External Quality Review Organization

The Ohio Department of Medicaid (ODM) has released a Request for Proposals (RFP) for an External Quality Review Organization (EQRO) to perform independent external quality review services for Medicaid Managed Care Entities (MCEs). The procurement seeks a qualified supplier to conduct mandatory and optional activities required by the Centers for Medicare and Medicaid Services, including validation of performance improvement projects, encounter data validation studies, and consumer satisfaction surveys. Key deliverables include comprehensive assessments of the quality, accessibility, and timeliness of services provided to Medicaid enrollees, with the ultimate goal of ensuring compliance with federal requirements and improving Ohio's managed care delivery systems. The technical proposal will be evaluated through a three-phase process, with Phase I involving 22 initial qualifying criteria and Phase II scoring 56 requirements across categories such as organizational experience, key personnel qualifications, and administrative work plans. Proposals must achieve a minimum technical score of 63,750 points out of 106,250 possible points. The RFP was posted on December 10, 2024, with proposals due on January 22, 2025, at 2:00 PM EST, and contract award notification expected in March 2025, with implementation planned for April 2025.

The procurement includes a mandatory requirement for the selected supplier to assign a minimum of 15% of the total contract value per state fiscal year to an Ohio-certified Minority Business Enterprise (MBE) subcontractor. The contract will initially run through June 30, 2027, with potential renewal periods through June 30, 2031, contingent upon satisfactory performance and funding availability. The current Ohio Medicaid program serves approximately 3 million beneficiaries across seven Managed Care Organizations, the OhioRISE prepaid inpatient health plan, and a single pharmacy benefit manager. Successful bidders must demonstrate expertise in Medicaid policies, data systems, managed care delivery, quality assessment, performance improvement methods, and population health management strategies. The contract includes comprehensive data security and privacy requirements, mandating compliance with State IT Security Policies, NIST 800-53 security controls, and annual SSAE 18 SOC 1 Type 2 and SOC 2 Type 2 audits. While a specific contract value is not explicitly stated, the detailed cost proposal form suggests a multi-year engagement with extensive scope of work activities across various Medicaid programs.