External quality reviews

The South Carolina Department of Health and Human Services (SCDHHS) is seeking a qualified External Quality Review Organization (EQRO) to conduct comprehensive quality reviews for Medicaid Managed Care Organizations (MCOs), Integrated Managed Care Plans, and the Medically Complex Children (MCC) Waiver entity in Richland County. The primary responsibilities include performing readiness reviews for new health plans, conducting annual comprehensive reviews of existing MCOs, validating Performance Improvement Projects (PIPs), validating performance measures, conducting quality of care studies, and performing service access studies. Mandatory minimum qualifications require at least three years of prior EQR experience, demonstrated staff expertise in Medicaid programs, sufficient physical and technological resources, and organizational independence from the state Medicaid agency and MCOs being reviewed. Key personnel must include a full-time physician consultant and full-time contract manager, with review staff supervised by individuals possessing at least five years' quality assurance management experience. The evaluation criteria will be weighted at 45 points for technical approach, 35 points for qualifications and experience, and 20 points for price. Key dates include a proposal submission deadline of February 10, 2023, at 2:00 PM EST, with award notification scheduled for March 30, 2023, and an estimated contract start date of April 1, 2023.

The solicitation does not specify explicit set-aside designations for disadvantaged enterprises. The contract will have an initial two-year term with three optional one-year renewal periods, creating a maximum potential five-year contract period through March 31, 2028. While no specific budget range was explicitly stated, the current fiscal year purchase order amount for the existing contract is $700,000, which may provide some indication of potential contract value. The contractor must maintain comprehensive liability insurance, including errors and omissions coverage with limits of $5,000,000 per claim and $10,000,000 aggregate. All work must be performed within the continental United States, with no offshore contracting permitted. Offerors are required to submit various mandatory attachments, including a HIPAA Business Associate Agreement, Organizational Conflict of Interest Disclosure, Certification for Contracts, and Debarment Certification. The solicitation emphasizes strict compliance with federal regulations, including HIPAA requirements, Clean Air Act, Civil Rights Act, and various cybersecurity standards.