RFP-2027-DPQI-02-EQRO: External Quality Review Organization

State of New Hampshire
Department of Health and Human Services
REQUEST FOR PROPOSALS
FOR
External Quality Review Organization (EQRO)
RFP-2027-DPQI-02-EQRO
RELEASE DATE: September 15, 2026

New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
TABLE OF CONTENTS
1. PURPOSE AND OVERVIEW 3
2. STATEMENT OF WORK 5
3. SOLICITATION RESPONSE EVALUATION 9
4. SOLICITATION RESPONSE PROCESS 13
5. SOLICITATION RESPONSE SUBMISSION INSTRUCTIONS 15
6. SOLICITATION RESPONSE REQUIREMENTS 15
7. ADDITIONAL TERMS AND REQUIREMENTS 16
8. COMPLIANCE 20
9. APPENDICES TO THIS SOLICITATION 22
RFP-2027-DPQI-02-EQRO
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
1. PURPOSE AND OVERVIEW
Introduction
The New Hampshire Department of Health and Human Services, Division of Program Quality
and Integrity ("Department") is seeking responses to this Request for Proposals ("Solicitation"
or "RFP") from qualified Vendors to provide External Quality Reviews (EQRs) of healthcare
services provided to New Hampshire Medicaid beneficiaries enrolled in the Medicaid Care
Management, statewide. EQRs evaluate and analyze aggregated information on quality,
timeliness, and access to health care services provided by state contracted Managed Care
Plans. EQRs serve to improve the state's ability to oversee and manage the managed care
plans they contract with and help managed care plans improve their performance.
Qualified Vendors must confirm that they meet all the qualifications of an External Quality
Review Organization (EQRO) as outlined in 42 CFR 438.354.
Pursuant to 42 CFR 438, Subpart E, States are federally required to contract with an EQRO
to provide rigorous assessments of their contracted Managed Care Plans.
The Department anticipates awarding one (1) or more contracts for the services in this
solicitation. Vendors must submit one (1) proposal that includes services for both Part A and
Part B.
Key Information
The information in the table below is as anticipated by the Department and is subject to
change. Agreements are contingent upon the availability of funds, and/or approval by the
Governor and Executive Council.
Contract Effective Date Upon approval by the Governor and Executive Council
Contract End Date April 30, 2030
Renewal Options The Department may extend contracted services for up to four
(4) additional years.
Funding Source The Department anticipates using Federal, General, and Other
funds for resulting contract.
Assistance Listing Number 93.778
Award Name Medicaid
Match Requirements N/A
Point of Contact Danielle L. Richey, Contract Specialist
danielle.l.richey@dhhs.nh.gov
603-271-9099
From the date of release of this solicitation until an award is made and announced regarding the
selection of a Vendor, all communication with personnel employed by or under contract with the
Department regarding this solicitation is prohibited unless first approved by the Point of Contact
listed above. Department employees have been directed not to hold conferences and/or
discussions concerning this solicitation with any potential contractor during the selection process,
unless otherwise authorized by the Point of Contact. Vendors may be disqualified for violating
this restriction on communications.
Interested Vendors must read this entire solicitation and submit the required documents
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
in the specified manner. Vendors are responsible for reviewing the most updated
information related to this solicitation before submitting responses.
Procurement Timetable
All times are according to Eastern Time. The Department reserves the right to modify
these dates and times at its sole discretion.
Item Action Date
1. S olicitation Released 9/15/2026
Letter of Intent Submission Deadline
2. 9/22/2026
(optional)
9/22/2026
3. V endor Questions Submission Deadline
12:00 PM - Noon
Department Response to Questions
4. 10/6/2026
Published
10/14/2026
5. V endor Solicitation Response Due Date
12:00 PM - Noon
Background
1.4.1. New Hampshire Department of Health and Human Services, Division of
Program Quality and Integrity
The Division of Program Quality and Integrity (DPQI) provides support to Department
programs to measure and achieve quality and maintain integrity in their day-to-day work.
DPQI assists programs by conducting audits, providing technical assistance in active
contract management, and identifying data sources from providers and Vendors.
The Division of Medicaid Services (DMS) has functional responsibility for the Medical
Assistance program (Medicaid) as well as health planning, reporting, data and research.
DMS is dedicated to identification of New Hampshire's health care needs through
assessment of health care and social services delivery systems.
