The purpose of this RFP is to solicit proposals from qualified proposers that provide External Quality Review (EQR) services. Proposers must demonstrate sufficient experience performing such reviews. The current RFP seeks qualified proposers to perform an annual external quality review of the recently implemented contract for the Statewide Management Organization (SMO). This external quality review is required by the Centers for Medicare and Medicaid Services (CMS) under the Medicaid waivers that authorize the SMO and as required by §1932(c)(2) of the Social Security Act and 42 CFR Part 438, Subpart E.
A contract is necessary to fulfill the CMS requirements for an external review of the performance of the SMO as required by the CMS approved Medicaid waivers and the contract between the SMO and OBH.