Request for Proposals for External Quality Review Organization (EQRO)

Summary

The New Hampshire Department of Health and Human Services (DHHS), Division of Program Quality and Integrity is soliciting proposals from qualified Vendors to provide External Quality Review (EQR) services of healthcare services delivered to Medicaid beneficiaries enrolled in Medicaid Care Management statewide. The selected organization(s) will conduct assessments of Managed Care Organizations (MCOs) and Dental Organizations (DOs) using current CMS protocols, covering activities such as validating performance measures, provider network adequacy, encounter data, compliance, and conducting focus studies and surveys. The contract is anticipated to start upon Governor and Executive Council approval and run through April 30, 2030, with up to four years of renewal possible.

Eligibility

Qualified Vendors must meet all the qualifications of an External Quality Review Organization (EQRO) as outlined in 42 CFR 438.354.

Requirements Checklist

• Submit separate documents for Technical Response and Cost Proposal
• Complete Appendices as specified (A-H), including technical responses, staff list, IT requirements, resumes for key staff