The QIO Statement of Work (SOW) is based on Part B of Title XI of the Social Security Act (hereinafter referred to as the Act), as amended by the Peer Review Improvement Act of 1982.  The Act established the Utilization and Quality Control Peer Review Organization Program, now known as the QIO Program.

The statutory mission of the Program, as set forth in Section 1862(g) of the Act, is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

Based on legislative language and the experience of CMS in administering the Program, CMS has identified the following requirements for the QIO Program:

• Improve quality of care for beneficiaries;
• Protect the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and medically necessary and that are provided in the most appropriate setting; and
• Protect beneficiaries by expeditiously addressing individual complaints, notices, and appeals, such as beneficiary complaints; provider-issued notices of non-coverage (Hospital-Issued Notice of Non-Coverage [HINN], Notice of Discharge and Medicare Appeal Rights [NODMAR], and Medicare Advantage appeal); Emergency Medical Treatment and Labor Act (EMTALA) violations; and other related statutory QIO responsibilities.

8^th Statement of Work

The QIO Program is currently operating within its 8^th SOW contract cycle (August 2005 – July 2008).  The requirements for QIOs over this 3-year cycle are described in Section C of the 8^th SOW contract.

Based on these requirements, the Medicare Quality Improvement Organization Program Priorities document describes the national quality improvement projects led by CMS. It includes objectives, clinical background, measure specifications, public health importance, opportunity for improvement, and literature references for each setting.

9th Statement of Work

The QIO Program is preparing for its 9th SOW contract cycle (August 2008 – July 2011). The requirements for QIOs over this 3-year cycle are described in Section C of the 9th SOW contract.

Under the 9th SOW, the QIOs will focus on four main themes: Beneficiary Protection, Patient Pathways (Care Transitions), Patient Safety, and Prevention. In addition, the QIOs will be required to help Medicare promote three overarching themes: adopt value-driven healthcare, support the adoption and use of health information technology, and reduce health disparities in their communities.

As part of the 9th SOW, QIOs will be required to offer help to specific nursing homes and hospitals that have not recently performed well on important quality measures. Please refer to the "Downloads" section at the bottom of this page to learn more about the facilities targeted for improvement under the 9th SOW.

As part of the transition to the 9th SOW, CMS is conducting contract competition in several areas of the country. Please refer to the "Downloads" section at the bottom of this page to learn more about the Request for Proposals that CMS has solicited as part of this competition.

Downloads
8th SOW contract [PDF, 1.1MB] Pre-Proposal Transcript [PDF, 487KB] Qs & As Responses [ZIP, 2MB] 9th SOW: Contract Solicitation Revisions as of 3/6/08 [ZIP, 5MB] 9th SOW: Contract Solicitation Revisions as of 2/21/08 [ZIP, 965KB] 9th SOW: Contract Solicitation Documents as of 2/5/08 [ZIP, 9MB] 9th SOW: National List: Nursing Homes Targeted for High-risk Pressure Ulcer and/or Physical Restraint Improvement [PDF, 9,762KB] 9th SOW: National List: Hospitals Targeted for Improvement for Surgical Care Improvement Program [PDF, 1,457KB] 9th SOW: Explanation of Measure Details for Hospitals and Nursing Homes Targeted for Improvement [PDF, 122KB]
Related Links Inside CMS
Fact Sheet: Medicare Releases Solicitations for QIOs' 9th Statement of Work
Related Links Outside CMS
FedBizOpps: 9th SOW Solicitation Documents MedQIC QIO Directory AHQA Medicare Quality Improvement Organization Program Priorities

Page Last Modified: 03/06/2008 9:56:27 AM
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