospital Conditions of Participation (COP), which was unable to be resolved by staff present. This definition has brought about much discussion over the last year, resulting in CMS allowing the 2004 SHCA President, Brenda Radford to attend a meeting at CMS in Baltimore, Maryland with Captain Eddinger, his supervisor and several AHA staff. Download the entire article.
May 13, 2005 - CMS Update
SHCA continues to keep its members informed with news about the CMS Conditions of Participation.
We are happy to report that CMS has accepted our January 2005 proposed changes, and a new version of the Grievance Conditions of Participation will be published very soon. Initially CMS stated it would most likely be the end of the summer before these guidelines were published, but in conversation as recent as May 12, 2005, Captain David Eddinger felt that these guidelines should be ready within the month.
SHCA again thanks Past President Brenda Radford for her ongoing communication with Captain Eddinger to bring you the latest developments and updates. Please remember that at this writing, nothing has been put in place. However, you can be assured that as soon as CMS alerts SHCA that the guidelines have been posted, we will forward all communication through e-SSENTIALS.
April 15, 2005 - CMS Response Letter Template from the SHCA Conference
At SHCA's recent Annual Conference & Exhibition in Chicago, attendees heard the Board of Directors outline the current status of our assistance with revisions to the CMS' Conditions of Participation. Included in the information presented was suggested information and content that should be included in patient response letters for grievances. Conference attendees indicated that access to this information via the SHCA Web site would be beneficial. Therefore, as requested, the Response Letters for Grievances template, as presented at the CMS Grievance Session, is accessible via the website under the Members' Arena (login required) - Community - Member's Forum - SHCA-AHA - Reference Library (located on the top menu bar).
Download: Response Letters for Grievances (Members Only Arena - login required)
February 1, 2005 - From the Desk of the President
As you know, SHCA's Board of Directors has been working on your behalf with the American Hospital Association in Washington, DC, to review our concerns regarding the CMS Interpretive Guidelines.
Last November, Brenda Radford, 2004 SHCA President, met with Captain David Eddinger, RN, MPHS, Health Program Evaluation Officer; Frank Sokolik, CMS Director of Acute Care Services, Survey and Certification Group; Nancy Foster, Senior Associate Director, AHA Policy/Center for Public Affairs; Lawrence Hughes, AHA Director and Regulatory Counsel; and Joann Webb, Senior Director of Federal Relations and Policy, American Organization of Nurse Executives.
In December 2004, Captain Eddinger visited Brenda Radford at Duke University Hospital to gain a better understanding of the patient advocate role, and was very impressed with the work they do. Captain Eddinger agreed to provide his updated version of the grievance interpretive guidelines to the SHCA Board of Directors for their January review.
On January 22, 2005, during the Annual SHCA Board of Directors Meeting in Chicago, we reviewed the draft and identified areas for possible revision. We were very pleased with the way Captain Eddinger responded to the concerns we raised, and only offered a few further revisions regarding suggested language. At this time, we do not have an exact date when the updated guidelines will be published. However, we hope to be able to provide you with more detailed information at our Annual Conference in Chicago, March 31 - April 3, 2005.
Only through collaboration is change possible. I am grateful for all the support we have received during the past year, and sincerely thank Brenda Radford for taking the lead in this effort.
We will continue to work on your behalf as the representative of healthcare patient advocates. Look to SHCA for issues affecting you and further updates on this important issue as they occur. Until then, take care and keep up the wonderful work you do.
Irene Zbiczak, SHCA President
November 19, 2004 - Results from November 19, 2004 Meeting with CMS
The SHCA Board has been working with the American Hospital Association to establish a meeting with the Center for Medicare and Medicaid Services (CMS) to review the concerns that the SHCA membership has with the Grievance Interpretive Guidelines.
Thanks to SHCA staff and Nancy Foster, Senior Associate Director, AHA Policy/Center for Public Affairs, we were able to meet with CMS on November 19. Nancy, Lawrence Hughes, AHA Director and Regulatory Counsel, Joann Webb, Senior Director of Federal Relations and Policy for the American Organization of Nurse Executives, and I met with Captain David Eddinger RN, MPH, Health Program Evaluation Officer and Frank Sokolik, Director of Acute Care Services, Survey and Certification Group.
The AHA had several issues to review, but I am very pleased to let you know that our voice has been heard and the CMS leaders have agreed to revise the Grievance Interpretive Guidelines. They also plan to allow the SHCA Board of Directors the opportunity to suggest specific wording to clarify the guidelines.
Captain Eddinger has also accepted an invitation to spend the day with my Patient Relations Department on December 13 to provide him with a clearer understanding of the patient advocate role.
We are thrilled with this progress and look forward to providing you updates on the newly revised guidelines very soon.
Best wishes to all of you for a wonderful holiday season. We definitely have many things to be celebrate, including the results of this meeting.
May 28, 2004 CMS State Operations Manual Revisions
The CMS State Operations Manual (SOM) has been revised, effective May 28, 2004. In addition, certain appendices were revised that affect many patient representatives:
• Appendix A (Hospitals)
• Appendix T (Hospital Swing Bed Requirements)
• Appendix W (Critical Access Hospitals)
Please note that Section 482.13 in Appendix A addresses Patients' Rights. Also, please be reminded that these documents are available for your information only. SHCA members should look to their own hospital for official notification. We encourage you to forward these documents to your accreditation and/or regulatory managers so your institution's key players are aware of these revisions.
You can access the entire SOM by going to www.cms.hhs.gov, select "Manuals" in the left-hand column, select "IOM (Internet Only Manuals)," select PUB 100-07 (State Operations Manual).
According to CMS, these on-line documents will be available on May 28, 2004.
SHCA recognizes the valuable work you do as patient advocates, so will continue to provide this type of critical, up-to-date information to its members. Look to SHCA for all your professional needs.
