Description
The Mississippi Division of Medicaid (DOM) is seeking a qualified and responsible Offeror to conduct External Quality Review (EQR) activities in compliance with applicable federal regulations. The selected External Quality Review Organization (EQRO) will analyze and evaluate aggregated data concerning the quality, timeliness, and accessibility of services covered under Medicaid and CHIP, as delivered by Managed Care Organizations (MCOs). The EQRO must meet all federal qualifications and independence standards and perform required and optional EQR activities in accordance with federal regulations and the most current CMS guidance. The contract will be a firm, fixed-rate agreement, and the selected Contractor must comply with all requirements as a condition of contract award and performance.
Some key responsibilities of the EQRO include:
• Validating performance improvement projects
• Validating performance measures
• Reviewing compliance with Medicaid and CHIP managed care regulations
• Validating network adequacy
• Validating encounter data reported by MCOs
• Administering or validating quality of care surveys
• Calculating additional performance measures
• Implementing additional performance improvement projects
• Conducting focus studies of health care quality
• Assisting with quality rating of Medicaid and CHIP managed care organizations
• Reviewing and auditing MCO reports
• Providing summaries of review findings and recommendations.