CMS:  Beneficiary Complaint Program to be revised

     The Center for Medicare and Medicaid Services has released plans to overhaul the Beneficiary Complaint Program.  Objectives of the new program will include:  satisfaction among 80% of complainants; recommendation of quality improvement plans in an as yet undetermined percentage of complaints; resolution of communication issues in a percentage of complaints; completion of reviews within accepted timeframes in 90% of cases; and a minimum threshold of reliability in case review.

     New strategies for the program will also include case managers to improve beneficiaries' understanding of the process and the use of mediation to resolve disputes between beneficiaries and providers.  Case managers will also offer the complainant a single point of accountability, explain the complaint process, and update the complainant on the status of the complaint.

     CMS plans to help prepare for changes in the complaint program by providing support and networking opportunities.  Testing for the new process will begin this spring, using pilots for case manager implementation, improved letters to beneficiaries and providers, and surveys of beneficiary satisfaction.