T1619 - Medical Consulting: External Quality Review Organization, DMAHS

**Bid Solicitation # 24DPP00958 T1619 – Medical Consulting: External Quality Review Organization, DMAHS** **Summary:** The New Jersey Department of the Treasury, Division of Purchase and Property, on behalf of the Department of Human Services, Division of Medical Assistance and Health Services (DMAHS), is seeking Quotes for an External Quality Review Organization (EQRO) to conduct mandatory and voluntary quality assurance activities of Managed Care Organizations (MCOs) and other providers contracted with DHS to manage the healthcare of NJ FamilyCare/Medicaid Beneficiaries. **Key Details:** - Bid Submission Deadline: August 15, 2024, at 2:00 PM - Optional Pre-Quote Submission Conference: July 25, 2024, at 11:30 AM - Quote Opening Date: September 5, 2024, at 2:00 PM - Set-Aside Contracts: Small Business and Disabled Veteran-Owned Business Set-Aside Contracts are available. **Scope of Work:** The EQRO will be responsible for designing and conducting various quality assurance activities, including: - Core Medicaid/MLTSS review of compliance with Medicaid and Children's Health Insurance Program (CHIP) managed care regulations - Validation of MCOs' core Medicaid performance measures - Validation of the FIDE SNP MCOs' Performance Measures - MLTSS performance measure development/validation - MLTSS calculation of performance measures - FIDE SNP performance measure development/validation - FIDE SNP calculation of performance measures - Evaluation of the MCOs' Performance Improvement Projects (PIP) - Core/MLTSS Annual Technical Report (ATR) - FIDE SNP/MLTSS annual technical report (ATR) - Focused quality studies - Core Medicaid – Care Management (CM) - MLTSS/Care Management (CM) - FIDE SNP care management - Individual case reviews/quality of care concerns - Validation of encounter data - Consumer assessment of healthcare providers and systems (CAHPS) survey-core Medicaid - Consumer assessment of healthcare providers and systems (CAHPS) survey-FIDE SNP - Validation of network adequacy - Quality rating system **Evaluation Criteria:** Quotes will be evaluated based on the following criteria: - Technical Evaluation Criteria (70%) - Price Evaluation (30%) **Contract Award:** The State