External Quality Review Organization (EQRO) ? RFP # 20260731/ RFx # 3160008164 ? 7/31/2026 RFP # 20260731 ? Word RFP # 20260731 ? PDF Business Associate Agreement

Request for Proposal
RFP # 20260731/ RFx # 3160008164
External Quality Review Organization
(EQRO) Services
DOM Procurement Of(cid:976)icer: Issu e Date: July 31, 2026
Sharon Clark, Procurement Of(cid:976)icer
Email: procurement@medicaid.ms.gov
601.359.6153
RFP PROCESS DESCRIPTION ANTICIPATED DUE DATE
Questions Due
Submit all questions using the designated Q&A form, per August 18, 2026
RFP instructions. Responses will be published as an RFP
2:00 PM, CT
amendment to ensure all potential Offerors have access to
the same information.
SharePoint Access Request
September 9, 2026
Offerors must submit the required information on the
2:00 PM, CT
attached form to obtain access to the secure (cid:976)ile share.
Proposal Submission Deadline
Proposals shall be submitted in accordance with the RFP September 18, 2026
submission instructions prior to the time and date
2:00 PM, CT
indicated here, or as may be amended through an RFP
Amendment
OFFERORS ARE STRONGLY ENCOURAGED TO CAREFULLY READ THE ENTIRE SOLICITATION
DOM WELCOMES PARTICIPATION OF MINORITY BUSINESSES

Table of Contents
Request for Proposal ..................................................................................................................................... 1
1.0 PROCUREMENT OVERVIEW ............................................................................................................ 5
1.1 Purpose ................................................................................................................................................ 5
1.2 Authority ............................................................................................................................................. 5
1.3 Organizations Eligible to Submit Proposals ........................................................................................ 7
1.4 Request for Reconsideration of the Terms of the Submission ............................................................ 8
1.5 Procurement Timetable ....................................................................................................................... 8
1.6 Pre-Submission Requirements ............................................................................................................. 8
1.7 Expenses Incurred in the Procurement Process ................................................................................. 10
1.8 Type of Contract ................................................................................................................................ 10
1.9 Written Proposals ............................................................................................................................... 10
1.10 Accuracy of Statistical Data .............................................................................................................. 10
1.11 Security Requirements ....................................................................................................................... 11
1.12 Incorporation of Documents by Reference ........................................................................................ 13
1.13 Electronic Access to Materials .......................................................................................................... 14
2.0 SCOPE OF SERVICES ......................................................................................................................... 15
2.1 General Overview and Responsibilities ............................................................................................ 15
2.2 Proposal Requirements ...................................................................................................................... 16
2.3 Federally Defined Protocols .............................................................................................................. 16
2.4 Protocol 1-Validation of Performance Improvement Projects .......................................................... 17
2.5 Protocol 2-Validation of Performance Measures .............................................................................. 18
2.6 Protocol 3-Review of Compliance with Medicaid & CHIP Managed Care Regulations - (AQS) .. 19
2.7 Protocol 4-Validation of Network Adequacy ................................................................................... 22
2.8 Protocol 5-Validation of Encounter Data Reported by the Medicaid & CHIP Managed Care Plan 24
2.9 Protocol 6-Administration or Validation of Quality of Care Surveys .............................................. 24
2.10 Protocol 7-Calculation of Additional Performance Measures .......................................................... 27
2.11 Protocol 8-Implementation of Additional Performance Improvement Projects ............................... 27
2.12 Protocol 9-Conducting Focus Studies of Health Care Quality .......................................................... 27
2.13 Protocol 10-Assist with Quality Rating of Medicaid and CHIP Managed Care Organizations ...... 28
2.14 Additional Activities Required By DOM .......................................................................................... 29
2.15 MCO Reporting Requirements .......................................................................................................... 36
2.16 Security and Privacy .......................................................................................................................... 36
2.17 Contractor Review and Audit ............................................................................................................ 36
2.18 Contractor Requirements ................................................................................................................... 37
2.19 Deliverable Management / Reporting Requirements ......................................................................... 38
2.20 Training and Administrative Requirements ....................................................................................... 41
2.21 General Staffing Requirements .......................................................................................................... 41
2.22 Accessible Staffing Requirements ..................................................................................................... 42
2.23 Subcontracted Staff Requirements ..................................................................................................... 43
2.24 Key Personnel Requirements ............................................................................................................. 43
2.25 Contract Phases .................................................................................................................................. 45
3.0 PROCUREMENT PROCESS ............................................................................................................... 47
3.1 Approach ............................................................................................................................................ 48
3.2 Multi-Term Contracts ........................................................................................................................ 49
