Integral Healthcare Solutions (IHS) helps hospitals subject to 42 CFR 482.13 develop patient rights notices, grievance procedures and restraint and seclusion policies. We assess existing documents and draft policies and audit tools for hospital leaders to approve.
Last updated: November 2026
What does 42 CFR 482.13 require for patient rights and grievances?
It requires a hospital to tell patients their rights and to run a grievance process. Paragraph (a)(1) says: "A hospital must inform each patient, or when appropriate, the patient's representative (as allowed under State law), of the patient's rights, in advance of furnishing or discontinuing patient care whenever possible." Paragraph (a)(2) says: "The hospital must establish a process for prompt resolution of patient grievances and must inform each patient whom to contact to file a grievance."
The governing text is 42 CFR 482.13, "Condition of participation: Patient's rights." This page follows the text in the govinfo bulk data for Title 42 (title last amended October 8, 2026), page opened November 5, 2026. The section's last amendment is 84 FR 51817, September 30, 2019. The table covers paragraph (a), notice of rights and the grievance process, and the core of paragraph (e), restraint or seclusion.
| Paragraph | What it asks, in IHS's words | What shows it |
|---|---|---|
| (a)(1) | Tell each patient, or when appropriate the patient's representative as allowed under State law, the patient's rights, in advance of furnishing or discontinuing care whenever possible. | Patient rights notice and a record of when it was given |
| (a)(2) | The governing body must approve and be responsible for the effective operation of the grievance process and must review and resolve grievances, unless it delegates the responsibility in writing to a grievance committee. | Governing body minutes and any written delegation |
| (a)(2) | The grievance process must include a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate Utilization and Quality Control Quality Improvement Organization. | Referral step in the procedure |
| (a)(2)(i) | A clearly explained procedure for the submission of a patient's written or verbal grievance to the hospital. | Grievance procedure with a submission route |
| (a)(2)(ii) | The process specifies time frames for review of the grievance and the provision of a response. | Time frames written into the procedure |
| (a)(2)(iii) | In its resolution of the grievance, written notice of the decision with four items: the name of the hospital contact person, the steps taken on behalf of the patient to investigate, the results of the grievance process, and the date of completion. | Decision letter template and grievance log |
| (e) | Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time. | Restraint and seclusion policy |
| (e)(6) | Orders for the use of restraint or seclusion must never be written as a standing order or on an as needed basis (PRN). | Order set and an audit of orders |
| (e)(8)(i) | Unless superseded by State law that is more restrictive, orders for restraint or seclusion used for violent or self-destructive behavior that jeopardizes immediate physical safety may only be renewed within these limits, for up to a total of 24 hours: 4 hours for adults 18 or older, 2 hours for children and adolescents 9 to 17, and 1 hour for children under 9. | Order renewal rules in the policy and an audit tool |
Section 482.13 specifies no day count; it requires prompt resolution and specified review and response time frames. The table's evidence examples are IHS's suggestions as of November 5, 2026, not prescribed document titles.
The section also covers exercise of rights, privacy and safety, record confidentiality, restraint and seclusion training, death reporting and visitation in paragraphs (b)–(d) and (f)–(h). This offer focuses on paragraphs (a) and (e); related work is scoped separately.
Who needs it and what triggers it?
Any hospital subject to the condition needs a patient rights notice, a grievance process and restraint and seclusion policies. These triggers are IHS's reading, not a CMS list.
- The hospital is updating its patient rights notice, grievance procedure and restraint and seclusion policies together.
- The governing body has not approved the grievance process, or responsibility for reviewing and resolving grievances is unclear.
- Decision notices omit the contact person, investigation steps, results or completion date.
- Restraint orders are written as standing or PRN orders, which paragraph (e)(6) bars.
How IHS helps
IHS assesses gaps against paragraphs (a) and (e), maps evidence, drafts missing content, and conducts a mock review and readiness support for your team. The drafts are a patient rights notice, a grievance procedure with a submission route, time frames and a referral step, a decision letter template carrying the four required items, a grievance log, a restraint and seclusion policy set, an audit tool and a governing body reporting template. Integral Healthcare Solutions (IHS) was founded in 2002 by Thomas G. Goddard, JD, PhD, former Chief Operating Officer and General Counsel of URAC, and works across three practice lines: accreditation consulting, compliance services and program development. This build sits in our Program Development practice line.
Your hospital supplies the governing body decisions and any written delegation, your current notice, policies, grievance log and restraint records, the State law requirements, and the clinical leaders who approve policy content.
The limit: IHS does not receive, investigate or resolve grievances, and it does not set clinical restraint practice. Your clinical leaders decide practice. IHS also does not communicate with CMS, a state agency or an accreditor for the hospital.
What to have ready
Checklist source: 42 CFR 482.13, Condition of participation: Patient's rights, current eCFR text opened November 5, 2026; Title 42 last amended October 8, 2026.
