[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR475.105]



[Page 463]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 475_QUALITY IMPROVEMENT ORGANIZATIONS--Table of Contents

 

     Subpart C_Utilization and Quality Control Quality Improvement 

                              Organizations

 

Sec.  475.105  Prohibition against contracting with health care 



facilities.



    (a) Basic rule. Except as permitted under paragraph (b) of this 

section, the following are not eligible for QIO contracts:

    (1) A health care facility in the QIO area.

    (2) An association of health care facilities in the QIO area.

    (3) 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 or association of 

health care facilities in the QIO area.

    (b) Exceptions. Effective November 15, 1984, the prohibition stated 

in paragraph (a) of this section will not apply to a payor organization 

if CMS determines under Sec.  462.106 that there is no other eligible 

organization available.

    (c) Subcontracting. A QIO must not subcontract with a facility to 

conduct any review activities except for the review of the quality of 

care.



[50 FR 15328, Apr. 17, 1985. Redesignated at 64 FR 66279, Nov. 24, 1999]