If you have concerns or complaints about your kidney care, you have the right to file a grievance.

A grievance is a written or oral communication from an ESRD patient, and/or individual representing an ESRD patient, and/or another party, alleging that an ESRD service received from a Medicare-certified provider did not meet the grievant’s expectations with respect to safety, civility, patient rights and/or clinical standards of care.

You have three options for filing a grievance:

• File a grievance with your facility
• File a grievance with the Network
• File a grievance with your state survey agency

Option 1 — File a Grievance With Your Facility

Facilities are required to have a process for addressing patient concerns and complaints. Ask a staff member for the process at your facility. You are not required to use your facility’s grievance process, but we encourage you to do so.

Option 2 — File a Grievance With the Network

f you are not satisfied with the result of your facility’s process or you do not want to use the facility’s process, you have the right to file a grievance with the Network.

As an ESRD patient, you can file your own grievance. Family members or other representatives can also file grievances for you. To file a grievance with the Network, please call us at 800-262-1514.

• Comagine Health ESRD Grievance Brochure
• National Forum of ESRD Networks Grievance Toolkit
  English | Spanish

Patient Toll-Free Phone Number

800-262-1514

Network Grievance Process

When we receive your grievance, the Network Patient Services department starts working toward a resolution so that you can continue to receive care in a healthy treatment environment. We often ask you to take part in the process because it increases our ability to achieve a positive outcome.

The Network Patient Services department:

• Requests and reviews documentation from your facility that is related to your grievance
• Works with you and facility staff to reach a resolution
• Provides you with the outcome of the investigation in writing
• Works with your state’s health department when necessary

You have the right to file an anonymous or confidential grievance. (“Anonymous” means you don’t tell us your name. “Confidential” means you tell us your name but ask us not to share it with the facility.) Your confidentiality is important to us, and we will not share your name with the facility. However, if your anonymous or confidential grievance is about your individual care, our ability to investigate your claims may be limited.

Network Role

The Network is a nonprofit organization funded by the Centers for Medicare & Medicaid Services (CMS). One of our most important responsibilities is to serve as an unbiased, outside review agency for ESRD grievances. Our primary goal is to resolve grievance cases as successfully as possible for the grievant.

We can:

• Investigate grievances filed by patients, family members or patient representatives in an effort to resolve any issues a patient is experiencing at a dialysis facility or transplant center
• Provide individualized interventions and recommendations for rebuilding positive patient-provider relationships to treatment teams and patients
• Advocate for patient rights
• Assist with locating facilities through Care Compare
• Provide resources like educational materials and contact information

We cannot:

• Require a dialysis facility, transplant center or physician to accept a patient
• Change or become involved in facility or personnel policies and procedures
• Facilitate the firing or transfer of a physician or staff member
• Directly provide patients with monetary compensation, payment of bills or transportation arrangements
• Override state or federal licensing/certification requirements
• Assist in the pursuit of legal action

Option 3 — File a Grievance With Your State Survey Agency

You also have the option to file a grievance with your state survey agency.
https://www.cms.gov/medicare/health-safety-standards/quality-safety-oversight-general-information/contact-information
 

Comagine Health’s ESRD program serves end-stage renal disease patients and providers through:

• Grievance investigations
• Quality improvement technical assistance
• Data management
• Emergency management support
• Patient and provider education

We are committed to improving care and quality of life for people with kidney disease.

Networks 15 and 18

Networks 15 and 18 are two of 18 Networks under contract with CMS to work collaboratively with dialysis professionals, providers and patients to improve patient care. Network 15 operates in Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming. Network 18 operates in Southern California.

According to Title XVIII Section 1881 of the Social Security Act, we are responsible for:

• Encouraging, consistent with sound medical practice, the use of the treatment settings most compatible with the successful rehabilitation of the patient and the participation of patients, providers of services, and renal disease facilities in vocational rehabilitation programs
• Developing criteria and standards relating to the quality and appropriateness of patient care and with respect to working with patients, facilities, and providers in encouraging participation in vocational rehabilitation programs; and network goals with respect to the placement of patients in self-care settings and undergoing or preparing for transplantation
• Evaluating the procedure by which facilities and providers in the Network assess the appropriateness of patients for proposed treatment modalities
• Implementing a procedure for evaluating and resolving patient grievances
• Conducting on-site reviews of facilities and providers as necessary, utilizing standards of care established by the Network Organization to assure proper medical care