DMS is responsible for the administration of the Medical Assistance Program, called
New Hampshire Medicaid, for low-income NH adults and children. DMS's development
and facilitation of program policy and financial management for Medicaid services
assists other Department program areas manage specialized Medicaid programs for
children, seniors, the blind or disabled, including persons with mental illness,
developmental disabilities, and those residing in long term care facilities.
1.4.2. Objective
The Department seeks an experienced, qualified, independent, and financially strong
EQRO Vendor(s) to provide project management and support, follow specific data usage
and security requirements, and provide specific reporting requirements. The selected
Vendor(s) will be responsible for conducting periodic reviews of the quality, timeliness,
and access to care provided by Medicaid managed care entities (MCEs) including three
(3) MCOs and one (1) dental organization (DO), and any MCE's that may be added
during the course of the resulting contract, utilizing current CMS External Quality Review
(EQR) protocols. The RFP describes each activity including evaluation of MCE
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
contractual compliance, validation of MCE performance measures, evaluation of
performance improvement projects, validation of encounter data reported by MCEs,
implementation of surveys, validation of provider network adequacy, conduct focus
studies of health care quality, and provide a detailed Managed Care Organization (MCO)
and Dental Organization (DO) EQR Technical Report. The current contracts can be
found here: 109A GC Agenda 121725.pdf
The State is required to contract with an EQRO to comply with regulations established
by the Balanced Budget Act of 1997 and 42 CFR 438 Subpart E.
2. STATEMENT OF WORK
Scope of Services- See Appendix A - Scope of Services
Mandatory Questions
2.2.1. In response to this solicitation, Vendor(s) must respond to the Mandatory
Questions below for both Part A and Part B, utilizing Appendix E - Technical
Responses to Mandatory Questions.
Part A: Mandatory Questions for Deliverables 1-11 (MCO) and 1-10 (DO)
Q1. Describe your experience evaluating Managed Care Organization (MCO) and
Dental Organization (DO) Performance Measures and how you will meet all
requirements of Sections 2.2. and 3.2., in Appendix A - Scope of Services.
a. Provide one (1) example of a report, from another state, if possible, that
shows the results of a performance measure validation audit.
Q2. Describe your experience evaluating MCO and DO Rapid Cycle Performance
Improvement Projects (PIPs) and how you will meet all requirements of Sections
2.3. and 3.3., in Appendix A - Scope of Services, respectively. Additionally,
please provide:
a. An example, from another state, if possible, of your prior experience
evaluating multiple MCO PIPs utilizing the rapid cycle methodology and tools
the Vendor created; and
b. An example, from another state, if possible, of your prior experience
evaluating at least one (1) DO PIP utilizing the rapid cycle methodology and
tools created (if different than those utilized for MCOs.)
Q3. Describe your experience validating MCO and DO Provider Network Adequacy
and how you will meet all requirements in Sections 2.4. and 3.4., in Appendix A -
Scope of Services. Please provide:
a. One (1) example of a combined MCO and DO Medicaid managed care report
OR two (2) separate reports (one (1) MCO and one (1) DO), from another
state, if possible, demonstrating your prior experience validating provider
network adequacy.
Q4. Describe your experience validating MCO and DO Encounter Data and how you
will meet all requirements of Sections 2.5. and 3.5., in Appendix A - Scope of
Services. Please provide the following:
a. One (1) example of a combined MCO and DO Medicaid managed care report
or two (2) separate reports (one (1) MCO and one (1) DO), from another
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
state, if possible, demonstrating your prior experience validating encounter
data;
b. One (1) example (if possible) demonstrating that the EQRO has had prior
experience writing a certification letter attesting to the level of completeness
and accuracy of the encounter data submitted by an MCO or DO; and
c. One (1) example, from another state, if possible, of an analysis or report as
referenced in 2.5.5.4., based on the Vendor conducting a managed care
medical record review for confirmation of findings of analysis of encounter
data.
Q5. Describe your experience conducting provider MCO and DO Secret Shopper
surveys in compliance with 42 CFR 438.68(f) and 42 CFR 438.01(h) and
describe how you would meet the requirements of Sections 2.6., and 3.6., of
Appendix A - Scope of Services.
a. Please provide one (1) example of a report, from another state, if possible,
demonstrating that the Vendor has had prior experience writing an MCO or
DO Secret Shopper Survey report.
Q6. Describe your experience conducting focus studies of health and dental care
quality and describe how your organization will meet the requirements of
Section 2.7. and 3.7., of Appendix A - Scope of Services.
a. Provide one (1) MCO example and one (1) DO example of a report, from
another state, if possible, of an MCO focus study and a DO focus study that
you have designed and implemented.
