Content of Report

9045.1.1 – Content of Report (Rev. 24, Issued: 02-12-16, Effective: 03-14-16, Implementation: 03-14-16) The QIO report must include at least the following information: 1. Identification of the practitioner or other person and, when applicable, the name of the director, administrator, or owner of the entity involved; 2. The type of health care services involved; 3. A description of each failure to comply with an obligation, including specific dates, places, circumstances, and other relevant facts; 4. Pertinent documentary evidence; 5. Copies of written correspondence, including reports of conversations with the practitioner or other person about the violation and, if applicable, a copy of the verbatim transcript of the meeting with the practitioner or other person; 6. The QIO’s finding that an obligation under §1156(a) of the Act has been violated, that the violation is substantial and has occurred in a substantial number of cases, or is gross and flagrant; 7. A case-by-case analysis and evaluation of any additional information provided by the practitioner or other person in response to the QIO’s initial finding; 8. A copy of the CAP that the QIO developed and documentation of the results of the plan; 9. The number of admissions by the practitioner or other person the QIO reviewed during the period in which the violation(s) was identified; 10. The professional qualifications of QIO reviewers; and 11. The QIO sanction recommendation.