External Quality Review Organization (EQRO) Services Amendment #2 – Questions and Answers RFP # 20260731 – RFx # 3160008164 September 3, 2026 This Amendment #2 is issued in response to the vendor questions received regarding RFP # 20260731. Vendors are advised to review the following questions and responses carefully and incorporate them into their proposal submission, as applicable.

Will the incumbent EQRO will be responsible for completing all external quality review (EQR) activities to be included in the 2026 EQR technical report that must be submitted to CMS by April 2027?

No.

Any work related to the 2026 year for the April 2027 reporting must be completed by the Vendor who is awarded this contract.

The Vendor who is awarded this contract will perform all other activities.

The Vendor who is awarded this contract will perform the EQR activities. EQR Protocol 5 will be performed by the incumbent Vendor, and that report will be submitted separately to CMS and not part of the April 2027 EQR Technical Report.

Are Offerors required to address each of the items?

If so, are responses to items 1-11 subject to the page limit, and where in the proposal should the be included?

The acknowledgment of these requirements should be included within the proposal’s Executive Summary and is subject to the applicable page limit for the Executive Summary.

scheduled monthly, quarterly, and annual reports.

Is this an accurate date, or is DOM's expectation that the Offeror will be responsible for the activities and reports beginning December 3, 2026, which is the effective date of the Contract once awarded?

The regularly scheduled reports may begin once the Operational part of the contract begins but retro reporting back to July 1, 2025.

DOM is most interested in meeting the CMS deadline of April 2027. If any reporting does not support meeting this deadline, DOM and the Vendor may mutually agree to delay any reporting that may hinder meeting the April 2027 Technical Report deadline.

Will DOM allow virtual site visits as revised by EQR Protocols to obtain information for EQR activities?

Yes.

DOM expects most, if not all, to be virtual. DOM put “onsite” to allow if at any point there is a need for the Vendor to visit the MCO in person. At this time, the expectation is to make one-two onsite visits during the contract period (not each year), and these visits are expected to be just a small portion of the review (two-three days) and not encompass the entire EQR process/review.

Will DOM publish a revised Year 1 deliverable calendar before proposal submission, or should Offerors propose using the standard dates listed in Sections 2.4–2.19?

The Offeror may publish a proposed date. DOM and the Offeror will mutually agree on any adjusted dates that are needed in order to meet the CMS Deadline of April 2027.

Will DOM allow the contractor to adjust its budget based on Scope if Services changes?

Cost modifications may be permissible if changes in scope of services due to changes in state or federal law or regulations creates a material, demonstrable increase in the cost of contract performance. Any resulting cost adjustments must be executed via a formal written amendment.

If reviews were already conducted satisfying the July 1, 2025 effective date, will the vendor be responsible for retrospectively conducting EQR reviews?

Yes.

No reviews have been completed effective July 1, 2025. DOM and the Offeror may adjust the schedule in the first Year by mutually agreeing to the schedule to meet the April 2027 deadline.

There is an EQR Protocol 5 being performed by a vendor for Calendar Year 2025, but that will not be part of the April 2027 Technical report and submitted separately.

In some cases, the RFP clearly requires prior approval of methodologies, timelines, templates, survey, etc. (such as for the Annual Quality Survey and Network Adequacy tasks), but for other tasks, the RFP is silent (PIP Technical Papers).

No.

Prior approval is not required unless expressly stated, however DOM may request detail regarding the other tasks and processes and reserves the right to request any modifications necessary.

How many PIPs will each MCO submit for annual validation for the Medicaid population?

How many PIPs will each MCO submit for annual validation for the CHIP population?

How many PIPs will each MCO submit for annual validation that include both the Medicaid and CHP populations?

Each MCO is required to have five PIPs covering the MSCAN and CHIP populations combined:

2 PIPs are required by both MSCAN and CHIP.

1 PIP is specifically designated for MSCAN.

2 PIPs are selected by each MCO and may cover MSCAN, CHIP, or both populations. Generally, MCOs select PIPs that cover both populations.

Is the Annual PIP Summary Report a separate activity than what is required for the Annual EQR Technical Report?

The Annual PIP Summary Report and Annual EQR Technical Report are two separate activities.

Is the "joint" PIP conducted for each MCO for both the Medicaid and CHIP populations and submitted for annual validation?

Yes. Each MCO has a joint PIP that addresses both the MSCAN and CHIP populations and is subject to annual validation.