3.3 Rules of Procurement ......................................................................................................................... 49
3.4 Proposal Receipt and Proposal Opening ............................................................................................ 53

3.5 Notice of Intent to Award .................................................................................................................. 53
3.6 PPRB Approval.................................................................................................................................. 54
3.7 Mississippi Contract/Procurement Opportunity Search Portal ........................................................... 54
3.8 Right to Reject, Cancel and/or Issue Another Solicitation ................................................................. 54
4.0 TERMS AND CONDITIONS ............................................................................................................... 56
4.1 Entire Agreement ............................................................................................................................... 56
4.2 Performance Standards, Damages and Retainage ............................................................................. 57
4.3 Acknowledgement of Amendments .................................................................................................. 60
4.4 Applicable Law ................................................................................................................................. 60
4.5 Approval ............................................................................................................................................ 60
4.6 Availability of Funds ......................................................................................................................... 60
4.7 Certification of Independent Price Determination ............................................................................. 60
4.8 Compliance with Equal Opportunity in Employment Policy ............................................................ 60
4.9 Compliance with Laws ...................................................................................................................... 61
4.10 Contract Rights .................................................................................................................................. 61
4.11 E-Payment.......................................................................................................................................... 61
4.12 E-Verification .................................................................................................................................... 61
4.13 Force Majeure .................................................................................................................................... 62
4.14 Minor Informalities and Irregularities ............................................................................................... 62
4.15 Contractor's Representation Regarding Contingent Fees .................................................................. 62
4.16 Paymode ............................................................................................................................................ 62
4.17 Procurement Regulations ................................................................................................................... 63
4.18 Property Rights .................................................................................................................................. 63
4.19 Representation Regarding Gratuities ................................................................................................. 63
4.20 Required Public Records and Transparency ...................................................................................... 63
4.21 Stop Work Order ................................................................................................................................ 63
4.22 Termination for Convenience ............................................................................................................ 64
4.23 Termination for Default ..................................................................................................................... 64
4.24 Termination Upon Bankruptcy .......................................................................................................... 64
4.25 Non-performance or Delayed Performance of a Subcontractor ........................................................ 65
4.26 Procedure on Termination ................................................................................................................. 65
4.27 Effective Date of Termination ........................................................................................................... 66
4.28 Terms Survive Termination ............................................................................................................... 66
4.29 Notice ................................................................................................................................................. 67
4.30 Contract Assignment and Subcontracting .......................................................................................... 67
4.31 Protection of Personal Privacy and Sensitive Data ............................................................................ 68
4.32 Ownership of Information and Data .................................................................................................. 68
4.33 Right of Inspection ............................................................................................................................ 69
4.34 Records Retention Requirements....................................................................................................... 69
4.35 Interpretations/Changes/Disputes ...................................................................................................... 70
4.36 Waiver ............................................................................................................................................... 70
4.37 Severability ........................................................................................................................................ 70
4.38 Disputes ............................................................................................................................................. 70
4.39 State's Attorney Fees and Expenses .................................................................................................. 71
4.40 Indemnification .................................................................................................................................. 71
4.41 Status of the Contractor ..................................................................................................................... 72
4.42 Insurance ............................................................................................................................................ 73
4.43 Release of Public Information ........................................................................................................... 75
4.44 Contractor Compliance Issues ........................................................................................................... 76
