StacksVerified U.S. regulatory reference

42 CFR §475.101

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
In order to be eligible for a QIO contract, an organization must meet the following requirements:
  1. (a)Have a governing body that includes at least one individual who is a representative of health care providers and at least one individual who is a representative of consumers.
  2. (b)Demonstrate the ability to perform the functions of a QIO, including—
    1. (1)The ability to meet the eligibility requirements and perform activities as set forth in the QIO Request for Proposal; and
    2. (2)The ability to—
      1. (i)Perform case reviews as described in § 475.102; and/or
      2. (ii)Perform quality improvement initiatives as set forth in § 475.103.
  3. (c)Demonstrate the ability to actively engage beneficiaries, families, and consumers, as applicable, in case reviews as set forth in § 475.102, and/or quality improvement initiatives as set forth in § 475.103.
  4. (d)Demonstrate the ability to perform the functions of a QIO with objectivity and impartiality and in a fair and neutral manner.