Q7. Describe your experience conducting member focus groups and/or semi-
structured interviews of health and dental care quality and describe how your
organization will meet the requirements of Sections 2.8.2.1. and 3.8.2., of
Appendix A - Scope of Services.
a. Provide one (1) MCO example and one (1) DO example of a report, from
another state, if possible, of an MCO member focus groups and/or semi-
structured interviews and a DO member focus groups and/or semi-structured
interviews that you have designed and implemented.
Q8. Describe your experience writing EQR MCO and DO Technical Reports.
a. Please provide one (1) MCO example and one (1) DO example, from another
state, if possible, demonstrating your prior experience writing an EQR
Technical Report.
Q9. Describe your organization's ability to track, analyze, and report the EQRO data
required within the Appendix A - Scope of Services Part A. Include:
a. Methods to identify trends, service gaps, or systemic issues.
b. Processes for sharing findings with the Department.
c. Safeguards for protecting sensitive personal and medical information
collected.
d. A completed Appendix H - IT Requirements Workbook.
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
Q10. Describe your organization's ability to provide the entire Scope of Services -
Part A and meet all requirements in this solicitation. Include your organization's
approach to meeting State needs when federal regulations change (i.e. federal
reporting requirements, protocols, rules, etc.).
a. Provide a detailed Implementation Plan with timelines and milestones for
deliverables identified in Appendix G - Deliverables Cost Sheet.
Q11. Provide your organization's staffing plan within Appendix F - Program Staff List,
including:
a. An organizational chart including the number of full-time equivalent staff
(FTE.)
b. Description of qualifications, curriculum vitae/resumes, and/or credentials for
key personnel.
c. Any specialized staff training completed relevant to providing services in this
solicitation.
d. Description of your organization's approach to customer service, supervision,
and training, including any ongoing training or continuing education you
provide to your staff to maintain current knowledge of conducting EQRs.
Part B: Mandatory Questions for Deliverables 12-14 (MCO) and 11-12 (DO)
Q1. Describe your experience and expertise in evaluating MCO and DO Contractual
Compliance. Include:
a. How your organization will meet the requirements of Sections 2.11. and 3.10.,
in Appendix A, Scope of Services. The Vendor must verify that all
components will be included in the compliance audit or specifically state what
section(s) they will not include and state the specific reason(s) for exclusion.
b. One (1) MCO example and one (1) DO example of a report from another
state if possible, demonstrating the Vendor's prior experience conducting
reviews relative to contract compliance pursuant to 42 CFR 438.358(b)(1)(iii).
Q2. Describe your experience conducting large conference-style virtual meetings such
as described in Sections 2.9 and trainings for other State Medicaid agencies that
include medical providers, MCOs, and community partners. Describe the
technology you will use to:
a. Host online registration;
b. Host a virtual conference including providing technical assistance to
attendees/speakers during the meeting;
c. Post polling questions during the conference;
d. Obtain participant feedback during the conference; and
e. Provide an electronic evaluation tool to attendees and collect completed
forms post-conference.
Q3. Describe your experience conducting other provider surveys in compliance with 42
CFR 438.358(c)(2) and describe how you would meet the requirements of Sections
2.10. and 3.9., of Appendix A, - Scope of Services. Please explain your experience,
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
including your organization's strategies for engaging providers to ensure constructive
feedback, conducting the following surveys:
a. MCO and DO Provider Satisfaction Surveys. Please include an example of a
report, from another state, if possible, demonstrating your prior experience
writing or managing subcontractors to write an MCO or DO Provider
Satisfaction Survey report.
Q4. Please describe your organization's ability to track, analyze, and report the EQRO
data required within the Appendix A - Scope of Services Part B. Include:
a. Methods to identify trends, service gaps, or systemic issues.
b. Processes for sharing findings with the Department.
c. Safeguards for protecting sensitive personal and medical information
collected.
d. A completed Appendix H - IT Requirements Workbook.
Q5. Please describe your organization's ability to provide the entire Scope of Services -
Part B and meet all requirements in this solicitation. Include your organization's
approach to meeting State needs when federal regulations change (i.e. federal
reporting requirements, protocols, rules, etc.).
a. Provide a detailed Implementation Plan with timelines and milestones for
deliverables identified in Appendix G - Deliverables Cost Sheet.
