Initial Response to Complainant

5100.2 – Initial Response to Complainant (Rev. 243; Issued: 06-12-26; Effective: 06-12-26; Implementation: 06-12-26) • If the SA concludes that a complaint represents a substantial allegation of noncompliance (i.e., it is appropriately triaged as an IJ or non-IJ high), it requests authorization in ACTS from the CMS location to conduct a survey. If the CMS location authorizes a survey, the SA acknowledges receipt of the complaint by a letter to the complainant, and advises that a SA investigation will be initiated. The acknowledgment letter also advises that the complainant may also wish to file a complaint with the applicable accrediting organization (AO), naming the AO and attaching a current list of AOs and their contact information. This list may be found at: https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertificationGenInfo/Downloads/Accrediting-Organization- Complaint-Contacts.pdf • If the SA concludes that a complaint does not represent a substantial allegation of noncompliance (i.e., it is appropriately triaged as non-IJ medium or low) the SA sends the complainant a letter indicating that the complaint does not meet the criteria for a Federal on-site investigation of an accredited health care facility. The letter also advises the complainant which AO(s) accredit the provider/supplier for Medicare participation purposes and provides the above AO contact information, should the individual wish to pursue a complaint with the AO. If the CMS location directly receives a complaint, it is responsible for sending the complainant a letter which acknowledges the receipt of the complaint and advises the complainant in the same manner as indicated above for complaints received by the SA.