At this time, the MCO is required to have five PIPs for MSCAN and CHIP.

There are two PIPs required by the contract that are the same for both populations of MSCAN and CHIP.

One is specifically designated for MSCAN. The remaining two PIPs are picked by each MCO and may or may not cover both MSCAN and CHIP although generally they try to select a PIP to cover both populations.

The Contractor’s expertise is to help provide any guidance, if needed, on quality improvement.

Is this requirement for the PIP or the PMV activity?

Can DOM provide a sample comparison report?

Is there an associated deliverable?

This requirement is part of the PIP activity. It’s included in Section 2.4.3.

No. DOM does not have a sample comparison report to provide. Offerors should describe their proposed approach and report format in their response.

No. There is no separately identified deliverable for this comparison.

5. Be responsible for conducting the validation of non-HEDIS performance measures in alignment with CMS Protocols, including an on-site visit.

This requirement applies when a PIP includes a non-HEDIS performance measure. A PIP measure may be selected by an MCO or by DOM and may include an Adult or Child Core Set measure that is not a HEDIS measure. In those instances, the Contractor shall validate the non-HEDIS performance measure in alignment with CMS Protocols, including an on-site visit.

Is the contractor required to be an NCQA Licensed Organization?

The Offeror shall be an NCQA licensed organization, or subcontract with a vendor, that is NCQA-Licensed organization to conduct HEDIS audits. The Contract must meet all applicable federal and state requirements and possess the qualifications, credentials, and resources necessary to perform the required EQRO activities.

Is the contractor required to perform on-site performance measure validation or is virtual acceptable as permissable by EQR Protocols?

Virtual is acceptable.

DOM expects most, if not all review, to be virtual. DOM put “onsite” to allow if at any point there is a need for the Vendor to visit the MCO in person. At this time, the expectation is to make one to two onsite visits during the contract period (not each year), and these visits are expected to be just a small portion of the review (two-three days) and not encompass the entire EQR process/review.

Will DOM specify the annual measure list before contract execution, or should Offerors assume validation of the full Adult and Child Core Sets each year?

Offerors should assume validation of the full CMS Adult and Child Core Sets for MississippiCAN and CHIP each year, in addition to the annual audited HEDIS data. Many Adult and Child Core Set measures are HEDIS measures; however, the Core Set validation requirement applies to the full applicable Adult and Child Core Sets.

Will this include all mandatory AND voluntary Adult and Child Core Set Measures?

Yes, both mandatory and voluntary.

Please confirm if this deliverable is comprised of individual plan-specific PMV reports or is this expected to be a single, aggregated PMV report deliverable?

DOM’s preference is for individual plan-specific PMV reports. Plan-specific reporting will provide DOM with clearer information on each MCO’s performance and better support quality-improvement decisions. However, DOM will also accept a single aggregated PMV report if it clearly identifies the validation results, findings, and recommendations for each individual MCO.

DOM does not intend for the Contractor to divide the AQS requirements into approximately one-third of the requirements each year over the three-year contract period. The AQS is an annual activity and shall be conducted annually for each MCO, or at DOM’s discretion, in accordance with Section 2.6.

When does DOM anticipate providing to the Contractor the MCOs' accreditation survey results that are needed to complete the AQS deeming table?

Yes.

The Offeror must submit the AQS Deeming Table to DOM within 30 days of the contract effective date.

DOM anticipates providing the Contractor with the MCO’s accreditation survey results immediately upon the contract effective date, as DOM has this information available.

Does DOM intend to update its MCQS to allow for non-duplication of EQRO activities?

No.

DOM does not intend to update the MCQS to allow for non-duplication of EQRO activities. The MCQS currently states that non-duplication does not apply under 42 CFR § 438.360(c), and the Contractor remains responsible for submitting the AQS Deeming Table as required in Section 2.6.2.

In addition to reviewing compliance with applicable federal and State MCO contract requirements, the AQS report should include the results of other mandatory and optional EQR activities, such as PIP validation and PMV, as applicable.

Will the scores/rates be available for the comparison with MCO rates?

No, this is not done in the FFS program; therefore, AQS scores/rates are not available for comparison with MCO rates.

Is the AQS Summary Report a separate activity than what is required for the Annual EQR Technical Report?

Yes. The AQS Summary Report is a separate deliverable from the Annual EQR Technical Report. The AQS Summary Report should summarize the results of the AQS Technical Papers, while the Annual EQR Technical Report addresses the broader EQR activities required under the RFP.

