MBQIP MOU and Consent Forms

Federal Office of Rural Health Policy (FORHP)

A memorandum of understanding (MOU) is required in order for any critical access hospital (CAH) to participate in the Medicare Beneficiary Quality Improvement Project (MBQIP). MOUs will carry forward so a CAH can continue to participate in MBQIP without the need to sign a new MOU.

Current MOU documents. Use one of the forms as described below.

  • MBQIP Data Consent Continuation Template: This template letter is for use with CAHs with an original MOU on file, to inform them of the decision to allow prior MOUs to carry forward. It does not require a signature on the part of the hospital.
  • MBQIP Consent Form: This consent form is for use with new CAHs without an original MOU on file or CAHs that wish to update their MOU. It requires a signature on the part of the hospital.

The following original MOU consent form is for reference only. Do not use it for hospitals newly signing consent to participate in MBQIP.

  • Original MBQIP Consent Form - For Reference Only: This document served as a template MOU for the first three years of MBQIP. It should not be used for new hospitals; rather new hospitals should complete the MBQIP Consent Form linked above.