New Hampshire Department of Health and Human Services Appendix E – Technical Responses to Mandatory Questions Instructions: Provide detailed responses in the text boxes to the questions below. If additional attachments are required as specified below, submit the attachments in the order they are requested below. There is no page limit for this Appendix E – Technical Response to Mandatory Questions or any associated attachments.

Vendor Name

1. Describe in detail your experience and expertise evaluating Managed Care Organization (MCO) and Dental Organization (DO) Contractual Compliance. Include:

a. A description of how your organization will meet the requirements of Sections 2.2. and 3.2., in Appendix A, Scope of Services. The vendor must verify that all components will be included in the compliance audit or specifically state what section(s) they will not include and state the specific reason(s) for exclusion.

b. Provide one (1) MCO example and one (1) DO example of an analysis or report, from another state if possible, demonstrating the Vendor’s prior experience conducting reviews relative to contract compliance pursuant to 42 CFR 438.358(b)(1)(iii).

2. Describe in detail your experience evaluating MCO and DO Performance Measures and how you will meet all requirements of Sections 2.3. and 3.3., in Appendix A, Scope of Services.

a. Provide one (1) example of a report, from another state, if possible, that shows the results of a performance measure validation audit.

3. Describe in detail your experience evaluating MCO and DO Rapid Cycle Performance Improvement Projects (PIPs) and how you will meet all requirements of Sections 2.4. and 3.4., in Appendix A, Scope of Services, respectively. Additionally, please provide:

a. An example, from another state, if possible, of your prior experience evaluating multiple MCO PIPs utilizing the rapid cycle methodology and tools the Vendor created; and

b. An example, from another state, if possible, of your prior experience evaluating at least one (1) DOs PIP utilizing the rapid cycle methodology and tools created (if different than those utilized for MCOs.)

4. Describe in detail your experience validating of MCO and DO Provider Network Adequacy and how you will meet all requirements in Sections 2.5. and 3.5., in Appendix A, Scope of Services. Please provide:

a. Provide one (1) example of a combined MCO and DO Medicaid managed care report OR two (2) separate reports (one (1) MCO and one (1) DO), from another state, if possible, demonstrating your prior experience validating provider network adequacy.

5. Describe in detail your experience validating MCO and DO Encounter Data and how you will meet all requirements of Sections 2.6. and 3.6., in Appendix A, Scope of Services. Please provide the following:

a. One (1) example of a combined MCO and DO Medicaid managed care report or two (2) separate reports (one (1) MCO and one (1) DO), from another state, if possible, demonstrating your prior experience validating encounter data;

b. One (1) example (if possible) demonstrating that the EQRO has had prior experience writing a certification letter attesting to the level of completeness and accuracy of the encounter data submitted by an MCO or DO; and

c. One (1) example of an analysis or report as referenced in 2.6.5.4., based on the Vendor conducting a managed care medical record review for confirmation of findings of analysis of encounter data.

6. Describe in detail your experience conducting provider MCO and DO Secret Shopper surveys in compliance with 42 CFR 438.358(c)(2) and describe how you would meet the requirements of Sections 2.7. and 3.7., of Appendix A, Scope of Services.

a. Please provide one (1) example of a report, from another state, if possible, demonstrating that the Vendor has had prior experience writing an MCO or DO Secret Shopper Survey Report.

7. Describe in detail your experience conducting other member and/or provider surveys in compliance with 42 CFR 438.358(c)(2) and describe how you would meet the requirements of Sections 2.8. and 3.8., of Appendix A, Scope of Services. Please explain your experience, including your organization’s strategies for engaging providers or Medicaid beneficiaries to ensure constructive feedback conducting the following surveys:

a. MCO and DO Provider Satisfaction Surveys. Please include an example of a report, from another state, if possible, demonstrating your prior experience writing or managing subcontractors to write an MCO or DO Provider Satisfaction Survey report.

b. MCO Revealed Caller Surveys. Please include an example of a report, from another state, if possible, demonstrating your prior experience writing or managing subcontractors to write an MCO Revealed Caller Survey report.

c. MCO and DO Semi Structured Qualitative member focus group and/or Surveys. Please include an example of a Medicaid survey report, from another state, if possible, inclusive of the methodology used for data collection and analysis demonstrating your prior experience writing or managing a subcontractor to write an MCO or DO Semi-Structured Qualitative member focus group and/or survey report.

d. For each type of survey listed above, please indicate whether you have staff with the expertise to conduct this activity, and if not, how you would undertake the task of finding appropriately skilled subcontractors to perform this work.

8. Describe in detail your experience conducting focus studies of health and dental care quality and describe how your organization will meet the requirements of Sections 2.9. and 3.9., of Appendix A, Scope of Services.

a. Provide one (1) MCO example and one (1) DO example of a report, from another state, if possible, of an MCO focus study and a DO focus study that you have designed and implemented.

9. Describe in detail your experience conducting large conference-style virtual meetings and trainings for other State Medicaid agencies that include medical providers, MCOs, and community partners. Describe the technology you will use to:

a. Host online registration;

b. Host a virtual conference including providing technical assistance to attendees/speakers during the meeting;

c. Post polling questions during the conference;

d. Obtain participant feedback during the conference; and

e. Provide an electronic evaluation tool to attendees and collect completed forms post-conference.

10. Describe in detail your experience writing EQR MCO and DO Technical Reports.

a. Please provide one (1) MCO example and one (1) DO example, from another state, if possible, demonstrating your prior experience writing an EQR Technical Report.

11. Please describe your organization’s ability to track, analyze, and report the EQRO data required within the Scope of Services. Include:

a. Methods to identify trends, service gaps, or systemic issues.

b. Processes for sharing findings with the Department.

c. Safeguards for protective sensitive personal and medical information collected.

d. A completed Appendix H, IT Requirements Workbook.

12. Please describe in detail your organization’s ability to provide the entire Scope of Services and meet all requirements in this solicitation. Include your organization’s approach to meeting State needs when federal regulations change (i.e. federal reporting requirements, protocols, rules, etc.).

a. Provide a detailed Implementation Plan with timelines, milestones for deliverables identified in Appendix F, Deliverables Cost Sheet, and detailed below. Please also include which key personnel will be responsible for each activity and/or deliverable, and measurable performance goals or indicators:

1. Evaluation of MCO or DO Contract Compliance;

2. Validation of MCO or DO Performance Measures;

3. Evaluation of MCO or DO Rapid Cycle Performance Improvement Projects;

4. Validation of MCO or DO Provider Network Adequacy;

5. Validation of MCO & DO Encounter Data;

6. MCO or DO Secret Shopper Survey;

7. MCO or DO Provider Satisfaction Survey;

8. MCO or DO Semi-Structured Qualitative member focus group and/or Survey;

9. MCO or DO Quality Study;

10. MCO Annual Meeting; and

11. MCO or DO Technical Report.

13. Provide your organization’s staffing plan within Appendix F – Program Staff List, including:

a. An organizational chart including the number of full-time equivalent staff (FTE).

b. Description of qualifications, curriculum vitae/resumes, and/or credentials for key personnel.

c. Any specialized staff training completed relevant to providing services in this solicitation.

d. Description of your organization’s approach to customer service, supervision, and training, including any ongoing training or continuing education you provide to your staff to maintain current knowledge of conducting EQRs.

RFP-2027-DPQI-01-EQRO

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