42 CFR § 476.110 - Use of immediate advocacy to resolve oral beneficiary complaints.
(1) The complaint is received not later than 6 months from the date on which the care giving rise to the complaint occurred.
(2) After initial screening of the complaint, the QIO makes a preliminary determination that -
(i) The complaint is unrelated to the clinical quality of health care itself but relates to items or services that accompany or are incidental to the medical care and are provided by a practitioner and/or provider; or
(ii) The complaint, while related to the clinical quality of health care received by the beneficiary, does not rise to the level of being a gross and flagrant, substantial, or significant quality of care concern.
(4) All parties orally consent to the use of immediate advocacy.
(5) All parties agree to the limitations on redisclosure set forth in § 480.107 of this subchapter.
(c) Confidentiality requirements. All communications, written and oral, exchanged during the immediate advocacy process must not be redisclosed without the written consent of all parties.
(d) Abandoned complaints. If any party fails to participate or otherwise comply with the requirements of the immediate advocacy process, the QIO may determine that the complaint has been abandoned and -
(1) Inform the parties that immediate advocacy will be discontinued; and