Q6. Provide your organization's staffing plan within Appendix F - Program Staff List,
including:
a. An organizational chart including the number of full-time equivalent staff
(FTE.)
b. Description of qualifications, curriculum vitae/resumes, and/or credentials for
key personnel.
c. Any specialized staff training completed relevant to providing services in this
solicitation.
d. Description of your organization's approach to customer service, supervision,
and training, including any ongoing training or continuing education you
provide to your staff to maintain current knowledge of conducting EQRs.
Finance
2.3.1. The selected Vendor(s) must submit monthly invoices using a form satisfactory
to the Department, which identifies and requests payment for accepted
deliverables rendered in accordance with the terms of the resulting contract.
Payment shall be made only for completed Department-accepted deliverables.
The selected Vendor(s) must ensure invoices are completed, dated, and
submitted to the Department to initiate and request payment.
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
3. SOLICITATION RESPONSE EVALUATION
The Department will evaluate responses from Vendors based upon the criteria and
standards contained in this solicitation and by applying the points as set forth below,
which will be used to determine the overall highest scoring Vendor for Part A and Part
B, which will be scored separately. Vendors are advised that this is not a low-cost award.
Part A:
TECHNICAL RESPONSE POSSIBLE SCORE
Evaluation of Performance Measures (Q1) 75 Points
Evaluation of PIP (Q2) 75 Points
Validations of Provider Network Adequacy (Q3) 75 Points
Validation of Encounter Data (Q4) 65 Points
Experience Conducting Secret Shopper Surveys
65 Points
(Q5)
Experience Conducting Focus Studies of Health and
55 Points
Dental Care Quality (Q6)
Experience Conducting Member Focus Studies (Q7) 55 Points
Experience Providing Technical Reports (Q8) 55 Points
Data Tracking and Reporting (Q9) 60 Points
Ability (Q10) 70 Points
Capacity/Staffing Plan (Q11) 50 Points
Technical Response - Total Possible Score 700 Points
COST PROPOSAL POSSIBLE SCORE
Vendor Cost (see formula below) 300 Points
Cost Proposal - Total Possible Score 300 Points
MAXIMUM POSSIBLE SCORE 1000 Points
Part B:
TECHNICAL RESPONSE POSSIBLE SCORE
Evaluation of Contractual Compliance (Q1) 175 Points
Experience Conducting Conferences (Q2) 140 Points
Experience Conducting Other Member and/or
140 Points
Provider Surveys (Q3)
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New Hampshire Department of Health and Human Services
External Quality Review Organization (EQRO)
Data Tracking and Reporting (Q4) 85 Points
Ability (Q5) 90 Points
Capacity/Staffing Plan (Q6) 70 Points
Technical Response - Total Possible Score 700 Points
COST PROPOSAL POSSIBLE SCORE
Vendor Cost (see formula below) 300 Points
Cost Proposal - Total Possible Score 300 Points
MAXIMUM POSSIBLE SCORE 1000 Points
Preliminary Scoring of Technical Responses
3.2.1. The Department will establish an evaluation team. The evaluation team will
review the Technical Proposal and provide a preliminary score. Should a
Vendor fail to achieve a minimum of 500 points during the preliminary scoring,
it will receive no further consideration from the evaluation team and the Vendor's
Cost Proposal will remain unopened.
Scoring of Technical Proposals
3.3.1. Vendor Technical Responses will be scored based on the following criteria:
Part A:
Question 1 0-25 Points 26-50 Points 51-75 Points
Vendor does not demonstrate Vendor minimally Vendor mostly or fully
experience necessary to demonstrates experience demonstrates experience
evaluate MCO and DO necessary to evaluate MCO necessary to evaluate MCO
Performance Measures. and DO Performance and DO Performance
Measures Measures.
Question 2 0-25 Points 26-50 Points 51-75 Points
Vendor does not demonstrate Vendor minimally Vendor mostly or fully
experience necessary to demonstrates experience demonstrates experience
evaluate MCO and DO necessary to evaluate MCO necessary to evaluate MCO
Performance Improvement and DO Performance and DO Performance
Projects Improvement Projects Improvement Projects.
Question 3 0-25 Points 26-50 Points 51-75 Points
Vendor does not demonstrate Vendor minimally Vendor mostly or fully
experience necessary to demonstrates experience demonstrates experience
conduct validations of MCO necessary to conduct necessary to conduct
and DO Provider Network validations of MCO and DO validations of MCO and DO
Adequacy. Provider Network Adequacy. Provider Network Adequacy.
Question 4 0-21 Points 22-44 Points 45-65 Points
Vendor does not demonstrate Vendor minimally Vendor mostly or fully
experience necessary to demonstrates experience demonstrates experience
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