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Quality of Care Issues | Medicare Payment Issues | Licensing and Certification Issues | State Survey Agencies

Grievance Protocol

What to do if You Have a Problem
Patients or family members have a right to address problems they identify in a facility without fear of discrimination or punishment. Generally, when you want help to solve a problem, you should:

  • Start by making every attempt to work it out informally with your facility staff.
  • Follow the steps of your facility's grievance procedure.
  • Review the rights you have been given by Medicare.
  • See the resources below for additional options.

Quality of Care Issues

If a problem persists and is about quality of care issues you can contact:

Intermountain End-Stage Renal Disease Network
165 S. Union Blvd., Suite 466
Lakewood, CO 80228
1-800-783-8818
E-mail: info@nw15.esrd.net

OR

Your State Survey Agency as listed below:

Arizona Dept. of Health Services
Assurance/Licensure, ESRD Surveyor
150 N. 18th Ave, Suite 450
Phoenix, AZ 85007
602-364-3030
Nevada Division of Health, Bureau of
Licensure and Certification/EMS
1550 East College Pkwy #158
Carson City, NV 89706-7921
(800) 225-3414
Colorado Dept of Public Health
4300 Cherry Creek Dr South HFD,
Bldg A, 2nd Floor
Denver, CO 80246
1-800-886-7689 (toll free in-state)
(303) 692-2904
Utah Dept of Health, Medicare/Medicaid
Program, Cert/Resident Assessment
ESRD Surveyor
P.O. Box 144103
Salt Lake City, UT 84114-4103
1-800-662-4157 (toll free in-state)
801-538-6158
New Mexico Dept of Health, Health Facility Licensing and Cert., ESRD Surveyor
2040 S Pacheco St, 2nd Floor #413
Santa Fe, NM 87505
1-800-752-8649 (toll free in-state)
(505) 476-9027
Wyoming Dept of Health
Office of Health Quality
ESRD Surveyor
6101 N. Yellowstone, #400
Cheyenne, WY  82202
307-777-7123

 

 

 

 

 

 

 

 

 


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The Network's Role
The Network is a facilitator. It can assist in the resolution of a grievance by acting as a third party or intermediary between a patient and a facility or a professional provider. If you need help, or information, you can write or call the Network office at:

Intermountain End-Stage Renal Disease Network
165 S. Union Blvd., Suite 466
Lakewood, CO 80228

303-831-8818 or toll free 1-800-783-8818 and 1-888-777-0105

Here are some rules you will have to follow:

  • You are asked to confirm the grievance in writing if you make the initial contact by phone.
  • You may designate anyone you choose as your representative, though you must designate in writing if you want someone to act in your behalf.
  • You are not required to use the facility grievance procedure before contacting the Network, but it is recommended in most cases; however, if you fear reprisal by your facility, you are free to contact the Network first.
  • You can withdraw a grievance at any time.

The Network will:

  • Keep your identity confidential and will not release it without your permission.
  • Send you a written acknowledgment within 5 days that your formal grievance has been received.
  • Respond in writing if we determine that the problem is not a Network issue, or is more appropriately handled by another agency.
  • Conclude our mediation/resolution activities within 90 days of receipt of the inquiry, and make a written response to you, including results, agreements and options to follow if you are not satisfied.

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Medicare Payment Issues

Network #15 cannot handle issues dealing with money or payment of bills.  Here is the phone number for Medicare billing and coverage issues: 1 (800) 633-4227 (the Medicare Hotline)

See our ESRD Medicare Coverage page for additional information on this subject.

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Licensing and Certification Issues

State or Federal licensing or certification issues are handled by the CMS Regional offices. Here is the contact information for patients living in:

Arizona or Nevada
DHHS, CMS Region IX, Providers & Policies
4th Floor, 75 Hawthorne St
San Francisco, CA 94105
(415) 744-3501

Colorado, Utah, or Wyoming
DHHS, CMS Region VIII, BMSO
1600 Broadway St #700
Denver, CO 80202
(303) 844-4024

New Mexico
DHHS, Region VI, DHSQ, CMS
1301 Young ST, #833
Dallas, TX 75202
(214) 767-6423

Your identity will be kept confidential throughout the process unless you specifically authorize a release.

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Intermountain End-Stage Renal Disease Network, Inc.
1301 Pennsylvania St #750, Denver, CO 80203-5012
Phone: 303-831-8818     Fax: 303-860-8392
Toll free for patients only: 1-800-783-8818 or 1-888-777-0105

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Supported by Centers for Medicare and Medicaid Services (CMS) Contract No. HHSM-500-2006-NW015C. The content of this website does not necessarily reflect the views or policies of CMS or the Department of Health and Human Services; nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Network #15 assumes full responsibility for the accuracy and completeness of this website.