Grievances and Complaints: Ensuring Compliance with the CMS and OCR Requirements
Date: 8/12/25
9:00 – 10:30 a.m. Central time
Audience:
Chief Medical Officer, Chief Nursing Officer, Compliance Officer, Emergency Department Personnel, Joint Commission Coordinator, Medical Records, Quality Improvement personnel, Risk Manager, Legal Counsel.
Overview:
This program will cover the Centers for Medicare & Medicaid Services (CMS) requirements on grievance regulations. The grievance standards for acute hospitals are in the patient rights section of the Conditions of Participation (CoPs) manual. Although there is no similar section for Critical Access Hospitals (CAH), and the requirements for acute hospitals do not apply to CAHs, those facilities should have policies and procedures to address patient rights to include any grievance or complaint.
The speaker will review a federal law that is enforced by the Office of Civil Rights requirements under Section 1557 of the Affordable Care Act. Hospitals must have a grievance procedure and compliance coordinator to investigate any grievances alleging noncompliance with this law, including discrimination.
Staff should be aware of and follow the hospital grievance and complaint policy, which should be approved by the board. This program will also cover what is now required to be documented in the medical record.
Learning 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 require a grievance committee.
– Explain that patients must be provided with a written notice that includes steps taken to investigate the grievance, results of the investigation, and the date of completion.
– Describe why, under Section 1557, the Office of Civil Rights requires hospitals to have a process to handle grievances related to discrimination.
Speaker:
Laura A. Dixon served as the director of risk management and patient safety for the Colorado Region of Kaiser Permanente. Prior to joining Kaiser, she served as the director, facility patient safety and risk management and operations for COPIC from 2014 to 2020. In her role, she provided patient safety and risk management consultation and training to facilities, practitioners, and staff in multiple states. Dixon has more than 20 years of clinical experience in acute care facilities, including critical care, coronary care, peri-operative services, and pain management. Prior to joining COPIC, she served as the director, Western region, patient safety and risk management for The Doctors Company in Napa, California. In this capacity, she provided patient safety and risk management consultation to the physicians and staff for the western United States As a registered nurse and attorney, Dixon holds a Bachelor of Science degree from Regis University, RECEP of Denver, a Doctor of Jurisprudence degree from Drake University College of Law, Des Moines, Iowa, and a Registered Nurse Diploma from Saint Luke’s School Professional Nursing, Cedar Rapids, Iowa. She is licensed to practice law in Colorado and California.
This speaker has no real or perceived conflicts of interest that relate to this presentation.
No Comments