External Quality Reviews for MCO Programs - FSSABid Documents

The State of Indiana Department of Administration, on behalf of the Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning, is requesting proposals for an External Quality Review Organization (EQRO) to evaluate quality, timeliness, and access to healthcare services under Indiana's four Medicaid managed care programs (Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging Program), with proposals due August 26, 2026 at 3:00 PM ET and a pre-proposal conference on July 30, 2026 in Indianapolis (in-person and virtual).

The contractor must be NCQA-certified for HEDIS and CAHPS activities and employ NCQA-certified HEDIS Compliance Auditors. The scope encompasses mandatory EQR activities—performance measure validation, performance improvement project validation, MCO compliance reviews, and network adequacy validation—plus seven additional optional EQR activities as directed by FSSA. Deliverables include MCO-specific and summary report cards, findings reports with recommendations, data workbooks, quarterly reports, monthly activity/status reports, and an annual technical report due to FSSA by March 1 and to CMS by April 30. The contractor must serve dual-eligible and Managed Long-Term Services and Supports populations and demonstrate experience with the four MCO programs. The Statement of Work specifies detailed project management structure with FSSA approval rights over key personnel; HIPAA compliance under a Business Associate Agreement; Indiana IT security policies and data residency requirements in U.S. data centers with encryption, role-based access, SOC 2 audits, and 24/7 support; and liquidated damages of $1,000 per day for late or incomplete deliverables with a 10% payment withhold pending quarterly performance verification.

The contract term is four years from execution with two optional one-year renewal periods available, for a potential six-year total. The cost proposal is scored on a 30-point scale using a normalization formula favoring the lowest cost; all costs must be captured in a four-year bid amount with position titles and hourly billable rates. An Indiana Veteran Owned Small Business (IVOSB) subcontractor goal of 3% of total bid amount is scored up to 6 points (5 base plus 1 bonus). An additional 5 points are available for Indiana businesses qualifying under the Buy Indiana Initiative. Evaluation criteria total 90 points maximum (91 with bonus): 50 points for management assessment and quality, 30 for cost, remainder for IVOSB and Buy Indiana. Written questions are due August 5, 2026, with responses posted by August 12. Evaluation begins September 1 with potential oral presentations September 7 and award recommendation targeted for September 22. All respondents must complete the Indiana Economic Impact Form and must not have had a state contract terminated for failure to perform within the last two calendar years.