Can DOM provide more details regarding what would be included in the requirement to outline and provide a rating for each MCO based on Protocol 10 in the AQS?

DOM has not finalized the specific measures or methodology that will be used for the Protocol 10-based MCO quality rating. A workgroup has begun developing these requirements. Offerors should describe their proposed approach for supporting the quality rating process based on Protocol 10, recognizing that DOM may establish or modify the measures and methodology during the contract term.

Is the Provider Network Scope deliverable for only this paragraph, or should it include all specialty types included in the above paragraph (i.e., Primary Care, Perinatal Health, Ophthalmologists, Dentists, Pediatric Dentists, Hospitals, Behavioral Health, Pharmacy, Wound Care and Home Health)?

The Provider Network Scope deliverable includes, at a minimum, the following provider types: Primary Care, Perinatal Health, Ophthalmologists, Dentists, Pediatric Dentists, Hospitals, Behavioral Health, Pharmacy, Wound Care and Home Health. For primary care, behavioral health and specialist services, the contractor must distinguish between adults and children.

Is there an expected number of focused analyses and how would this be incorporated into cost proposals?

DOM would like one in-depth network adequacy analysis each year, schedule mutually agreed upon, between DOM and Contractor. This analysis would assist DOM in the preparation of the CMS Network Access and Adequacy Assurances Report (NAAAR) due annually to CMS (or when there is a significant contract change). Pricing is to be included in the “operations cost” of the cost proposal.

for the ANA reviews. However, 42 CFR § Nonduplication of mandatory activities with Medicare or accreditation review does not allow for nonduplication activities within Protocol 4: Validation of Network Adequacy.

What is DOM's intent for the use of this comparison?

The CFR states “to avoid duplication the State may use information from a Medicare or private accreditation review of an MCO, PIHP, or PAHP to provide information for the annual EQR”.

Is this ANA deliverable the ANA methodology as required by CMS EQR Protocol 4, and, if not, can DOM explain what information should be included in the ANA Action Plan?

Yes, but DOM is also considering anything that will help support the CMS reporting, Network Adequacy and Access Assurances Report (NAAAR) plus eventually, DOM wants detailed analysis that further supports MCOs network adequacy in more detailed analysis than what is required in the EQR but the detailed analysis has not been defined at this time.

What are DOM's sampling expectations regarding sample size and sampling parameters (e.g., confidence level and margin of error) for encounter data validation?

DOM seeks for Offeror to include a recommendation for scope of work including sampling size and sampling parameters.

Please clarify the expected scope and frequency of the retrospective medical record review, including whether it is required annually for each MCO and whether DOM has established expectations for the encounter types and data elements to be reviewed.

DOM seeks for Offeror to include a recommendation for scope of work including the encounter types and data elements.

Every three years is the expectation per the CFR. If CMS changes the requirement, the Contractor is expected to update the frequency to match the CFR.

Please describe the current EDV process and clarify whether DOM expects the existing methodology and scope to continue under the new contract.

DOM contracts with a CPA firm who reconciles the Cash Disbursement Journal (CDJ) with the Encounters bi-monthly. In the process, the CPA firm reviews encounters for potential issues and issues a report. This report can be used for review by the Contractor.

Yes, we expect the existing Methodology and scope to continue under the new contract.

Will DOM provide access to the State’s encounter data warehouse (DSS / Fiscal Agent) for cross validation, or will the EQRO rely exclusively on MCO submitted encounter files?

The Contractor will not have direct access to the State’s encounter data warehouse, but DOM may provide data extracts from the Fiscal Agent to the Contractor for use in encounter data validation.

Is there a sample quality-of-care survey report that can be shared?

DOM does not have a sample quality-of-care survey report to share. Offerors should describe their proposed survey report format and approach in their proposal.

Will this be separate from the annual provider directory validation (PDV) and secret shopper activity, which also validates the accuracy of the provider information submitted by the MCOs?

If these are the same activity, will the activity be conducted annually, in accordance with 42 CFR §438.10(h) and 42 CFR §438.68(f) rather than quarterly?

The quarterly provider data validation surveys will not meet the 42 CFR §438.68(f) requirements, as those surveys utilize the most current DOM Provider Enrollment File (PEF) rather than the MCOs' online provider directories.

Yes, separate.

