The Centers for Medicare & Medicaid Services (CMS) recently launched the 13th Scope of Work to support healthcare quality improvement and the Secretary’s Make America Healthy Again (MAHA) initiative. As one of the largest federally funded quality improvement programs in the country, CMS directs Quality Improvement Organizations (QIOs) to collaborate with healthcare providers nationwide to improve outcomes for Medicare beneficiaries.
The next round of QIO contractors was announced on the CMS website. South Dakota is part of QIN-QIO Midwest Region 6, which was awarded to Telligen, headquartered in West Des Moines, Iowa. Midwest Region 6 includes the following 14 states: South Dakota, North Dakota, Iowa, Nebraska, Kansas, Missouri, Montana, Wyoming, Colorado, Utah, Idaho, Oregon, Washington, and Alaska.
The QIO Program has two core contract functions: case review and health care quality improvement support. Both functions are carried out through four initiatives:
- Two Beneficiary and Family Centered Care-Quality Improvement Organizations (BFCC-QIOs) help people with Medicare and their families exercise their right to high-quality health care. They do this by managing quality of care concerns, conducting immediate advocacy and reviewing appeals of discharge or decisions to end Medicare-covered services. (May 2024 – April 2029)
- Seven Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) work directly with nursing homes, hospitals, and physician offices to improve the quality and safety of care for people with Medicare. (May 2025 – May 2030)
- The American Indian Alaska Native Healthcare Quality Initiative (AIANHQI) works directly with Indian Health Service (IHS) hospitals to improve the quality of health care for people with Medicare who are American Indian or Alaska Native. (January 2025 – May 2030)
- The Opioid Prescriber Safety & Support (OPSS) initiative provides national outreach and education to eligible providers to promote safe opioid prescribing practices and to spread knowledge of non-opioid pain management therapies.
How do QIOs improve health delivery, status, and cost?
Nationally, the QIO Program partners with leading organizations like the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, and many others. QIOs also work with state, local, and tribal agencies, engaging them as partners in learning and action networks and improving collaboratives that rapidly effect large-scale change for the better.
To learn more, visit QIO Program 13th SoW | CMS
