1. The purpose of this RFP is to solicit proposals from qualified external quality review organizations (EQRO) to perform external quality review (EQR) activities consistent with federal regulations for Louisiana’s Medicaid managed care plans. The EQRO will provide analysis and evaluation of aggregated information on the plans’ quality, timeliness, and access to certain Medicaid covered health care services.
2. A contract is necessary to secure the services of an external quality review organization. 42 CFR § 438.350 requires that each state Medicaid managed care program be evaluated by an EQRO to identify problem areas and monitor the progress in this effort annually. This external review must be conducted by an independent entity that meets the qualifications set forth in 42 CFR § 438, using information obtained from EQR related activities that are consistent with protocols referenced by the CFR.