New Quality Improvement Organization (QIO) Contracts Awarded – Agreements Due July 31
Tuesday, July 22, 2014 9:31 AM
The Centers for Medicare and Medicaid Services (CMS) has awarded new quality improvement organization (QIO) contracts. For the first time, CMS restructured the QIO program by separating the QIO’s case review work from the quality improvement work, and issued separate requests for proposals (RFPs) and contracts for each. Two contracts were awarded to Beneficiary and Family Centered Care QIOs (BFCC-QIO) to perform case reviews, quality of care reviews, diagnosis-related group (DRG) reviews, EMTALA reviews, appropriateness of setting reviews, medical necessity reviews, readmission reviews, Physician Acknowledgment Statement monitoring, appeals and sanctions. KePRO (which previously held the QIO contract for Ohio), was awarded the BFCC-QIO contract for Kentucky as well as 32 other states and the District of Columbia. Kentucky hospitals should have received a letter from KePRO indicating they will begin this work August 1, and advising that hospitals should download, sign and return a Memorandum of Agreement (MOA) by July 31. Federal law requires that hospitals have these agreements with a QIO. The MOA can be downloaded at www.tiny.cc/moa and should be returned by fax to 216-654-1547 (Attn: MOA Coordinator) or via email to firstname.lastname@example.org.
In addition, CMS recently awarded 14 contracts to Quality Innovation Network QIOs (known as QIN-QIOs) to work on quality improvement initiatives. Under the 11th Scope of Work, these organizations will focus on reducing health care associated infections, readmissions, medication errors, work with nursing homes on improving care for residents, supporting clinical practices in using interoperable health information technology, activities to reduce cardiac disease and diabetes, reducing health care disparities and improving patient and family engagement. Qsource, the existing QIO for Tennessee, has been awarded the QIN-QIO contract for Kentucky, as well as Tennessee, Alabama and Mississippi. Kentucky’s existing QIO – Health Care Excel – did not bid on either contract. Contracts for the QIN-QIOs begin on August 1. KHA anticipates hospitals will receive more information from Qsource shortly. (related KHA News article)
If you have any questions concerning the new QIO contracts, please contact Nancy Galvagni at KHA (502-426-6220 or 800-945-4542 or via email at email@example.com).