External Quality Review Organization

Background
The Ohio Department of Medicaid (ODM) is seeking a qualified Supplier to provide independent external quality review (EQR) services for Medicaid Managed Care Entities (MCEs). This initiative aims to validate performance improvement projects, conduct encounter data validation studies, and perform consumer satisfaction surveys as mandated by the Centers for Medicare and Medicaid Services.

The results from these reviews will help assess the quality, accessibility, and timeliness of services provided to Medicaid members, ensuring compliance with federal regulations outlined in the Code of Federal Regulations (CFR) Title 42 § 438 Subpart E. The selected Supplier will also offer technical assistance and national expertise to enhance Ohio's managed care delivery systems.

Work Details
The Supplier will be responsible for conducting mandatory and optional EQR activities which include:
- Validation of performance improvement projects
- Encounter data validation studies
- Consumer satisfaction surveys
- Producing a detailed technical report that aggregates and analyzes data on service quality, accessibility, and timeliness
- Providing assessments of MCEs' performance and recommendations for quality improvement
- Monitoring compliance with state and federal regulations
- Evaluating the effectiveness of ODM’s Quality Strategy.

Additionally, the Supplier must demonstrate capabilities in managing large datasets covering approximately 3 million individuals, utilizing advanced analytic tools, ensuring data integrity, and maintaining compliance with HIPAA regulations.

Period of Performance
The contract period is expected to commence upon award in March 2025 and run through June 30, 2027. There are options for two renewal periods extending through June 30, 2031, contingent upon satisfactory performance and funding availability.

Place of Performance
The services will primarily be performed within the state of Ohio.