Referrals from Other Federal Government Organizations

5085.1 – Referrals from Other Federal Government Organizations (Rev. 28, Issued: 10-21-16, Effective: 10-21-16, Implementation: 10-21-16) When a QIO receives a referral or request for review for potential Quality of Care Concerns from Federal Government organizations outside of the Centers for Medicare & Medicaid Services (e.g., the Office of Inspector General, the Department of Justice [DOJ], or the Office for Civil Rights), the QIO should provide a copy to the appropriate CMS COR. When a potential Quality of Care concern is referred to the QIO, the requestor will use the authorized QIO Case Review Referral Request Form. (See Appendix 5-8.) Upon receiving any referred potential Quality of Care Concerns, the QIO must follow the process requirements set forth in §5100, “Quality of Care Reviews – General.” When a potential Quality of Care Concern is referred, the QIO must conduct a General Quality of Care Review. (See §§5100-5115.3.)