Administrative Memos

200203

FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 30, 2002
SUBJECT: Medicare Home Health Agency Memorandum Of Agreement (MOA) 7th Scope Of Work
IPRO CONTACTS:

Harry M. Feder, Senior Vice President, Ext. 528

Enclosed for your review and signature please find two copies of the Memorandum of Agreement (MOA) for Medicare Seventh Scope of Work (7th SOW) review activities between IPRO, as the Federally designated Quality Improvement Organization (QIO) for New York State, and your Home Health Agency. This agreement replaces the MOA currently in effect.

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, 2002, IPRO entered into a new contract with the Centers for Medicare & Medicaid Services (CMS) to conduct activities required under the Medicare Seventh Scope of Work (7th SOW). IPRO will continue to review medical records to determine whether services delivered to these beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. In addition, IPRO will 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, skilled nursing facilities, and home health agencies are required to have a Memorandum of Agreement (MOA) with a QIO under Federal law. MOAs 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. MOAs are also intended to be informational. IPRO wants to inform New York State hospitals, skilled nursing facilities and home health agencies of:

IPRO procedures with respect to certain 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.

Please have the appropriate representative of your facility sign and return both copies of the MOA by January 30, 2003.

Should you have any questions or require additional information, please feel free to contact Harry M. Feder, Senior Vice President, at 516-326-7767, Ext. 528.