CFR > Title 42 - Public Health > CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES > SUBCHAPTER F—QUALITY IMPROVEMENT ORGANIZATIONS (parts 475 to 481) > PART 475—QUALITY IMPROVEMENT ORGANIZATIONS > SUBPART C—Utilization and Quality Control Quality Improvement Organizations (§475.100 to §475.107) > 475.105—Prohibition against contracting with health care facilities.

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 § 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]