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 On August 8, 2008, CMS announced publicly it has awarded the contract for the QIO Program 9th Statement of Work (beginning August 1) to Health Services Advisory Group for the state of California and WVMI Health Insights for the state of North Carolina.  On the week of August 12, 2008, protests against these awards were filed with the Government Accountability Office (GAO). GAO's decision on the protests must be issued no later than 100 days after the protest was filed. In this case, the deadline for the GAO decision on the protest is November 21, 2008.  In accordance with the Competition in Contracting Act (CICA), the filing of the protest triggered an automatic stay on performance of the Health Services Advisory Group and WVMI Quality Insights contracts pending GAO's decision.  This stay on performance will not impact the rights of California- or North Carolina-based beneficiaries to file complaints about the quality of care in their state.



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.


Report to Congress: Response to IOM Study on the QIO Program [PDF, 225KB]
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