CMS-R-193 Comment # 10

Massachusetts Hospital
Association
February 14, 2007
Bonnie L. Harkless
Centers for Medicare & Medicaid Services
Office of Strategic Operations and Regulatory Affairs
Division of Regulations Development - C
Room C4-26-05
7500 Security Boulevard
Baltimore, MD 21244- 1850
RE: Medicare Program: Notification Procedures for Hospital Discharges Proposed Notice
of Rule Making, CMS-R-193,published in the Federal Register, January 5,2007
The Massachusetts Hospital Association, on behalf of our member hospitals and health care
systems, submits these comments and requests for clarifications related to the proposed
"Important Message from Medicare" (Form CMS-R-193). At the outset, MHA would like to
note that our members are committed to providing patients with information and assistance to
ensure that they receive timely and appropriate medically necessary care. To that end, we
seek clarifications and assistance from CMS in implementing this new form.

Provisions of the Proposed Form CMS-R-193:
We offer three suggestions which we believe will address patient and provider interests.
First, MHA requests that CMS clarify the sentence related to the fact that the Quality
Improvement Organization (QIO) accepts requests for appeals 24 hours a day (see the second
page, second bullet after the blank space for adding the local QIO contact information). For
many QIOs, as similar to any federal or state agency, there is a process for calls to be taken
after normal work hours and for the agency to retrieve and respond within an appropriate
time during the next day.
We suggest that CMS clarify that the QIO accepts calls 24 hours a day, but calls accepted
after the normal work day hours will be returned the next day (or at whatever time frame the
QIOs have developed for fielding and responding to such calls). Our concern is that patients
who expect prompt return calls will feel that it is the provider and not the system that is
preventing their case from being reviewed. Clarifying this issue will alleviate patient and
provider concerns.
Second, we request that CMS clarify the process for verifying the valid delivery of the notice.
We suggest that CMS indicate that a valid delivery is verified by documenting in the medical
record, computerized documentation system, or through any other documentation process,
including paperless systems, that the hospital generally uses in verifying the receipt of notices
and forms. The concern here is that there is no indication in the regulations whether the
hospital has discretion to develop the process, which will differ by each hospital's admitting
practices.

5 New Englawd Executiu~Park, Ri~rlingtonMA 01803-5096

781-272-8000

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Third, we strongly urge CMS to provide copies of the approved form in various languages.
With hospitals and providers strongly motivated to reduce racial and ethnic disparities in
health care, it would be helpful if CMS would assist by providing copies of the final form in
multiple languages, including Chinese (traditional), French, Haitian-Creole, Khmer, Polish,
Portuguese, Russian, Spanish, and Vietnamese.
MHA and our members are willing and ready to work with CMS to assist with clarifying
these issues. While we are actively working with our state QIO to develop briefings to help
all providers understand the process under the new regulations, we urge CMS to also hold
special open-door forums, or other such seminars, for providers to address common issues
and clarifications. Should you have any questions about our comments, please contact Anuj
Goel of my staff at (781) 272-8000, ext. 140.
Sincerely

Karen S. Nelson, R.N., MPA
Senior Vice President of Clinical Affairs