External Quality Review Organization

The Washington State Health Care Authority is requesting proposals for an External Quality Review Organization to conduct oversight activities for the Washington Apple Health Medicaid Integrated Managed Care and Integrated Foster-Care programs, with proposals due August 7, 2026 at 2:00 p.m. Pacific Time. The pre-proposal conference is July 14, 2026 at 11:00 a.m., the Letter of Intent to Propose deadline is July 16, 2026 at 2:00 p.m., and bidder questions are due July 21, 2026 at 2:00 p.m.

Bidders must meet mandatory minimum qualifications: five years of experience conducting External Quality Review activities under 42 C.F.R. Subpart E, NCQA certification as both a CAHPS vendor and HEDIS audit licensee, 70% of staff located in Washington State with dedicated office space, and demonstrated independence from the state and managed care organizations per federal regulations. The organization must be licensed to do business in Washington or willing to obtain licensure within 30 days of selection.

The scope covers annual External Quality Review Technical Reports assessing managed care organization performance; HEDIS compliance audits and performance measure validation; comparative managed care performance analysis; Consumer Assessment of Healthcare Providers and Systems survey administration; network adequacy validation through secret shopper surveys; and technical assistance to five MCOs serving approximately 1.9 million Medicaid enrollees across three programs.

The contract value is $12,071,505 for an initial five-year term running January 1, 2027 through December 31, 2031, with HCA holding the option to extend for up to five additional one-year periods. The clinical lead must hold an independent license (MD, DO, or ARNP). The contractor must comply with HIPAA Security and Privacy Rules and WaTech IT Security Policies, including mandatory Security Design Review within six months of award, completion of Data Security Questionnaire (Exhibit F), and implementation of Enterprise Active Directory or MS Entra Active Directory for state staff and Secure Access Washington for end users with SAML 2.0 support. Commercial General Liability Insurance ($1 million per occurrence / $2 million aggregate), Professional Liability Errors and Omissions ($1 million per claim / $2 million aggregate), and Business Automobile Liability ($1 million per occurrence) are required. HCA will evaluate proposals on Executive Order 18-03 worker rights provisions (50 points), written proposal quality (500 points), cost (300 points), references, and optional oral presentations for finalists (up to 250 points), for a maximum total of 1,100 points. The Apparent Successful Bidder will be announced by August 31, 2026.