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On August 8, 2008, CMS publicly announced the award of 53 contracts for the QIO Program 9th Statement of Work (SOW) with an effective date of August 1, 2008. Of the 53 contracts for the core 9th SOW, 13 were competitively awarded and 40 were negotiated renewals. On August 12 and 13, 2008 respectively, CMS received notification that a protest to the award of WVMI Quality Insights for the state of North Carolina and a protest to the award of Health Services Advisory Group (HSAG) for the state of California had been filed with the Government Accountability Office (GAO). As both protests were filed timely, an automatic stay of performance went into effect for both the NC and CA 9th SOW awards. The following provides an update to the status of the protests and the stay of performance for the states of NC and CA. **UPDATE: November 14, 2008** Status of QIO Contract for North Carolina On September 5, 2008, CMS was granted an override to the stay of performance for the state of North Carolina. This means that WVMI may proceed with the work under its 9th SOW contract as directed by CMS up until the time the GAO renders its protest decision. The GAO has 100 days from the date of the protest to render a final decision. The GAO decision is due November 21, 2008. However, WVMI Quality Insights has not yet assumed beneficiary protection responsibilities in the state. Until further notice, North Carolina beneficiaries who wish to file complaints or appeals about the quality of their care under Medicare should contact the existing QIO in North Carolina, the Carolinas Center for Medical Excellence at 1-800-922-3089. Status of QIO Contract for California On September 5, 2008, CMS was granted an override to the stay of performance for the state of California. This meant that Health Services Advisory Group (HSAG) could proceed with the work under its 9th SOW contract as directed by CMS up until the bid protest at GAO was resolved. On September 22, the GAO dismissed the protest because the protestor to the award chose to withdraw its protest from the GAO and has filed a Motion for a Temporary Restraining Order and/or Preliminary Injunction and Complaint for Injunctive Relief and Declaratory Judgment in the U.S. Court of Federal Claims. At the moment, no stay is in place, and the Claims Court has not granted the Motion for a Temporary Restraining Order. A hearing on the Complaint will be held in October 2008. The 9th SOW contractor, HSAG, is authorized to continue work under their current contract as directed by CMS. We will provide updates to this website as new information is received At this time HSAG has assumed beneficiary protection responsibilities in California, and is the only entity serving as the California QIO. California beneficiaries who wish to file complaints or appeals about the quality of their care under Medicare should contact the HSAG at 1-800-841-1602 (or 1-800-881-5980 for TDD-hearing impaired callers). **UPDATE: AUGUST 5, 2008** In August 2008, QIOs began work on their 9th Statement of Work with CMS. To learn more, read our Fact Sheet on the 9th SOW page. CMS contracts with one organization in each state, as well as the District of Columbia, Puerto Rico, and the U.S. Virgin Islands to serve as that state/jurisdiction's Quality Improvement Organization (QIO) contractor. QIOs are private, mostly not-for-profit organizations, which are staffed by professionals, mostly doctors and other health care professionals, who are trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. QIO contracts are 3 years in length, with each 3-year cycle referenced as an ordinal "SOW." What do QIOs do? By law, the mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. Based on this statutory charge, and CMS' Program experience, CMS identifies the core functions of the QIO Program as: - Improving quality of care for beneficiaries;
- Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and
- Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other related responsibilities as articulated in QIO-related law.
Why does CMS have QIOs? CMS relies on QIOs to improve the quality of health care for all Medicare beneficiaries. Furthermore, QIOs are required under Sections 1152-1154 of the Social Security Act. CMS views the QIO Program as an important resource in its effort to improve quality and efficiency of care for Medicare beneficiaries. Throughout its history, the Program has been instrumental in advancing national efforts to motivate providers in improving quality, and in measuring and improving outcomes of quality. The Report to Congress in the Downloads area outlines improvements, based on an extensive CMS review and recommendations from the Institute of Medicine, to strengthen Medicare's oversight and evaluation of the QIO Program to better meet the future needs of beneficiaries and health care providers.
Page Last Modified: 11/14/2008 1:55:57 PM
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