Administrative Memos

200510

FROM: Theodore O. Will, Chief Executive Officer
DATE: Dec 06, 2005
SUBJECT: MEDICARE MEMORANDUM OF AGREEMENT (MOA) 8TH 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 Eighth Scope of Work (8th SOW) review 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.

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, 2005, IPRO entered into a new contract with the Centers for Medicare & Medicaid Services (CMS) to conduct activities required under the Medicare Eighth Scope of Work (8th 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. 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 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 providers in New York State 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 13, 2006.

Please note that the QIOs received a "Revised Policy Regarding the Mail and Delivery of Memorandum of Agreements (MOAs)" from CMS dated November 16, 2005. The policy requires that if the provider does not return the initial MOA (with signature) by the specified date to the QIO, a second MOA will be mailed to the provider using certified mail. If after the second mailing the provider fails to return the signed MOA, the QIO must report the circumstances to the CMS project officer for resolution.

IPRO appreciates the assistance in preparing this MOA received from the members of the Provider Relations Committee, chaired by Paul Rowland and Jackie Talcik, 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, and the Western New York Healthcare Association.

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.

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.

Please note: Due date for return of enclosed MOA, with appropriate signature, is January 13, 2006.