1628-27-R-IFBD-00001-V03

The Mississippi Division of Medicaid is requesting proposals for an External Quality Review Organization to conduct annual external quality reviews of the state's Medicaid managed care program (MississippiCAN) and CHIP, with proposals due September 18, 2026.

Offerors must demonstrate a minimum of three years of experience within the last five years conducting external quality review activities or substantially similar quality oversight activities for Medicaid and/or CHIP managed care programs, with proven experience overseeing at least one risk-based MCO serving comparable populations. The EQRO must meet all federal independence standards under 42 CFR Part 438, Subpart E, and certify that it is not the state agency, a managed care plan, or a competitor of any plan under review. This is a firm, fixed-rate agreement with no cost adjustments regardless of changes in actual expenses.

The scope encompasses ten federally defined protocols including validation of performance improvement projects, performance measures, network adequacy, encounter data, and quality-of-care surveys, as well as additional DOM-directed activities such as corrective action plan monitoring, quality improvement committees, readiness reviews, and mental health parity compliance reviews. Services will be delivered for three contracted managed care organizations. The EQRO will analyze and evaluate aggregated data concerning quality, timeliness, and accessibility of services. The contract includes multiple deliverables with specific submission deadlines throughout the term, including technical papers, summary reports, and annual technical reports.

All proposals must be submitted electronically via DOM's secure SharePoint platform. The EQRO must execute a Business Associate Agreement establishing HIPAA, GINA, and HITECH Act compliance obligations, including 72-hour breach notification and comprehensive PHI handling protocols. All DOM data must remain within the continental United States with specified encryption standards. Written questions are due August 18, 2026. SharePoint access requests are due September 9, 2026. Notice of intent to award is anticipated October 22, 2026, with Public Procurement Review Board approval targeted for December 2, 2026, and operational period commencing December 3, 2026.