CMS QIO Next Scope of Work Summary

Nancy Leveille in Clinical & Quality

AHCA has noted that CMS released the Quality Improvement Organization (QIO) program’s 11th Scope of Work (SoW) that will start August 2014.  The main changes are outlined below and the section pertinent to skilled nursing facilities (SNFs) is attached. For those interested in seeing the entire scope of work and all documents please click here:

Major Organizational Changes from prior QIO SOW

  • QIOs are to be regional covering 3 to 6 states and called Quality Innovation Networks (QIN) –QIOs
  • Contract cycle is extended to 5 years (from3 years)
  • Family and beneficiary complaint investigation shifted to Five (5) Beneficiary and Family Centered Care QIOs (BFCC-QIOs) covering entire country;

Purpose of QIN Contract

The purpose of the Quality Innovation Network (QIN) contract is to improve care for Medicare beneficiaries in a manner that aligns with the work that CMS will be doing in its efforts toward achievement of the National Quality Strategy (NQS) and the CMS Quality Strategy.

Skilled Nursing Facility 11th Scope of Work

(Task C.2:  Reducing Healthcare-Acquired Conditions in Nursing Homes section -- attached)

  • Recruit 75% of SNFs in each state with oversampling of 1 STAR facilities

o    QIOs must collect from all SNFs

  • Who participate, a signed statement that the nursing home will actively participate in the Collaborative, including data submission and data sharing
  • Who elect not to participate, a signed statement that they decline to participate and why.
  • The QIN-QIO shall have a targeted focus on

o    increasing mobility among long-stay residents,

o    decreasing unnecessary use of antipsychotics in dementia residents,

o    decreasing potentially avoidable hospitalizations,

o    decreasing Health Care Acquired Infections (HAIs) such as Methicillin - resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C.Diff), and vaccinations, such as pneumonia and influenza,

o    decreasing other Healthcare Acquired Conditions (HACs) such as: urinary tract infections, pressure ulcers, physical restraints, and ensuring an “injury and violence free living” environment as noted in the National Prevention Strategy, and

o    improving resident satisfaction.

  • The QIN-QIO’s efforts related to beneficiary satisfaction shall focus on the nursing home systems that impact quality, such as consistent/permanent staff assignment, communications, leadership, regulatory compliance, clinical models, and quality of life indicators.
  • The QIN-QIO shall recruit residents/beneficiaries and their family-members for participation as a part of the QIN-QIO’s Peer-Coach activity. In addition, the QIN-QIO shall include residents/beneficiaries and/or family members in at least two quality improvement activities initiated or performed by the QIN-QIO under Task C.2.
  • QINs will conduct two Collaboratives: NNHQCC Collaborative(s) I and II shall commence in Year 1 and Year 3 of the contract term, respectively, and each Collaborative shall last for 18 months. 
  • NNHQCC will use the Quality Assurance &. Performance Improvement (QAPI) model as the framework for nursing home quality improvement.
  • QIN-QIO shall recruit nursing homes to act as “Peer-Coaches” for other nursing homes in the Collaboratives if they are a high-performing nursing home, defined as being in the top 10% of the National Nursing Home Composite Quality Measure (to be provided by CMS).
  • QIOs will work to attain a score of six or better on the National Nursing Home Composite Quality Measure (TBD).
  • Improve the rate of mobility among long-stay nursing home residents.
  • Reduce the use of unnecessary antipsychotic medication in dementia residents.
  • The QIN-QIO shall create or engage with other Learning Area Networks such as, Advancing Excellence in America’s Nursing Homes Local Area Networks for Excellence (LANEs), Long Term Care Ombudsmen, nursing homes, HHS and CMS agencies, and others committed to nursing home excellence.


  • RFP released December 5, 2013
  • Proposals due to CMS February 14, 2014
  • Notification Awards expected July 2014
  • Work begins August 2014
  • Contracts are for five years
  NYSHFA CONTACT: Nancy Leveille, RN, MS
Sr. Director, Member Operational Support
518-462-4800 x20