April 4 CMS Information Session for NQIIC IDIQ 13th SOW planning.pptx

National Quality Improvement and Innovation Contractors

(NQIIC)

CMS Information Session April 4, 2023

CMS Speakers

Anita Monteiro Group Director Quality Improvement and Innovation Group Center for Clinical Standards and Quality (CCSQ)

Michael Connors Director Division of Quality Contracts Office of Acquisitions and Grants Management (OAGM)

CMS Authorities & Programs 1115 Waivers Demonstration programs Innovation Accelerator Program Hospital Inpatient Quality Hospital Outpatient In-patient psychiatric hospitals Cancer hospitals Nursing homes Home Health Agencies Long-term Care Acute Hospitals In-patient rehabilitation facilities Hospices

CLIA

Target surveys Quality Assurance Performance Improvement Hospitals, Home Health Agencies, Hospices, ESRD facilities Part D VBP hospitals, SNF, HHA, ESRD Payment adjustments HAC, Hospital RRP Physician Quality Payment Program (QPP) National & Local Decisions Mechanisms to support innovation (CED, parallel review, other) Provider Enrollment Fraud, Waste & Abuse Prevention & Detection Medical Review Audits and Investigations *Quality Improvement & Innovation Programs (BFCC and QIN QIO (provider types), Indian Health Service, End Stage Renal Disease Networks)

Advanced Alternative Payment Models ACOs, PCMH, Bundles Multi-payer State Agreements Prevention and Population Health Rapid Cycle Evaluation Procurement Sensitive / CMS Confidential

CMS Programs and Actions

Clinical Standards

Medicaid and Medicare Coordination

Payment

Quality & Public Reporting

Coverage

Program Integrity

Value- Based Incentive Models

Quality & Safety Oversight

Quality Improvement*

Stakeholder Input Into Program Design Lessons learned from 12th SoW Targeted Listening sessions with:

Internal Stakeholders: Across CCSQ, CPI, CMMI, CM, OMH, OPOLE, CTR, CMCS, OMH, OAGM, OFM, OC, OL Federal Partners: CDC, AHRQ, HRSA, VA External Stakeholders: Provider associations, patient advocates, private sector, state and local organizations dedication to quality improvement Direct feedback about QIO assistance from providers who received it Resources HHS Strategic Plan FY 2022 – 2026: https://www.hhs.gov/about/strategic-plan/2022-2026/index.html CMS Framework for Health Equity 2022 – 2032: https://www.cms.gov/files/document/cms-framework-health-equity.pdf CMS National Quality Strategy: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/CMS-Quality-Strategy CMS National Quality Strategy (blog): https://www.cms.gov/blog/cms-national-quality-strategy-person-centered-approach-improving-quality CMS Behavioral Health Strategy: https://www.cms.gov/cms-behavioral-health-strategy

CMS’ Vision for the 13th Scope of Work QIO Program Program focus and design to align with the HHS Strategic Plan, National Quality Strategy, CMS’ Strategic Pillars, CMS’ Behavioural Health Strategy and Health Equity Strategy Target quality improvement models where evidence suggests they will improve outcomes. CMS lead and direct QI – both the “what” and “how” it is done with clearly defined interventions Shift the QIO program from an information dissemination role via QI education, towards QI implementation and national leadership of QI. Help facilities to assess and build their internal capacity to drive culture change and implement improvements at all the levels that are necessary to effectively implement a quality improvement and management system. Meaningfully influencing leadership and governance is key.

Foundation is the Community Health model so that QI is targeted at the health system as a whole in an integrated fashion, not at discrete, fragmented models in isolation Better linkage between the BFCC-QIO and the QIN-QIO activities to identify trends in quality of care issues in real time and address them.

Ensure that collection and use of data, which is foundational to all QI, is brought into the modern age with state of the art IT systems and enhanced data analytics capability.

Optimize use of all levers for outcomes, oversight and culture change: program design, payment model, contract structure, selection of contractors, role of CMS staff, technology Position QIO Program as the nation’s resource for QI, providing integrated, systemic QI while also serving as CMS’ rapid response arm to address quality and safety issues.

CMS National Quality Strategy Goals

An Integrated, Community-based Approach Total of 7 regions Multiple states within a single region.

Each state has multiple provider/facility types and communities.

An award of one task order for each of the 7 regions unlike current 12th SoW design of separate task orders for HQIC (hospital) and QIN QIO (NH and community) A QIN-QIO will be accountable for a region, inclusive of the identified member states, multiple provider and facility types and communities.

An assessment was completed regarding the use of already-established HHS regions as geographic boundaries for awarding 13th SOW QIN-QIOs to allow for synergy with other federal agencies among local, tribal, and state partnerships, allow comparative data modeling, and facilitate cross-agency projects.

This would create 10 QIN-QIOs in the 13th SOW.

Further analysis suggested that this approach will result in inequitable distribution of work between the 10 QIN-QIOs despite the alignment with the established 10 HHS regions.

