Description
The Washington State Health Care Authority seeks a qualified External Quality Review Organization (EQRO) to perform comprehensive external quality‑review services for the Apple Health Medicaid Integrated Managed Care (AH‑IMC) and Integrated Foster‑Care (AH‑IFC) programs. The contractor will produce annual technical reports, validate HEDIS and other performance measures, conduct managed‑care comparative analyses, verify network adequacy via secret‑shopper surveys, administer and report CAHPS® surveys, and provide technical assistance to Managed Care Organizations. The work spans a five‑year base period (Jan 1 2027 – Dec 31 2031) with possible one‑year extensions, and the contract’s maximum value is $12.07 million. The solicitation includes a pre‑proposal virtual conference (July 14 2026) and a deadline for questions (July 21 2026).
• Produce Annual Technical Report (ATR) for each MCO under 42 C.F.R. § 438.364.
• Validate performance measures (HEDIS) and network adequacy, and conduct secret‑shopper surveys.
• Administer CAHPS® surveys for adult, child, and foster‑care populations and provide related reporting.
• Deliver technical assistance, training, and support to MCOs throughout the contract term.
• Meet strict data‑security, HIPAA, and Washington state security requirements, including a Security Design Review.