T1619 - Medical Consulting: External Quality Review Organization, DMAHS

The State of New Jersey, specifically the Department of the Treasury's Division of Purchase and Property and the Department of Human Services' Division of Medical Assistance and Health Services (DMAHS), is procuring an External Quality Review Organization (EQRO) for a four-year contract to conduct comprehensive quality assurance activities for New Jersey FamilyCare/Medicaid programs. The EQRO will design and execute mandatory and voluntary quality assessments for Managed Care Organizations (MCOs) serving Medicaid beneficiaries, with specific focus on core Medicaid, Managed Long Term Services and Supports (MLTSS), and Fully Integrated Dual Eligible Special Needs Plans (FIDE SNP). Key deliverables include annual work plans, MCO operational assessments, performance measure validations, technical reports, focused quality studies, care management audits, and network adequacy validations. The procurement involves 40 distinct deliverables across the contract term, with bidders required to submit firm fixed unit pricing for each. An optional pre-quote conference was held on July 25, 2024, with electronic bidder questions accepted until August 15, 2024, and final quote submissions due by February 26, 2025, at 2:00 p.m. Eastern Time. Evaluation criteria include pricing, with a specific preference for Small Businesses and Disabled Veteran-Owned Businesses.

The solicitation includes a pricing evaluation preference for Small Businesses and Disabled Veteran-Owned Businesses, providing potential competitive advantages for these enterprise types. Current participating MCOs include Aetna Better Health of NJ, Amerigroup of NJ, Horizon NJ Health, United Healthcare Community Plan, and Fidelis Care, with a total enrollment of 2,062,546 beneficiaries as of November 2023. The contract will support services for over 2 million Medicaid beneficiaries, including 59,066 MLTSS beneficiaries and 61,554 FIDE SNP beneficiaries. While no specific contract value is explicitly stated, the detailed price sheet requires bidders to provide pricing for 40 distinct deliverables across the four-year contract term. Bidders must comply with extensive information security requirements, including completing a comprehensive Third-Party Information Security Questionnaire, which will be evaluated by the New Jersey Cybersecurity and Communications Integration Cell to determine acceptable risk levels. The state's ability to make payments remains contingent on the availability of appropriated funds, and contractors must adhere to the State of New Jersey's Standard Terms and Conditions.