Rollout Issues with New Beneficiary and Family-Centered Care Vendors

Starting August 1, two Beneficiary and Family-Centered Care Quality Improvement Organizations’ (BFCC-QIO) contractors, Livanta and KEPRO come responsible for providing the program’s case review and monitoring activities.  This separates the function from the traditional quality improvement activities of the QIOs.  This important function ensures the safety of beneficiaries, provides an appeal process regarding one’s care, and is a key element in our national dialogue around transitions of care.

If you are not aware of how this system works here is an example: if my 89 year old Mom is in the hospital and the hospital wants to discharge her and my family feels and has reason to believe that she is in no condition to move or transfer, we can appeal that decision. Mom gets to stay at the hospital until the matter is investigated and a decision is reached.  This formerly local process is now being administered nationally by the two companies.
The American Health Care Association (AHCA) has heard from many State Affiliates as well as providers that there has been a wide array of problems affecting Medicare beneficiaries since the new vendors started on August 1.  AHCA is working with partners and makes the following recommendations:

  1. The Beneficiaries should call 1-800-Medicare and they should not accept being told to call Livanta or KEPRO. VHCA recommends they (or their advocate) ask for a supervisor to let them know they are having problems exercising their Medicare beneficiary appeal rights! (This specific language is important)
  2. Make any issues known to your local State Survey Agency and Ombudsman. This will help to bring the problem to light on many fronts to ensure it is resolved soon.
  3. The local QIO, who many people counted on, no longer is doing the Beneficiary Protection work so they are unable to assist.

AHCA, in the meantime, is working hard to get providers information and is working with partners to resolve this issue. Safety and quality care is a critical concern and AHCA will continue to appraise providers as they receive more information.

Attached are handouts that provide information on the new QIO program and a map of 5 QIO areas and vendor responsibility.  As you will see, KePro is the vendor for Virginia in area 2.