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). 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.

Tags

MBQIP Hospital Compare Consent Form FY2015.docx (30.3 KB) , MBQIP Data - Consent Continuation FY2015.docx (24.72 KB) , MBQIP MOU Template with For Reference Only Watermark.pdf (292.91 KB)

Was this information helpful?

Please include your email if you want us to follow up with you.

Related Resources

Document

Building Sustainable Capacity for Quality and Organizational Excellence

This report serves as a framework to inform quality in critical access hospitals, assist them in creating sustainable quality infrastructure, moving beyond mere measures, and toward organizational excellence.
Document

A Guide for Rural Hospitals to Identify Populations and Shift to Population Health

Learn a practical approach to identifying key patient populations and a process to initiate population health planning. Learn how to integrate population health initiatives as part of an organization’s strategy.
Document

Federal Grant Writing Workshop

View presentation materials from a workshop held for state Flex Programs to provide resources for federal grant writing.
Document

EMS Community Benefit Pilot Project

Information on the pilot tests for a tool created by The Paramedic Foundation for rural ambulance services, the Community Benefit and Financial Distress Tool.
Document

MBQIP Measure Change Summaries

These summaries provide information about measures added and removed from MBQIP since fall 2017. For more information about measure changes to MBQIP, see Appendix B in the MBQIP Fundamentals Guide for State Flex Programs.