4.45 Authority to Contract ......................................................................................................................... 78
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4.46 Confidentiality ................................................................................................................................... 79
4.47 Strict Performance ............................................................................................................................. 79
5.0 PROPOSAL SUBMISSION FORMAT AND CONTENT SPECIFICATIONS .............................. 80
5.1 Proposal Formatting ............................................................................................................................ 80
5.2 Proposal Submission Requirements .................................................................................................... 80
5.3 Proposal Content ................................................................................................................................. 82
6.0 EVALUATION ....................................................................................................................................... 99
6.1 Evaluation of Proposals ....................................................................................................................... 99
6.2 Phase I - Evaluation of Offerors' Response to RFP and Transmittal Letter (Pass/Fail) ..................... 99
6.3 Phase II - Evaluation of Technical Proposal (35 pts / 35%) ............................................................. 100
6.4 Phase II - Evaluation of Management Proposal (30 pts / 30%) ........................................................ 101
6.5 Phase III - Cost Proposal (35 pts / 35%) ........................................................................................... 102
6.6 Phase IV - Discussions with Offerors and Selection and Award...................................................... 103
ATTACHMENT A - Transmittal Letter ................................................................................................... 104
ATTACHMENT B: ADDENDUM 1 - Executive Summary .................................................................... 105
ATTACHMENT B: ADDENDUM 2 - Technical - Methodology ........................................................... 106
ATTACHMENT B: ADDENDUM 3 - Technical - Work Plan and Schedule ...................................... 107
ATTACHMENT B: ADDENDUM 4 - Management - Corporate Background and Experience ......... 108
ATTACHMENT B: ADDENDUM 5 - Management - Organization and Staffing ............................... 109
ATTACHMENT B: ADDENDUM 6 - Management - Ownership & Finance Disclosure Info ........... 110
ATTACHMENT B: ADDENDUM 7 - Cost Proposal Worksheet ........................................................... 111
ATTACHMENT C - Disclosure of Subcontractor Information .............................................................. 114
ATTACHMENT D - Drug-Free Workplace Requirements ..................................................................... 116
ATTACHMENT E - Debarment, Suspension and Other Responsibility Matters ................................. 119
ATTACHMENT F - Proprietary Information Form ............................................................................... 120
ATTACHMENT G - References ................................................................................................................ 121
ATTACHMENT H - Acknowledgement of Amendments ....................................................................... 122
ATTACHMENT I - Business Associate Agreement ................................................................................. 123
ATTACHMENT J - Proposal Response Checklist .................................................................................... 124
ATTACHMENT L - SharePoint Access Request ..................................................................................... 126
APPENDIX 1 - Reference Survey Score Sheet (Sample Copy Only) ...................................................... 127
APPENDIX 2 - Acronyms Used in the Protocols ...................................................................................... 129
APPENDIX 3 - MCO Additional Required Reporting ............................................................................ 131
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1.0 PROCUREMENT OVERVIEW
1.1 Purpose
The Mississippi Division of Medicaid (DOM) is seeking to contract with a qualified and responsible
Offeror to conduct External Quality Review (EQR) activities in compliance with applicable federal
regulations. These activities are intended to support the Mississippi Coordinated Access Network
(MississippiCAN) and the Mississippi Children's Health Insurance Program (CHIP). The selected
External Quality Review Organization (EQRO) will be responsible for analyzing and evaluating
aggregated data concerning the quality, timeliness, and accessibility of services covered under
Medicaid and CHIP, as delivered by Managed Care Organizations (MCOs).
Pursuant to 42 CFR 438.350, as amended, each state's Medicaid managed care program must undergo
an annual external quality evaluation by an EQRO to identify performance improvement opportunities
and assess progress over time. This review must be conducted by an independent entity that meets the
qualifications set forth under 42 CFR Part 438, Subpart E, and must utilize information obtained
through EQR activities consistent with federally approved protocols.
The Centers for Medicare and Medicaid Services (CMS) have established detailed protocols to guide
EQROs in the execution of both mandatory and optional review activities. Mandatory EQR activities
are federally required evaluations that state Medicaid agencies must conduct annually on their
contracted Managed Care Organizations (MCOs), while Optional EQR activities are additional
oversight evaluations that state Medicaid agencies can choose to have an External Quality Review
Organization (EQRO) conduct. Offerors must demonstrate a thorough understanding of these federal
regulations and protocols, including the most recent CMS guidance titled Monitoring Medicaid
Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plans (PIHPs): A Protocol for
Determining Compliance with Medicaid Managed Care Proposed Regulations at 42 CFR Part 400,
430, et al., as amended.
Any contract awarded pursuant to this Request for Proposal (RFP) will be contingent upon approval by
the Public Procurement Review Board (PPRB). In the event that PPRB approval is not obtained, the
contract shall be deemed null and void, and no compensation will be paid.
1.2 Authority
1.2.1 Legal and Regulatory Mandate
This Request for Proposal (RFP) is issued under the authority of Title XIX and Title
XXI of the Social Security Act, as amended, and its implementing federal regulations.
As the single state agency designated to administer Medicaid and CHIP programs, the
Mississippi Division of Medicaid (DOM) is authorized under the Mississippi Code of
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1972, as amended, to procure services necessary to ensure compliance with federal
managed care oversight and quality assurance requirements.
