GroundRules
42 CFR 475.101: Eligibility requirements for QIO contracts.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS
- PART 475—QUALITY IMPROVEMENT ORGANIZATIONS
- Subpart C—Quality Improvement Organizations
In order to be eligible for a QIO contract, an organization must meet the following requirements:
(a) Have a governing body that includes at least one individual who is a representative of health care providers and at least one individual who is a representative of consumers.
(b) Demonstrate the ability to perform the functions of a QIO, including—
(1) The ability to meet the eligibility requirements and perform activities as set forth in the QIO Request for Proposal; and
(2) The ability to—
(i) Perform case reviews as described in § 475.102; and/or
(ii) Perform quality improvement initiatives as set forth in § 475.103.
(c) Demonstrate the ability to actively engage beneficiaries, families, and consumers, as applicable, in case reviews as set forth in § 475.102, and/or quality improvement initiatives as set forth in § 475.103.
(d) Demonstrate the ability to perform the functions of a QIO with objectivity and impartiality and in a fair and neutral manner.
Collected 2026-08-27T02:26:11Z. Source file · JSON