Participation Agreement

Our facility agrees to work with the IPRO Quality Innovation Network-Quality Improvement Organization (QIN-QIO) as part of the five-year Nursing Home Quality Care Collaborative (NHQCC) from November 2019 through November 2024. We understand this commitment to improve quality requires leadership support.

By signing this Participation Agreement, I assert that I have read and understand the expectations outlined in the accompanying overview document and have the authority to represent the organization delineated below. Thus, the facility agrees to work with the IPRO QIN-QIO on the NHQCC and meet the following project expectations:

  • Implement facility-level quality improvement efforts with on-site technical support
  • Participate in educational sessions, collaborative sessions, conference calls, and webinars
  • Share and spread best practices with support from the IPRO QIN-QIO
  • Submit and share resident-level data as requested to IPRO QIN-QIO for analysis, reporting and evaluating QI implementation to support collaborative efforts. No data or information related to IPRO QIN-QIO's quality improvement project that may implicitly or explicitly identify another participant will be disclosed.
  • Authorize IPRO to release all provider and de-identified resident-level data submitted by our organization to CMS or its authorized contractors for quality improvement evaluation purposes.
  • Authorize IPRO to release our facility's name as participant to other affiliated providers (e.g., corporate senior leaders) and to other affiliated participants in the quality improvement program.
Nursing Home Name: 
Medicare Provider # (MPN): 
Address Line 1: 
Address Line 2: 
Email Address: 
Direct Phone Number: 
Current Resident Census: 
Current Electronic Health 
Record (EHR) Vendor: 
Current Pharmacy Vendor: 

By entering this information and clicking on the Submit button below you are confirming
by electronic signature your organization's commitment to this Participation Agreement

The Centers for Medicare and Medicaid Services (CMS) contracts with Quality Improvement Networks-Quality Improvement Organizations (QIN-QIOs) to perform core functions relating to quality improvement including, but not limited to, technical assistance, data collection and analysis, quality review studies and stakeholder engagement activities. Applicable statutory and regulatory authorities for the QIO program are codified in Sections 1151-1160 of the Social Security Act (42 USC §§ 1320c-1320c12) and Title 42 of the Code of Federal Regulations.

Under contract to CMS, IPRO serves as the QIN-QIO for the New England states, New York, New Jersey, Ohio, Delaware, Maryland, and the District of Columbia. In this capacity, we are committed to protecting the data collected from your facility for healthcare quality improvement projects. The quality improvement projects that we will work on with your facility are "quality review studies," defined in 42 CFR Section 480.101(b) as "assessment[s], conducted by or for a QIO, of a patient care problem for the purpose of improving patient care through peer analysis, intervention, resolution of the problem and follow-up." Federal regulations, in 42 CFR Section 480.140, mandate confidentiality protections for individual patients, practitioners and institutions that participate in such studies. Accordingly, IPRO QIN-QIO cannot and will not disclose data about participants in a quality review study to any party other than CMS and/or its authorized contractors.

This material was prepared by the IPRO QIN-QIO, a partnership of Healthcentric Advisors, Qlarant and IPRO, serving as the Medicare Quality Innovation Network-Quality Improvement Organization for the New England states, NY, NJ, OH, DE, MD, and the District of Columbia; under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 12SOW.IPRO.Tsk.1.2.A1-5.19.01