In accordance with Section 1902(a)(30)(A) of the Social Security Act, DOM maintains
procedures to safeguard against unnecessary utilization of care and to ensure efficiency,
economy, and quality of care across its programs.
1.2.2 External Quality Review (EQR) Requirements
Pursuant to 42 CFR 438.350 and Section 1932(c)(2) of the Social Security Act,
DOM is required to contract with an independent External Quality Review
Organization (EQRO) to perform annual external quality reviews of managed care
organizations (MCOs). These reviews assess the quality, timeliness, and accessibility
of services to support the State in monitoring and improving managed care program
performance.
The EQR program shall be managed in full compliance with state and federal
standards, including:
42 CFR Part 438, Subpart E: Governing EQR requirements for Medicaid managed
care.
42 CFR 438.350, 438.354, 438.358, 438.360, and 438.364: Establishing
standards for independence and mandatory/optional EQR activities.
42 CFR 457.1250: Incorporating EQR requirements for the Children's Health
Insurance Program (CHIP).
Mississippi Administrative Code: Title 23, Part 100.
1.2.3 Programs Subject to Oversight
DOM operates the following managed care programs subject to EQR oversight:
MississippiCAN: A coordinated care program for eligible Medicaid beneficiaries,
currently served by three (3) Managed Care Organizations (MCOs).
CHIP: The State's Children's Health Insurance Program, administered by DOM
and currently served by the same three (3) MCOs listed above.
1.2.4 Contractor Compliance and Standards
DOM is conducting this procurement to secure an EQRO that meets all federal
qualifications and independence standards. The selected Contractor shall perform
required and optional EQR activities in accordance with:
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Federal regulations and the most current or superseding guidance issued by the
CMS;
All applicable state laws and regulations and State Plan Amendments (SPAs); and
The specific requirements and standards outlined in this RFP.
Submission of a proposal constitutes the Offeror's acknowledgment of these
authorities. The selected Contractor must comply with all such requirements as a
condition of contract award and performance. DOM reserves the right to interpret and
apply these authorities in the best interest of the State.
1.3 Organizations Eligible to Submit Proposals
1.3.1 Minimum Qualifications
Offerors must certify that they meet the following minimum qualification requirements:
1. Must have a minimum of three (3) years of experience within the last five (5) years
conducting External Quality Review (EQR) activities, or substantially similar quality
oversight activities, for Medicaid and/or CHIP managed care programs. For purposes
of this solicitation, substantially similar quality oversight activities are those
performed under contract with a state Medicaid agency or other governmental entity
and must include quality oversight of risk-based Medicaid and/or CHIP managed
care programs that align with one or more External Quality Review (EQR) activities
described in 42 CFR Part 438, Subpart E, including validation of performance
improvement projects, performance measure validation, compliance reviews, or
quality systems assessments. Such experience must have involved oversight of at
least one (1) Medicaid and/or CHIP managed care organization (MCO) operating
under a risk-based managed care delivery system and serving a comparable
Medicaid and/or CHIP population. (Offeror's submission of References (Section
5.3.5.(2)) shall satisfy this eligibility requirement)
2. Must meet all requirements to serve as an External Quality Review Organization
(EQRO) as defined in 42 CFR Part 438, Subpart E, including independence
standards (at minimum the EQRO cannot be the state agency, a managed care plan,
or a competitor of a plan it is reviewing). (Offeror's response to this statement in the
Transmittal Letter (Section 5.3.1) shall satisfy this eligibility requirement)
3. The Offeror has the capacity to fulfill all required components and deliverables as
outlined in the Scope of Services. (Offeror's response to this statement in the
Transmittal Letter (Section 5.3.1) shall satisfy this eligibility requirement)
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1.4 Request for Reconsideration of the Terms of the Submission
Prospective Offerors are hereby informed that they may request reconsideration of the terms outlined in
this solicitation. The procedures and requirements for submitting such a request are detailed in Section
6.5.4 of the Mississippi Public Procurement Review Board (PPRB) Office of Personal Service Contract
Review (OPSCR) Rules and Regulations.
1.5 Procurement Timetable
The following schedule represents DOM's anticipated timeline for the RFP and procurement process.
Please note that DOM reserves the right to modify the Procurement Timetable at its discretion.
