Milestone: Establish a system for tracking and reporting consumer complaints
Regardless of how well health care systems and policies are designed, some patients and families will have suboptimal experiences. By establishing complaint tracking and reporting systems, states can better analyze and act on their feedback.
*Full name: Establish a system for tracking and reporting consumer complaints.
*Relevance to the ACA:
Certain provisions of the ACA envision establishing mechanisms for the tracking and reporting of specific types of consumer complaints. States may wish to establish one central system to direct consumers to the appropriate forum for their complaints. Policymakers may also consider integrating and harmonizing the new complaint mechanisms of the ACA with existing consumer protection agencies and processes. Sections pertaining to tracking and reporting consumer complaints include:
§1002 – States receiving Health Insurance Consumer Information Grants will have to designate an agency or office that “receives and responds to inquiries and complaints concerning health insurance coverage”.
§1311 – Health plans sold through the Exchanges will be assessed on performance in handling complaints and appeals.
§6105 – Outlines a new state process for soliciting and responding to consumer complaints about nursing homes.
§6703 – Grants to entities that can improve ability of state “long-term care ombudsman programs to respond to and resolve complaints and neglect.” In addition, a new National Training Institute for Federal and State Surveyors will focus on helping state officials investigate allegations of misconduct in long-term care settings.less