EQRO AMENDMENT 4 RELEASE.docx

External Quality Review Organization (EQRO) Services Amendment #4 – Deliverable Clarification RFP # 20260731 / RFx # 3160008164 September 3, 2026

Purpose The purpose of this amendment is to clarify and identify provisions within the Scope of Services that constitute required Contractor deliverables. Sections requiring the Contractor to provide, submit, develop, prepare, or otherwise produce a deliverable have been clarified by adding the notation “(Deliverable)” in red font to the applicable provisions that were not originally identified.

This amendment is intended to provide consistency and clarity regarding the deliverables required under the RFP and does not otherwise modify the Scope of Services, requirements, or Contractor responsibilities unless specifically stated herein.

Every quarter, Contractor shall conduct quality-of-care survey phone calls to a distinct and statistically valid sample of provider types to be defined by DOM, for each MCO, and shall submit the Quality-of-Care Survey report. (Deliverable)

Contractor shall perform a quarterly validation of the accuracy of the provider information reported by the MCOs and shall submit the Provider Data Validation (PDV) report to DOM. (Deliverable)

The Contractor shall on an annual basis:

1. Establish a work plan for producing the Mississippi Medicaid QRS, considering applicable national requirements from CMS including compliance with new CMS guidelines and recommending innovative approaches used by other state Medicaid programs and/or the health care industry (Deliverable);

2. Support, as necessary, any data collection from MCOs and data submission to CMS as required for specified QRS performance measures;

3. Produce any associated reference materials (e.g., score calculation and data source documentation), as specified and approved by DOM, on an annual basis (Deliverable);

4. Develop and maintain the Mississippi Medicaid QRS methodology documents and revise annually in collaboration with DOM (Deliverable);

5. Integrate new measures as CMS and industry measurement sets evolve and as requested by DOM;

6. Modify/enhance the MCO QRS as specified by DOM in response to and in alignment with DOM’s changing business requirements (e.g., DOM branding, changes in federal regulations, revisions to the contracts between DOM and MCOs) and/or changes to report card measure specifications (e.g., HEDIS, CAHPS);

7. Modify and/or enhance the QRS tools (analytics, reporting, and/or reference materials) as needed, to align with DOM’s changing business requirements; and

8. Provide assistance to the MCO on how to read, interpret, and use the system as part of a performance improvement strategy.

The Quality Companion Guide shall be submitted to DOM for approval within sixty (60) calendar days of contract effective date and updated annually thereafter. (Deliverable)

The Contractor shall validate all Corrective Action Plans (CAPs) developed for each MCO and provide a summary report for each that includes a detailed section and analysis for every CAP item (Deliverable). The report shall assess not only compliance or non-compliance with the CAP but also the appropriateness of the CAP, taking into account findings from previous annual reviews, and offer recommendations for DOM’s compliance actions. Prior year EQRO annual reports are available for reference on the DOM website: https://medicaid.ms.gov/mississippican-resources/.

Following the completion of the first annual review and report, the Contractor shall conduct quarterly CAP compliance meetings with DOM Contract Compliance and relevant staff. Additionally, the Contractor is responsible for submitting a DOM-approved plan to collaborate with DOM Contract Compliance and other staff throughout the duration of active CAPs (Deliverable).

Every three years, the Contractor shall develop and prepare an evaluation of the prior three years of the QS, which will be made available for public comment on the State’s website, in accordance with 42 CFR § 438.340(c)(2) (Deliverable).

The Contractor shall collaborate with DOM to develop and maintain an electronic readiness review tool based on DOM-approved readiness review standards to collect information and supporting documentation from each MCO (Deliverable).

The Contractor shall provide DOM with a Readiness Review Tracking Report that details the progress of each MCO’s readiness review. This tracking report will include a summary of review status, areas of concern, key dates, and expectations for completing specific activities. The Tracking Report must be initiated at the time of the Contractor’s initial outreach to the MCOs and updated every two weeks. It shall be submitted electronically to DOM. (Deliverable)

The Contractor shall complete a Readiness Review Report for each MCO within three (3) weeks following the site visit. This report, which summarizes the findings of the readiness review, must also be submitted electronically to DOM. (Deliverable)

The Contractor shall electronically submit the following information to DOM during the Project Operations Phase:

1. A detailed technical report that describes the manner in which the data from all activities conducted was aggregated and analyzed, and the conclusions drawn as to the quality, timeliness, and access to care furnished by each MCO. This report shall be submitted to DOM within thirty (30) business days after the completion of the annual review of each MCO (Deliverable). The report shall include the following for each activity conducted:

a. Objectives;

b. Technical methods of data collection and analysis;

c. Description of data obtained;

d. Conclusions drawn from the data;

e. Problems encountered in performing the review;

f. Recommendations, if applicable, for modifications to the review process and suggested follow-up activity;

g. An assessment of each MCO’s strengths and weaknesses with respect to the quality, timeliness, and access to health care services furnished to MississippiCAN and CHIP beneficiaries;

h. Recommendations for improving the quality of health care services furnished by the MCO; and,

i. An assessment of the degree to which a MCO has effectively addressed the recommendations for quality improvement made by the EQRO during the previous year’s EQR, as applicable.

2. A tracking report of progress on annual reviews. This tracking report shall include a review of progress by MCO and areas of concern. The tracking report shall consist of a brief summary with dates and expectations for completing specified activities. This report shall be transmitted electronically and updated every two (2) weeks (Deliverable).

3. All internal procedures, written material, including all manuals, policies, and procedures related to the contract. This information shall be submitted to DOM for approval within thirty (30) calendar days after the contract approval date and thirty (30) calendar days prior to subsequent changes. (Deliverable)

Deliverables shall include, but shall not be limited to, the following:

1. Turnover Plan (Deliverable);

2. Detailed organizational chart (Deliverable);

3. Inventory of software, systems, and operational tools (Deliverable);

4. All Medicaid documents, case files, files, data, materials, reports, and related records (Deliverable);

5. Copies of all operational procedures and process documentation (Deliverable);

6. Work in Progress (WIP) inventories and status updates (Deliverable); and

7. Turnover Results Report summarizing turnover activities and certifying completion of all Turnover responsibilities (Deliverable).

Except as amended herein, all other terms and conditions of the RFP remain unchanged. Vendors are responsible for ensuring that their submissions reflect the corrections outlined in this amendment.

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