Request for Proposals for External Quality Review Organization (EQRO)

The New Hampshire Department of Health and Human Services, Division of Program Quality and Integrity, is issuing a Request for Proposals (RFP-2027-DPQI-01-EQRO) to procure external quality review services for New Hampshire Medicaid managed care plans. The selected contractor will serve as an External Quality Review Organization (EQRO) responsible for conducting comprehensive quality reviews of three Medicaid Managed Care Organizations (MCOs) and one Dental Organization (DO) statewide. Key deliverables include annual contract compliance audits, validation of up to twenty performance measures annually, validation of performance improvement projects (two concurrent eighteen-month rapid-cycle PIPs for MCOs and one for the dental organization), provider network adequacy validation, encounter data validation, annual secret shopper surveys, semi-annual member focus groups or surveys, provider satisfaction surveys (every three years beginning year three), revealed caller surveys (every three years beginning year two for MCOs), annual quality studies, and biennial quality roundtable meetings. All services must be provided during standard business hours (Monday-Friday, 8:00 am-5:00 pm EST), with comprehensive annual technical reports due by April 1st annually, along with stand-alone reports for each activity delivered within thirty days of completion. The contractor must maintain EQRO qualifications per 42 CFR 438.354, comply with all current CMS EQR Protocols, federal regulations, and HIPAA requirements, assign a dedicated contract manager (minimum 0.50 FTE for MCO services and 0.20 FTE for dental services), and implement comprehensive data security measures including 128-bit encryption minimum and secure storage protocols. The RFP uses a scoring methodology allocating 1,000 points for technical responses across thirteen mandatory questions and 450 points for cost proposals (maximum 1,450 points), with vendors required to achieve a minimum of 500 technical points or their cost proposals will remain unopened. Key deadlines include a Letter of Intent due February 18, 2026, vendor questions due February 18, 2026 at 12:00 PM Eastern Time, and proposals due March 13, 2026 at 12:00 PM Eastern Time, with contract performance anticipated to run from July 1, 2026, through June 30, 2029, with possible renewal extensions of up to four additional years.

The procurement does not include specific set-aside designations for disadvantaged enterprises, though vendors must be registered with the New Hampshire Department of State and possess a vendor code from the Department of Administrative Services. All respondents must demonstrate prior EQRO experience with both MCOs and dental organizations, provide examples of similar work performed in other states, and submit detailed implementation plans with timelines and staffing information, along with IT capability workbooks and itemized cost proposals by state fiscal year. Contractors must comply with all applicable federal and state laws, maintain commercial general liability insurance of not less than $1,000,000 per occurrence and $2,000,000 aggregate, and undergo comprehensive background checks and information security training. No incumbent vendor is identified in the procurement documents, and the Department anticipates awarding one contract for these services. While the specific contract award value is not disclosed in the RFP documents, the Department anticipates funding through Federal, General, and Other funds under Assistance Listing Number 93.778 (Medicaid), with all funding contingent upon Governor and Executive Council approval and continued legislative appropriation.