Quality Governance

Citation

42 CFR § 411.2

Conclusive effect of QIO determinations on payment of claims.

Medicare payment for services is contingent upon meeting quality improvement organization (QIO) review requirements when such review responsibility has been assumed.

Citation

42 CFR § 411.363

Process for requesting an exception from the prohibition on facility expansion.

This provision establishes the regulatory process and criteria for hospitals to request an exception from the prohibition on facility expansion, including requirements for data submission, community input, and CMS review.

Citation

42 CFR § 411.400

Payment for custodial care and services not reasonable and necessary.

This provision sets the conditions for Medicare payment for custodial care and services not considered reasonable and necessary, including time limits for post-discharge care planning.