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Separating Beneficiary Complaint Review Functions from Quality Improvement Functions

On May 9, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the first phase of its restructuring of the QIO functions.  In the first phase, CMS has contracted with Livanta LLC (for geographic areas 1 and 5), located in Annapolis Junction, Maryland, and KePRO (for geographic areas 2, 3, and 4), located in Seven Hills, Ohio. These contractors will be responsible for ensuring consistency in the review process with respect to beneficiary complaints. CMS describes these two contractors as its Beneficiary and Family-Centered (BFCC) QIO contractors.

The states in the designated geographic areas are:  Area 1: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Puerto Rico, Rhode Island, Vermont, Virgin Islands;  Area 2: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia;  Area 3: Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming;  Area 4: Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin, and  Area 5: Alaska, Arizona, California, Hawaii, Idaho, Nevada, Oregon, Washington. 

CMS will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on Aug. 1, 2014.  The second phase of CMS’ QIO restructuring is expected to begin in July 2014 with the awarding of QIO contracts to entities to work on quality improvement and clinical care matters.

The CMS announcement is available at: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-05-09.html/.   CMS will also host a national webinar for providers and other interested parties on July 23, 2014, from 11:00 am – 12:00 pm EDT.  Details are available at: http://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html.

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