External Quality Review Organization

The State of Nevada, through the Department of Health and Care Financing Policy (DHCFP), is seeking proposals from qualified vendors to provide External Quality Review Organization (EQRO) services. The EQRO will be responsible for conducting mandatory activities such as validating performance improvement projects, performance measurements, network adequacy, and operational readiness for the state's Managed Care Organizations (MCOs) and Prepaid Ambulatory Health Plans (PAHPs). Optional activities may include encounter data validation, consumer/provider surveys, and assistance with quality rating systems and value-based payment models. The contract term is expected to be four years from July 1, 2023 through June 30, 2027, with the option to renew for two additional one-year terms. Proposals are due by February 9, 2023 at 2:00 pm Pacific Time, and the State intends to award one contract as a result of this Request for Proposal (RFP). The EQRO vendor must have demonstrated experience with Medicaid programs, quality assessment, and research methodologies, and must maintain independence from the MCOs and PAHPs being reviewed.

The RFP does not specify any set-aside designations or restrictions on the types of organizations that can respond. An incumbent EQRO vendor is not identified, and the funding for this contract will come from Nevada's Medicaid and Children's Health Insurance Program (CHIP) budgets. The total contract value is not provided, but the cost schedule indicates that the EQRO will need to provide pricing for mandatory activities across the 4-year contract term, as well as pricing for various optional activities.