Patients Should Know Their Rights

Hospitals and health care providers who participate in the Medicare and Medicaid programs are bound by strict requirements. One of these requirements is to abide by a set of patients' rights approved August 2, 1999 by the federal agency that oversees the Medicare program called the Center for Medicare & Medicaid Services (CMS). It is important for patients to understand their rights in order to exercise them when using any health care service.

Q.: Exactly what rights does the CMS rule provide for patients?

A.: The CMS rule outlines a number of patient rights, including the right to:
1. be informed of one's health status;
2. develop and participate in one's plan of care;
3. request or refuse treatment;
4. complete Advance Directives and to have the medical and hospital staff respect those directives;
5. have the patient's own physician and family members notified of one's admission to a hospital;
6. personal privacy;
7. receive care in a safe setting;
8. be free from all forms of abuse;
9. confidentiality of one's medical records;
10. access information from one's medical record.

Q.: What should I do if I feel my rights as a patient have been violated?

A.: Hospitals and other health care providers that participate in Medicare and Medicaid programs must tell patients who they should contact to file a grievance. In addition, they must establish a process to promptly resolve patient grievances. The Board of Trustees or Directors of the health care facility must approve an effective grievance process, and must review and resolve all grievances unless it delegates this responsibility in writing to a grievance committee. When grievances are delegated to a committee, the Board must ensure that the committee does indeed resolve all grievances.

Q.: What happens if the grievance is not resolved?

A.: If a grievance is not addressed or resolved by the healthcare facility, the patient may contact Medicare by calling the Medicare Beneficiary Hotline at 800-589-7337. The hotline is open Monday through Friday from 8 a.m. to 3 p.m.

As of August 1, 1999, Ohio KePRO began serving and protecting the rights and health of Ohio's 1.8 million Medicare beneficiaries. KePRO is a Peer Review Organization, meaning that it has doctors and nurses on staff who review the care provided to Medicare patients. KePRO ensures that Medicare patients get the best possible care from their health care providers.