FROM: Theodore O. Will, FACHE /s/ Chief Executive Officer
DATE: April 12, 2012
RE: MEDICARE MEMORANDUM OF AGREEMENT (MOA) 10TH STATEMENT OF WORK
IPRO CONTACT: Harry M. Feder, Chief Operating Officer, 516-209-5528
Enclosed for your review and signature please find two copies of the Memorandum of Agreement (MOA) for Medicare 10th Statement of Work (10th SOW) activities between IPRO, as the Federally designated Quality Improvement Organization (QIO) for New York State, and your facility. This agreement replaces the MOA currently in effect for the 9th SOW, and contains only minor changes, e.g., the effective date and the change from 9th SOW to 10th SOW.
Please have the appropriate representative of your facility sign and return both copies to the following address no later than May 7, 2012: Harry M. Feder
Chief Operating Officer
1979 Marcus Avenue
Lake Success, NY 11042
One fully executed copy will be returned to you for your records. Please note that if a provider fails to sign an MOA, the QIO must report the circumstances to the Centers for Medicare & Medicaid Services (CMS) Contracting Officer Representative for resolution.
As you are aware, IPRO is the QIO authorized by the Medicare program to review medical services provided to Medicare beneficiaries in the state of New York. Effective August 1, 2011, IPRO entered into a new contract with CMS to conduct activities required under the Medicare 10th SOW. IPRO will continue to review medical records to determine whether services delivered to Medicare beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. These reviews may be conducted on an expedited basis, concurrently and/or retrospectively. In addition, IPRO will continue to review written complaints from Medicare beneficiaries about the quality of Medicare services they have received and conduct quality improvement projects to make measurable improvements in beneficiary health status.
In order to participate in the Medicare program, hospitals, critical access hospitals (CAHs), hospices, skilled nursing facilities, and home health agencies are required to have a Memorandum of Agreement (MOA) with a QIO under Federal regulations. MOAs are intended to be informational and facilitate the review process by outlining the QIO’s administrative and review responsibilities and the provider’s responsibility in assisting us in accomplishing our review requirements, including:
- IPRO procedures with respect to certain QIO contract obligations,
- review and appeal rights which providers have with respect to these obligations, and
- opportunities providers have to partner with IPRO in local and national quality improvement projects.
IPRO appreciates the assistance in preparing this MOA received from the members of the Provider Relations Committee, including representatives from the Healthcare Association of New York State (HANYS), Greater New York Hospital Association, Iroquois Healthcare Alliance, Nassau-Suffolk Hospital Council, New York City Health & Hospitals Corporation, Northern Metropolitan Hospital Association, Rochester Regional Healthcare Association, the Western New York Healthcare Association, and the Southern New York Association.
We have also enclosed, for your information, a flyer further describing the role of Quality Improvement Organizations.
Should you have any questions or require additional information, please feel free to contact Harry M. Feder, Chief Operating Officer, at 516-209-5528.
P.S.: Please note that the New York City Health and Hospitals Corporation and the New York State Office of Mental Health will be signing one Memorandum of Agreement that will cover all of their affiliated hospitals.