42 CFR § 475.101 - Eligibility requirements for QIO contracts.

---
identifier: "/us/cfr/t42/s475.101"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 475.101 - Eligibility requirements for QIO contracts."
title_number: 42
title_name: "Public Health"
section_number: "475.101"
section_name: "Eligibility requirements for QIO contracts."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "F"
subchapter_name: "QUALITY IMPROVEMENT ORGANIZATIONS"
part_number: "475"
part_name: "QUALITY IMPROVEMENT ORGANIZATIONS"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)."
cfr_part: "475"
---


# 475.101 Eligibility requirements for QIO contracts.

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.