Based on new priorities and an effort to establish a more equitable distribution of work and alignment with HHS Regions, we are combining HHS Regions 1 and 2 into a single QIO Region, and HHS Regions 7, 8 and 10 into another single QIO Region. This will allow for a balanced number of beneficiaries and providers for each QIN-QIO while still maintaining synergy with established HHS Regions, resulting in a total of 7 Regions intended for the 13th SOW QIN-QIOs.

Rationale for Determining the 7 Regions

CMS plans to utilize the NQIIC IDIQ to award task orders associated with the 13th Scope of Work.

In an effort to ensure that we have access to the most technically capable offerors, we will be issuing a Request for Information (RFI). This will be posted on SAM.gov.

CMS will use the information collected through this RFI notice to determine whether or not it would be in the Government’s best interest to initiate an open season to add additional contractors to the NQIIC IDIQ.

We don’t expect current IDIQ holders to respond to the RFI.

Network of Quality Improvement and Innovation Contractors (NQIIC): Indefinite Delivery Indefinite Quantity (IDIQ) Contract

The statutory authority for the QIO program is found in Part B of Title XI of the Social Security Act, section 1862(g) The statutory provisions originated with the Peer Review Improvement Act of 1982 (P.L. 97-248, §141-143, 96 Stat. 324) which established the Utilization and Quality Control Peer Review Organization program, now known as the QIO program.

The QIO statute, as amended by Section 261 of the Trade Adjustment Assistance Extension Act of 2011, also requires QIOs to perform, subject to the terms of their contracts, activities that the Secretary determines may be necessary for the purposes of improving the quality of care furnished to Medicare beneficiaries.

Statutory Authority

The period of performance for the newly defined, Integrated, Community-based Approach QIN-QIO task order under the 13th Statement of Work will begin in July 2024.

This newly designed task order will require the potential offeror to meet the statutory requirements: CFR-Title 42, Section 475

Eligibility Considerations

In order to be eligible for a QIO contract, an organization must meet the following requirements:

(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.

(b) Demonstrate the ability to perform the functions of a QIO, including—

(1) The ability to meet the eligibility requirements and perform activities as set forth in the QIO Request for Proposal; and

(2) The ability to—(i) Perform case reviews as described in § 475.102; and/or(ii) Perform quality improvement initiatives as set forth in § 475.103.

(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.

(d) Demonstrate the ability to perform the functions of a QIO with objectivity and impartiality and in a fair and neutral manner.

§ 475.101 Eligibility Requirements for QIO contracts https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-F/part-475/subpart-C/section-475.101

In determining whether or not an organization has demonstrated the ability to perform quality improvement initiatives, CMS will take into consideration factors such as:

The organization's proposed processes, capabilities, quantitative, and/or qualitative performance objectives, and methodology to perform quality improvement initiatives;

The organization's proposed involvement of and access to physicians and practitioners in the QIO area with the appropriate expertise and specialization in the areas of health care concerning the quality improvement initiatives;

The organization's access to professionals with appropriate knowledge of quality improvement methodologies and practices; and

The organization's access to qualified information technology (IT) expertise.

In making determinations under this section, CMS may consider characteristics such as the organization's geographic location and size.

CMS may also consider prior experience in health care quality improvement that CMS considers relevant to performing quality improvement initiatives; such prior experience may include prior similar quality improvement initiative experience and whether it achieved successful results.

A State government that administers a Medicaid program will be considered incapable of performing quality improvement initiative functions in an effective manner, unless the State demonstrates to the satisfaction of CMS that the State agency performing the quality improvement initiatives will act with complete objectivity and independence from the Medicaid program.

§ 475.103 Requirements for Performing Quality Improvement Initiatives

(a) Basic rule. Except as permitted under paragraph (a)(3) of this section, the following are not eligible for QIO contracts:

A health care facility in the QIO area.

A health care facility affiliate; that is, an organization in which more than 20 percent of the members of the governing body are also either a governing body member, officer, partner, five percent or more owner, or managing employee in a health care facility in the QIO area.

A payor organization, unless the Secretary determines that— There is no other entity available for an area with which the Secretary can enter into a contract under this part; or A payor organization is a more qualified entity to perform one or more of the functions of a QIO described in § 475.101(b), meets all other requirements and standards of this part, and demonstrates to the satisfaction of CMS that, in performing QIO activities, the payor organization will act with complete objectivity and independence from its payor program.

(b) [Reserved]

(c) Subcontracting. A QIO must not subcontract with a health care facility to perform any case review activities except for the review of the quality of care.

§ 475.105 Prohibition Against Contracting with Healthcare Facilities, Affiliates, and Payor organizations image1.jpeg image2.jpeg image3.jpeg image4.jpeg image5.emf image6.png image9.png image10.png image17.png image18.png image11.png image12.png image13.png image14.png image15.png image16.png image19.png