RFP-2027-DPQI-02-EQRO: External Quality Review Organization
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Description
The New Hampshire Department of Health and Human Services, Division of Program Quality and Integrity (“Department”) is seeking responses to this Request for Proposals ("Solicitation" or "RFP") from qualified Vendors to provide External Quality Reviews (EQRs) of healthcare services provided to New Hampshire Medicaid beneficiaries enrolled in the Medicaid Care Management, statewide. EQRs evaluate and analyze aggregated information on quality, timeliness, and access to health care services provided by state contracted Managed Care Plans. EQRs serve to improve the state’s ability to oversee and manage the managed care plans they contract with and help managed care plans improve their performance. Qualified Vendors must confirm that they meet all the qualifications of an External Quality Review Organization (EQRO) as outlined in 42 CFR 438.354. Pursuant to 42 CFR 438, Subpart E, States are federally required to contract with an EQRO to provide rigorous assessments of their contracted Managed Care Plans. The Department anticipates awarding one (1) or more contracts for the services in this solicitation. Vendors must submit one (1) proposal that includes services for both Part A and Part B.