RFP 26-87847 - External Quality Reviews for MCO Programs.docx

This is a Pre-Proposal Network Opportunities Form submission for Request for Proposal 26-87847 issued by the State of Indiana Department of Administration on behalf of the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning. The RFP seeks an External Quality Review Organization (EQRO) to evaluate quality, timeliness, and access to healthcare services under Indiana's four Medicaid managed care programs: Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging Program. The mandatory scope of work includes performance measure validation, performance improvement project validation, MCO compliance reviews, network adequacy validation, and up to seven additional optional EQR activities. Deliverables encompass MCO-specific and summary report cards, findings reports with recommendations, data workbooks, quarterly reports, monthly activity/status reports, and an annual technical report due to FSSA by March 1 and to CMS by April 30. A pre-proposal conference is scheduled for July 30, 2026 in Indianapolis with in-person and virtual attendance options. Written questions are due August 5, 2026, with responses posted by August 12. Proposals are due August 26, 2026 at 3:00 PM ET. The contract term is four years from execution with two optional one-year renewal periods available for a potential six-year total. Evaluation begins September 1, with potential oral presentations on September 7 and award recommendation targeted for September 22.

The cost proposal is scored on a 30-point scale using a normalization formula that favors the lowest cost, with all costs captured in a four-year bid amount including position titles and hourly billable rates. The contractor must be NCQA-certified for HEDIS and CAHPS activities and employ NCQA-certified HEDIS Compliance Auditors. An Indiana Veteran Owned Small Business (IVOSB) subcontractor goal of 3% of total bid amount is scored up to 6 points, and an additional 5 points are available for Indiana businesses qualifying under the Buy Indiana Initiative. Total evaluation criteria are 90 points maximum (91 with bonus), with 50 points for management assessment and quality. The contractor must serve dual-eligible and Managed Long-Term Services and Supports populations, comply with HIPAA requirements under a Business Associate Agreement, and adhere to Indiana IT security policies with U.S. data center residency, encryption, role-based access, SOC 2 audits, and 24/7 support. Liquidated damages are assessed at $1,000 per day for late or incomplete deliverables with a 10% payment withhold pending quarterly performance verification. All respondents must complete the Indiana Economic Impact Form and must not have had a state contract terminated for failure to perform within the last two calendar years.