View Bid
Solicitation Reference #:
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S-1007 DMS-23
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Title:
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External Quality Review (EQR) and/or Quality Improvement (QI) services for Medicaid Program
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Available Date:
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11/10/2022
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Due Date:
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12/20/2022 2:00:00 PM
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Bid Synopsis:
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The Wisconsin Department of Health Services (DHS) is seeking proposals from qualified Vendors to provide External Quality Review (EQR) and/or Quality Improvement (QI) services for the following three focus areas:
FOCUS AREA ONE: Seeks proposals from qualified organizations to conduct Federally and State-mandated external quality review (EQR) and EQR-related services for the Family Care, Family Care Partnership, HMO managed care services (which include provision of BadgerCare Plus and SSI managed care), children’s prepaid inpatient health plans (PIHPs), and any additional EQR-related services requested by DHS.
EQR is required by sections 1932(c)(2) and 1903(a)(C)(ii) of the Social Security Act. Section 42 CFR 438 Subpart E – External Quality Review states additional requirements and provisions. Mandatory activities that will be performed under this Contract include:
• Validation of performance improvement projects, 42 CFR 438.358(b)(1)(i)
• Validation of performance measures, 42 CFR 438.358(b)(1)(ii)
• Quality-standards compliance review, 42 CFR 438.358(b)(1)(iii)
• Validation of network adequacy, 42 CFR 438.358(b)(1)(iv)
Optional EQRO activities, defined under 42 CFR 438.358(c), and technical assistance related to quality-management activities, defined under 42 CFR 438.358(d), may be contracted for at the discretion of the State.
FOCUS AREA TWO: Seeks proposals from qualified organizations for quality review, case management record review, and quality improvement services, including data analytics and technical support requested by DHS for HMO managed care services and fee-for-service (FFS) Medicaid.
FOCUS AREA THREE: The Wisconsin Department of Health Services’ (DHS) Office of the Inspector General (OIG) is seeking proposals from qualified organizations to provide utilization and health care review services for Fee-for-Service (FFS) Medicaid.
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Agency Contact:
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Scott Noreuil,
Phone: 608-867-4455
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eSupplier:
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https://esupplier.wi.gov
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