MBQIP MOU and Consent Forms
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). For the current project period, fiscal years (FY) 2015-2018, prior MOUs will carry forward so a CAH can continue to participate in MBQIP without the need to sign a new MOU, even if the MOU expired.
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 through the current project period (FY 2015-2018). It does not require a signature on the part of the hospital.
- MBQIP Consent Form - FY 2015-2018: 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.