Search Frequenty Asked Questions

Quality Improvement Organizations (QIOs)

Statement of Work

The QIO Statement of Work (SOW) is based on Title XI of the Social Security Act, Part B as amended by the Peer Review Improvement Act of 1982. This legislation established the QIO Program. As a result of legislative mandates and CMS's experience in administering the Program, CMS has identified the following SOW requirements:

1. Improve quality of care for beneficiaries by ensuring that beneficiary care meets professionally recognized standards of health care;
2. Protect the integrity of the Medicare Trust Fund by ensuring that Medicare only pays for services and items that are reasonable and medically necessary and that are provided in the most appropriate (e.g., economical) setting; and
3. Protect beneficiaries by expeditiously addressing individual cases such as beneficiary complaints, provider-issued notices of noncoverage (HINNs), EMTALA violations (dumping), and other statutory responsibilities.

The following SOW material is available:

8th SOW Summary (PDF, 127 KB)

CMS is interested in receiving your comments on the 8th QIO SOW Summary. Please respond with your comments to CMS by September 20, 2004, to 8sowcom@cms.hhs.gov. We thank you in advance for your comments and feedback; however, due to the nature of the procurement process, we will not respond directly to your comments.

QIO Version 011503-4A
Section C (PDF, 228 KB)
Section F (PDF, 114 KB)
Attachment J-7 (PDF, 188 KB)


QIO Version 011503-3
Overview of Modification (PDF, 57 KB)
Section C (PDF, 182 KB)
Section F (PDF, 201 KB)
Attachment J-7 (PDF, 201 KB)
Attachment J-17 (PDF, 158 KB)


Group One Contracts
SOW (PDF, 201 KB)



This version of the 7th Round QIO SOW was contained in the February 25, 2002 Request for Proposal (RFP) sent out to the first 19 QIOs. This electronic version does not represent any part of the official version of the RFP and may change as a result of the RFP question and answer period and/or the negotiation process.

Questions and Answers
General Comments and Section C (PDF, 213 KB)
Section D (PDF, 289 KB)
Section E (PDF, 232 KB)
Section F (PDF, 193 KB)
Sections B, G, H, K, L (PDF, 152 KB)
Attachments: J2, J3, J4, J5 (PDF, 252 KB)
Attachments: J7, J11, J12, J16 (PDF, 281 KB)
Reference: Home Health OBQI System SOW (PDF, 164 KB)




This version of the 7th Round QIO Statement of Work Questions and Answers was contained in the March 22, 2002 Request for Proposal (RFP) Amendment CMS sent to the first 19 QIOs. This electronic version does not represent any part of the official version of the RFP and may change as a result of future RFP Question and Answer periods and/or the negotiation process.

Group Three Contracts
SOW (PDF, 171 KB)
Questions (PDF, 104 KB)
Attachment J7 (PDF, 163 KB)
Section F (PDF, 88 KB)

SOW (PDF, 242 KB)