PCG is proud to announce the renewal of its Centers for Medicare & Medicaid Services (CMS) Quality Improvement Organization-Like (QIO-Like) Entity designation through 2031. First designated as a QIO-Like Entity in 2017, PCG has spent over a decade supporting Medicaid agencies with quality assurance, utilization review, program oversight, and continuous quality improvement initiatives.

“The QIO-Like designation acknowledges the expertise of our clinical teams with improving the quality of services while helping states access additional federal resources to support these critical activities.” said Angelene Willetts-Carvi, Manager at PCG. “As a CMS-recognized QIO-Like Entity, we hold our quality assurance and improvement work to the highest standard.”

What is a QIO-Like Entity?

QIO-Like Entities are organizations recognized by CMS as having the expertise and clinical resources necessary to perform quality improvement and oversight activities within Medicaid programs. While traditional Quality Improvement Organizations focus on Medicare, QIO-Like Entities provide similar quality-focused services in the Medicaid space.

For state Medicaid agencies, partnering with a QIO-Like Entity offers a significant advantage: qualifying activities may be eligible for an enhanced 75% Federal Financial Participation (FFP) rate, compared to the standard 50% federal match available for many Medicaid administrative activities. This additional funding can help states expand oversight efforts, strengthen quality initiatives, and improve outcomes while reducing state costs.

As a QIO-Like Entity, PCG performs a wide range of activities designed to improve quality and ensure compliance across Medicaid programs, including:

• Medical and utilization reviews
• Clinical assessments and oversight
• Quality assurance and performance improvement activities
• Managed care quality reviews
• Provider and facility oversight
• Complaint investigations and monitoring
• Validation of compliance with federal requirements
• Program integrity and quality improvement initiatives

Delivering Impact Across the Country

As a QIO-Like Entity, PCG has been helping states ensure services are medically necessary, delivered appropriately, and aligned with federal and state requirements while promoting continuous quality improvement.

Illinois Department of Healthcare and Family Services

In 2018, PCG began providing QIO services to the five of Illinois’ nine Medicaid Home and Community Based Services Waiver (HCBS) programs. As a QIO-like entity, PCG’s team of clinicians partnered with the Illinois Department of Healthcare and Family Services (HSF) on a series of quality improvement and monitoring initiatives to advance and improve the State’s approach to ensuring Federally mandated Waiver Assurance requirements and quality improvement initiatives. In close collaboration, PCG assisted HFS in its administrative role as the State Medicaid Agency to ensure effective oversight of community-based services.

New York Department of Health

In 2025, PCG began supporting the New York Department of Health as a QIO-Like Entity by conducting recertification reviews and investigations for adult care facilities throughout the state. These efforts help ensure facilities maintain high standards of care while supporting state oversight responsibilities.

Ohio Department of Medicaid

Since 2013, PCG has supported the Ohio Department of Medicaid (ODM) by managing HCBS provider enrollment, conducting provider oversight activities, and delivering training and support to ensure compliance with Medicaid requirements. PCG performs unannounced onsite screenings, structural reviews, and comprehensive monitoring to assess provider quality and adherence to state and federal regulations. In addition, PCG investigates reported incidents, identifies potential fraud or compliance issues, and provides analytical reporting and recommendations to help ODM protect member health, welfare, and program integrity.

The renewal of the QIO-Like designation positions PCG to continue helping states address growing demands for accountability, transparency, and quality in Medicaid programs.

Connect with Zach Crawford-Theurkauf today to learn how PCG as a QIO-Like Entity can support your quality improvement goals, strengthen oversight efforts, and help maximize federal funding opportunities.