Summary

This is a Pre-Proposal Network Opportunities Form submission from Professional Management Enterprises, Inc. in response to RFP 26-87847 for External Quality Reviews for MCO Programs issued by the State of Indiana Department of Administration on behalf of the Family and Social Services Administration (FSSA). 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 contractor must be NCQA-certified for HEDIS and CAHPS activities and employ NCQA-certified HEDIS Compliance Auditors. Mandatory deliverables include performance measure validation, performance improvement project validation, MCO compliance reviews, network adequacy validation, and optional EQR activities as directed by FSSA. The contract term is four years from execution with two optional one-year renewal periods available for a potential six-year total. The proposal deadline is August 26, 2026 at 3:00 PM ET, with a pre-proposal conference scheduled for July 30, 2026 in Indianapolis offered in both in-person and virtual formats.

The cost proposal is scored on a 30-point scale using a normalization formula favoring the lowest cost, with all costs captured in a four-year bid amount including position titles and hourly billable rates. An Indiana Veteran Owned Small Business (IVOSB) subcontractor goal of 3% of total bid amount is scored up to 6 points, with an additional 5 points available for Indiana businesses qualifying under the Buy Indiana Initiative. Evaluation criteria total 91 points maximum, with 50 points for management assessment and quality, 30 for cost, and remaining points for IVOSB and Buy Indiana initiatives. The contractor must comply with HIPAA requirements under a Business Associate Agreement, Indiana IT security policies, and data residency requirements in U.S. data centers with encryption, role-based access, SOC 2 audits, and 24/7 support. Liquidated damages of $1,000 per day apply 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. Written questions are due August 5, 2026, with responses posted by August 12, and evaluation begins September 1 with potential oral presentations on September 7 and award recommendation targeted for September 22.