External Quality Review Organization

The New Hampshire Department of Health and Human Services, Division of Program Quality and Integrity, is soliciting proposals for an External Quality Review Organization (EQRO) to evaluate healthcare services provided to Medicaid beneficiaries. The selected vendor will be responsible for analyzing aggregated data on quality, timeliness, and access to care for contracted Managed Care Organizations (MCO) and Dental Organizations (DO). Key deliverables include the validation of performance measures, Performance Improvement Projects (PIP), provider network adequacy, and encounter data reporting, culminating in detailed annual technical reports. The contract requires strict adherence to 42 CFR 438.354 and current CMS External Quality Review protocols. The period of performance extends through April 30, 2030, with potential four-year renewal options. All staff will work remotely, though quarterly meetings may occur virtually or in person. The award is based on a point system where technical responses are weighted at 700 points and cost at 300 points, noting that this is not a low-cost award. Vendors must meet rigorous federal and state requirements, including HIPAA and HITECH compliance, Title VI language assistance, and specific insurance coverage of at least 1 million dollars per occurrence. Payment is contingent upon the submission of monthly invoices for completed, Department-accepted deliverables.