An annual PDV and secret shopper activity per 42 CFR §438.10(h) and 42 CFR §438.68(f). A quarterly PDV and secret shopper activity is also required.

Are these provider types intended to be included in a provider access survey conducted separately from the PDV, or is DOM intending to include the listed provider types within the PDV activity?

Please note that, in accordance with 42 CFR §438.10(h) and 42 CFR §438.68(f), the activity must include an annual provider directory validation (PDV) and secret shopper activity that assesses primary care providers, obstetricians/gynecologists, outpatient mental health and substance use disorder (SUD) providers, and one additional DOM-selected specialty.

Include within the PDV activity, not separately, comply with the CFR and add any additional per the RFP.

Does DOM intend to conduct two separate Secret Shopper activities—one to assess routine appointment availability and another to assess urgent care appointment availability?

Does DOM intend to conduct one Secret Shopper activity that includes both routine and urgent appointments?

DOM intends for one Secret Shopper activity to include validation of both routine new-patient appointment availability and urgent-care appointment availability. Separate Secret Shopper activities are not required for each appointment type.

Is DOM's intent for the Contractor to validate two different types of surveys?

Yes, as they are completely different surveys.

What is the length of each survey instrument that will be assessed?

The consumer survey instrument is the required CAHPS 5.0 survey. The RFP does not specify the length of the provider survey instrument.

Is DOM's intent that the contractor will be responsible for conducting survey data analysis and formulating findings/conclusions?

No. The Contractor is not responsible for conducting the survey data analysis or developing findings or conclusions. The Contractor is responsible for reviewing the MCO’s survey data analysis and findings and conclusions to assess whether they are appropriate.

Is it DOM's expectation that the Contractor ensure compliance with Section 508 of the Rehabilitation Act of 1973?

Yes.

For the purposes of planning and budgeting, which of these activities will be required on an annual basis and which will be required as needed?

The Contractor shall assess the effectiveness of the Quality Strategy annually. Calculating additional performance measures and conducting evaluations related to State Directed Payment Programs, In Lieu of Services, and other managed care initiatives will be required at DOM’s discretion, as needed.

Can DOM please clarify the potential number and type of additional performance measures?

The potential number and type of additional performance measures cannot be determined at this time. Any additional performance measures and related analyses will be identified by DOM, at its discretion, as needed during the contract term.

Can DOM provide the anticipated number of measures that would be calculated?

DOM cannot provide an anticipated number of additional performance measures at this time. Any additional measures will be identified by DOM, at its discretion, as needed during the contract term.

What is the expected number of focus studies and and will DOM provide topics at the start of each contract year, or will topics be assigned on an ad hoc basis throughout the year?

The number of focused studies is undetermined at this time.

Ad Hoc basis throughout the year

Can DOM confirm the type of data that needs to be collected by the contractor?

Will the contractor collect Medicaid administrative data?

If the contractor is collecting administrative data, will CMS, MCOs, DOM, or any combination of entities be providing the data?

The data for the MAC QRS website will consist of the MCO’s annual audited HEDIS results.

The Contractor will not be required to collect Medicaid administrative data, as the MAC QRS activity applies to MCO data.

MCOs submit their audited HEDIS results to DOM annually, and DOM will provide the applicable data to the Contractor.

If the contractor is responsible for collecting HEDIS and CAHPS rates, will validation of data include validating the collected HEDIS and CAHPS rates?

The MCOs submit their HEDIS and CAHPS rates to DOM, and DOM will share the applicable data with the Contractor.

The Contractor will not be responsible for collecting the rates directly from the MCOs. The Contractor will not be required to validate the submitted HEDIS data and CAHPS rates, as the MCOs submit audited HEDIS data and validated CAHPS rates.

Can the State clarify what data submission requirements the contract will be required to support?

The specific data submission requirements for the MAC QRS have not been determined at this time. DOM is in the beginning stages of developing the MAC QRS website and will provide additional direction regarding any required data collection from MCOs and data submission to CMS as the requirements are established.

What delivery format is the state expecting to receive from the Contractor for the MCO QRS (a Tableau dashboard, a Microsoft PowerBI dashboard, a PDF document displaying QRS information)?

Will DOM will be responsible for posting/transferring the information provided by the contractor to the MAC QRS website?

The delivery format for the MCO QRS has not been determined at this time. DOM is in the beginning stages of developing the MAC QRS website and will provide additional direction regarding the required format and the process for posting or transferring QRS information as the requirements are established.