Procurement Timetable
Date Time Process
7/31/2026 Request for Proposal (RFP) Release
8/18/2026 2:00 p.m. CT Deadline for Written Questions
9/3/2026 5:00 p.m. CT Anticipated Date of Response to Questions Posted
9/9/2026 2:00 p.m. CT SharePoint Access Request Deadline
9/18/2026 2:00 p.m. CT Proposal Submission Deadline
10/22/2026 Anticipated Date of Notice of Intent to Award
12/2/2026 Public Procurement Review Board Meeting
(Proposed)
12/3/2026 Operational Period
1.6 Pre-Submission Requirements
1.6.1 RFP Questions and Answers
Potential offerors may submit multiple questions related to this RFP no later than
Tuesday, August 18, 2026, by 2:00 p.m. CT, using the designated Question-and-
Answer template available at: https://medicaid.ms.gov/resources/procurement
All questions must be submitted using the required template and emailed to:
procurement@medicaid.ms.gov.
Subject Line: EQRO - Questions
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The Offeror bears all risks and responsibility for ensuring timely delivery. Questions
received after the deadline and Questions submitted by Offerors who do not submit a
timely Mandatory Letter of Intent will not be addressed by the DOM.
DOM anticipates that the written answers will be available on or about Thursday,
September 3, 2026, by 5:00 p.m. CT, via DOM's procurement website:
https://medicaid.ms.gov/resources/procurement/
and the Mississippi Contract/Procurement Opportunity Search portal website:
https://www.ms.gov/dfa/contract_bid_search/Bid?autoloadGrid=False
The Division of Medicaid (DOM) will compile a register of all questions received,
presented exactly as submitted, along with the corresponding responses. This register will
be issued as an official Amendment to the Request for Proposal (RFP). DOM's responses
will be considered formal amendments to the RFP and will require acknowledgment by
all Offerors.
All written responses provided by DOM are binding. The complete set of questions and
answers will be included as an attachment to the final executed contract.
1.6.2 Receipt of Acknowledgement of Amendments
Offerors shall acknowledge receipt of any amendment to the RFP, in writing, by signing
and returning as part of the proposal submission following the format as described in the
Proposal Submission Format (Section 5.1). This includes receipt of the Question-and-
Answer Document. Each Offeror shall submit a written acknowledgement of every
amendment to DOM with the proposal submission.
1.6.3 Proposal Submission Method and Access Requirements
Proposals for this solicitation must be submitted electronically via DOM's secure
SharePoint platform. No physical, emailed, or faxed proposals will be accepted.
To gain access to DOM's SharePoint site for proposal submission, the Offeror must
complete the SharePoint Access Request Form (Attachment L) and submit it via email
to procurement@medicaid.ms.gov, with the subject line:
EQRO 2026 - SharePoint Access Request
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Within the request form, the Offeror may provide email addresses for up to two (2)
designated individuals responsible for uploading the proposal. Please ensure that email
addresses are clearly typed or printed to ensure legibility. Shared email addresses are
not permitted; they must be individual email accounts.
The SharePoint Access Request form must be received no later than Wednesday,
September 9, 2026, by 2:00 p.m. CT, and must be signed by an individual authorized to
commit the Offeror to the proposed work. Submitting a SharePoint Access Request form
does not obligate an Offeror to submit a proposal. However, proposals will not be accepted
from vendors who fail to submit their designated upload contacts by the SharePoint Access
Request deadline.
Offerors are solely responsible for ensuring timely delivery of the Access Request Form
and assume all associated risks of delivery. To ensure timely technical support before
proposal upload, any assistance with SharePoint access or submission must be requested
no later than two (2) business days before the proposal's due date.
1.7 Expenses Incurred in the Procurement Process
All parties participating in the procurement process with regard to this solicitation shall bear their own
costs of participation, pursuant to Section 1.4.4 of the Mississippi Public Procurement Review Board
Office of Personal Service Contract Review Rules and Regulations.
1.8 Type of Contract
The resulting contract will be a firm, fixed-rate agreement. Compensation will be based on a set rate that
will not be adjusted, regardless of changes in the Contractor's costs to perform the specified services.
1.9 Written Proposals
All proposals shall be submitted in writing.
1.10 Accuracy of Statistical Data
When applicable, any statistical data provided by the Division of Medicaid (DOM) in relation to this RFP
represents the most accurate and current data available from DOM records at the time of publication.
Although DOM endeavors to ensure the accuracy of this information, it does not assume responsibility
for any potential discrepancies. Should any inaccuracies be discovered following the release of this RFP,
such findings shall not constitute a basis for renegotiation of any payment rate after contract award.
Additional statistical details concerning DOM operations are available on the DOM website.
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