- Your current patient rights notice and the way patients receive it (paragraph (a)(1)).
- Governing body minutes that approve the grievance process, and any written delegation to a grievance committee (paragraph (a)(2)).
- Your grievance procedure, its submission route, its time frames and its referral step for quality of care and premature discharge concerns (paragraph (a)(2), (a)(2)(i) and (a)(2)(ii)).
- Your grievance log and your decision notices, checked for the four required items (paragraph (a)(2)(iii)).
- Your restraint and seclusion policy and a sample of recent orders (paragraphs (e), (e)(6) and (e)(8)).
- Medical-record documentation for recent restraint or seclusion episodes, including the 1-hour face-to-face evaluation when used to manage violent or self-destructive behavior (paragraphs (e)(12) and (e)(16)).
- Your State law requirements, gathered by your counsel (paragraphs (a)(1) and (e)(8)).
If several of these are missing or out of date, book the free introductory call and bring what you have.
How does a built policy compare with a template or an internal draft?
A hospital can start from an association or insurer template, write the policies in-house, use outside drafting support or have counsel write them. An internal build by patient relations and risk staff keeps control and uses their time. Outside drafting support from IHS adds a writer and a gap assessment. IHS does not tell you which to choose. For other hospital conditions, see our QAPI program build page and our swing bed readiness page, which cover different sections of the Medicare rules.
What does it cost?
Section 482.13 does not publish a fee schedule for this work. IHS scopes each engagement after a free introductory call. Scope depends on the number of campuses and units and the condition of your existing documents.
Your own staff time is the third cost: patient relations, risk and nursing leaders gather records and approve content, whichever route you take.
What this is not
This is not legal advice. IHS is a consulting firm, not a law firm, and your counsel answers State law questions. It is not a guarantee of any survey result, and IHS does not decide whether your hospital meets the condition. IHS does not submit anything to CMS, a state agency or an accreditor; your hospital does.
Frequently asked questions
What does 42 CFR 482.13 require for patient grievances?
Paragraph (a)(2) requires prompt grievance resolution and tells hospitals to inform each patient whom to contact. It requires governing-body oversight, timely referral of quality-of-care or premature-discharge concerns to the appropriate Quality Improvement Organization, a clearly explained procedure for written or verbal grievances, specified review and response time frames, and written notice of the decision.
What must a grievance decision letter contain?
Paragraph (a)(2)(iii) says that in its resolution of the grievance the hospital must give the patient written notice of its decision containing four items: the name of the hospital contact person, the steps taken on behalf of the patient to investigate the grievance, the results of the grievance process, and the date of completion. IHS drafts a template that carries the four items.
Who must approve and oversee the grievance process?
The governing body must approve the process, be responsible for its effective operation, and review and resolve grievances, unless it delegates that responsibility in writing to a grievance committee. IHS drafts a minutes-ready record for your governing body to adopt.
What time frame applies to responding to a grievance?
Section 482.13 specifies no day count, but paragraph (a)(2) requires prompt resolution and paragraph (a)(2)(ii) requires specified review and response time frames. Your hospital's reviewers should also check applicable CMS guidance and State law when setting those time frames.
What must restraint and seclusion policies address?
Paragraph (e) says restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others and must be discontinued at the earliest possible time. Paragraphs (e)(2) to (e)(16) add conditions on orders, renewal, monitoring, the 1-hour face-to-face evaluation and documentation. IHS writes the policy from the whole paragraph, and your clinical leaders decide practice.
How long can restraint orders be renewed?
Unless more restrictive State law supersedes these rules, paragraph (e)(8)(i) permits renewal of restraint or seclusion orders for violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, staff or others for up to 24 hours total: 4 hours for adults 18 or older, 2 hours for ages 9 to 17, and 1 hour for children under 9. Under paragraph (e)(8)(ii), after 24 hours and before a new order for that behavior, the patient must be seen and assessed by a physician or other licensed practitioner responsible for the patient's care and authorized to order restraint or seclusion by hospital policy in accordance with State law. Orders for restraint of non-violent or non-self-destructive patients may be renewed as authorized by hospital policy under paragraph (e)(8)(iii).
What must a patient rights notice say and when is it given?
Paragraph (a)(1) requires the hospital to inform each patient, or when appropriate the patient's representative as allowed under State law, of the patient's rights, in advance of furnishing or discontinuing patient care whenever possible. Your counsel confirms the content against State law.
Can a hospital use a template grievance policy?
A template can be a starting point, but it is not built for your governing body, committee structure or grievance log. The condition asks for a process that the governing body approves and answers for, so a draft needs mapping to paragraph (a)(2) and to your own operation.
What does a patient rights and grievance process build cost?
Section 482.13 does not publish a fee schedule for this work. IHS scopes each engagement after a free introductory call. Scope depends on the number of campuses and units and the condition of existing documents; allow for your staff's time to gather records and approve drafts.