Regarding the Quality Rating System (QRS), does DOM expect the EQRO to host the public‑facing QRS website, or will DOM host the site and the EQRO provide data and scoring files only?

DOM will host the public facing MAC QRS website. The specific data, scoring files, or other materials the Contractor will be required to provide have not been determined at this time.

Is there schedule and count of the meetings in which the EQRO is required to participate?

How many in person meetings does DOM anticipate will be required annually?

DOM has not established a schedule or specific number of meetings at this time. Participation will be as requested by DOM.

DOM anticipates that no more than one of these meetings per year will require in-person attendance.

Does this requirement include the Contractor updating the quality strategy?

Yes. The Contractor shall assist DOM with updating the Quality Strategy as part of the annual review, including providing draft revisions or updates, as needed.

Is there a sample CAP summary report that can be shared?

No.

DOM seeks the Contractor’s input and recommendation on the CAP analysis and summary report.

Will the Contractor be required to validate and monitor CAPs required by DOM for non-EQRO activities?

The Contractor's CAP validation and monitoring responsibilities are not limited to CAPs arising from EQRO activities. They may also include CAPs associated with Additional Activities, such as Mental Health Parity, when the underlying review or assessment was performed by the Contractor.

Deliverable 3 includes a comparison of MCO results to the NCQA Quality Compass Data.

Is the vendor required to have access to NCQA's Medicaid Quality Compass data annually?

Yes.

Are these intended to be separate activities and deliverables, or may the provider directory accuracy audit be satisfied through the PDV/Secret Shopper methodology and reporting?

Section 2.14.7 checks the online directory itself and can cover all provider types.

Section 2.9.3 uses provider phone surveys to validate the MCO’s underlying provider file information.

Section 2.9.4 tests real world experience of getting an appointment and meeting access/wait time standards.

Section 2.14.7 does not specifically require telephone calls, wait time testing, or a statistically valid sample, while those elements are expressly required in Sections 2.9.3 and/or 2.9.4.

These are separate required activities and deliverables.

Is the contractor expectexd to conduct an ECHO survey or validate the results provided by the plans?

Also, does DOM anticipate implementing The Outpatient Mental Health Survey released by AHRQ?

The Contractor is expected to validate the results of the Echo Survey that will be provided by the plans, not conduct the ECHO survey.

No. DOM does not anticipate implementing the AHRQ Outpatient Mental Health Survey at this time.

Will the readiness reviews also include federal requirements?

Yes, as applicable.

For the purposes of planning and budgeting, is it DOM's expectation that the mental health parity assessment will occur annually?

Yes.

What are DOM's expectations of a technical review and validation of these reports?

What source data will be made available from the MCOs to conduct a validation of the MCO Manual Reports?

DOM expects the Contractor to independently review and analyze each Manual Report submitted by the MCO, validate the reported information to the extent necessary to assess its accuracy, reliability, and timeliness, and identify operational trends, inconsistencies, or deficiencies that may create risks to member access, quality of care, or financial compliance.

DOM will provide the MCO Manual Reports. If additional support is needed, the Contractor may work directly with the applicable MCO to request the relevant supporting documentation or data.

What are DOM's expectations for evaluating and validating these results?

DOM expects the Offeror to make a recommendation in its proposal.

What entity will provide the data and information to conduct the analysis?

Can DOM provide a sample analysis report for review?

The Fiscal Agent would provide most, if not all, information. However, the MCOs claims would help supplement if needed.

DOM does not have a sample report to provide.

Is DOM's expectation that the Contractor submit one comprehensive report detailing only areas of concern per MCO every two weeks?

Should the report include tracking of tasks for all EQRO activities?

No, DOM’s expectation is that the Contractor submit one comprehensive report detailing not only areas of concern per MCO but also the progress report shall specify accomplishments during the report period in a task-by-task format, including personnel hours expended, whether the planning tasks are being performed on schedule, and any administrative problems encountered.

Yes, the report should include tracking of tasks for all EQRO and additional requirements per the RFP.

Can DOM confirm whether Key Personnel must be dedicated 100% to the Mississippi EQRO contract, or whether shared staffing across other state EQRO contracts is permitted?

No, DOM does not require key personnel to be dedicated 100% to the Mississippi EQRO. However, DOM shall have unlimited access to key personnel for discussion of all aspects of this contract.

Please confirm Offerors are not required to respond to these items and that submission of a proposal is sufficient acknowledgement.

Ye…