Authorities

12100 - Authorities (Rev. 27, Issued: 07-08-16, Effective: 07-08-16, Implementation: 07-08-16) This chapter describes the minimum requirements and responsibilities of QIOs for communications and outreach. QIO Program communication, outreach, and information collection activities must comply with the following statutory and regulatory responsibilities as applicable based upon the QIO functions, care settings, types of reviews, and service areas defined by CMS in each QIO contract: • Maintain a beneficiary outreach program to apprise providers of healthcare services and individuals receiving care of their rights to QIO case reviews, and of a QIO’s obligation for making review determinations as authorized by Section 1154(a)(1) and 1154(a)(4) of the Social Security Act (the Act) • Provide a physician representing a QIO to meet several times a year with medical and administrative staff of hospitals whose services are reviewed by the QIO as required by Section 1154(a)(6)(B)(i) of the Act • Publish and distribute not less often than annually a report that describes the QIO’s review findings as required by Section 1154(a)(6)(B)(ii) of the Act • Coordinate activities for economical and efficient operation of the program as required by Section 1154(a)(10) of the Act • Conduct activities deemed necessary for improving the quality of care as required by Section 1154(a)(18) of the Act • Perform communication and outreach activities in accordance with the confidentiality and nondisclosure requirements defined in 42 CFR 480 and sections of the Health Insurance Portability and Accountability Act (HIPAA) CMS provides QIO contractors with program guides and handbooks that it routinely updates and revises as the program environment and operations change. The QIO Program Communications Handbook and the QIO Program Brand Guidelines Manual provide QIO Program contractors information regarding communications, outreach, information collection, and development of publications. QIO Program guides also direct QIO contractors to agency and departmental resources such as the CMS Contractor Website Guidelines and federal accessibility standards to comply with Section 504 and Section 508 of the Rehabilitation Act of 1973. CMS expects QIOs to use these guidance documents as a reference for operational questions not addressed in the QIO Manual. The QIO Program Communications Handbook and the QIO Program Brand Guidelines Manual are available to QIO contractors through the CMS- furnished secure Intranet site (secure log in is required).