External Quality Review Organization

The Ohio Department of Medicaid (ODM) releases this Request for Proposals (RFP) to obtain a qualified Supplier to perform independent external quality review (EQR) services that consist of mandatory and optional activities (e.g., validation of performance improvement projects, encounter data validation studies, and consumer satisfaction surveys) required by the Centers for Medicare and Medicaid Services for Medicaid Managed Care Entities (MCEs) contracted with ODM. Information obtained from the EQR is used to assess the quality, accessibility, and timeliness of services that Medicaid MCEs provide to their enrolled members. The EQR results are also used to ensure ODM’s compliance with federal requirements to arrange for an external, independent evaluation of contracted MCEs and to fulfill reporting requirements specified in the Code of Federal Regulations (CFR) Title 42 § 438 Subpart E. The Selected Supplier will also provide ODM and its MCEs with technical assistance, national expertise, and other support to improve the overall performance of Ohio’s managed care delivery systems.

As prescribed in Section 6.5, the Offeror’s total complete proposal submission (the original Technical and Cost Proposals, all required copies, and the electronic copies (USB drives) must be received by ODM no later than 2:00 p.m . EST on January 22, 2025.