Quality Improvement Organization (QIO) Quality Management

The State of Maine Department of Health and Human Services, Office of Aging and Disability Services is requesting proposals for a Quality Improvement Organization (QIO) or QIO-Like entity to provide quality management and critical incident support services, with proposals due July 20, 2026 by 4:00 p.m. and questions due June 24, 2026. Bidders must be CMS-designated QIO or QIO-Like entities—a mandatory eligibility filter.

The scope encompasses comprehensive reportable event management for approximately 30,000 annual incidents across multiple Home and Community Based Services waiver populations (older adults, individuals with developmental disabilities, intellectual disabilities, autism spectrum disorder, and brain injury). Core services include event triage with one-business-day completion, desk-level reviews, routing of high-risk events within one business day and non-high-risk events within three business days, consumer grievance and complaint intake and resolution, and trend analysis with monthly and quarterly reporting. The awardee must establish an on-site presence in Maine, maintain enhanced Medicaid Federal Financial Participation designation, and comply with federal and state confidentiality requirements. Mandatory performance measures include 100 percent triage completion within one business day and 100 percent written acknowledgment of grievances. Optional future services include technical assistance to providers, provider data management, surge review capacity, and prior authorization review services.

The cost proposal must cover the full eight-year period divided into an initial two-year performance term (September 1, 2026 through August 31, 2028) and three optional two-year renewal periods through August 31, 2034. The evaluation is weighted as follows: cost proposals account for 30 points (with 30 points awarded to the lowest bidder and proportionally fewer points for higher bids), organization qualifications and experience 30 points, and proposed services 40 points. Bidders must submit three years of audited or reviewed financial statements, CMS certification documentation, litigation history, and detailed staffing plans with clinical expertise and project management capacity. The state anticipates making one award and reserves the right to reject all proposals or negotiate with the highest-ranked bidder. No best and final offers will be solicited.