Indiana Department of Administration #005030000087847

Indiana Medicaid Seeks Contractor for External Quality Review Services

Indiana's Family and Social Services Administration (FSSA) is seeking a qualified contractor to provide comprehensive External Quality Review (EQR) services for its Medicaid managed care programs. - Government Buyer: - Family and Social Services Administration (FSSA), Office of Medicaid Policy and Planning (OMPP) - No specific OEMs or commercial vendors are named in the solicitation - Services Requested: - External Quality Review (EQR) activities for Medicaid Managed Care Programs (Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, Indiana PathWays) - Performance measure validation - Performance improvement project (PIP) validation - Compliance reviews - Network adequacy validation - Encounter data validation - Focused quality studies - Technical assistance to FSSA and Managed Care Organizations (MCOs) - Information Systems Capability Assessments (ISCA) - Workshops and training classes - Case management performance evaluation - MCO readiness reviews - MCO corrective action plans (CAPs) - Ad-hoc EQR-related projects - Annual technical reports and deliverables (MCO report cards, findings, data workbooks) - Notable Requirements: - Contractor must meet all CMS protocols for EQR activities - Data security and confidentiality are mandatory - Staffing must include experienced personnel (e.g., Project Director, Medical Records Review Staff Coordinator, Registered Nurse for medical records review) - All costs (salaries, benefits, software, travel, overhead, supplies) must be included in the proposal; no additional billable costs allowed - Deliverables include annual and ad-hoc reports, technical assistance, and educational sessions - Contract term is four years with two optional one-year extensions

Description

This solicitation seeks contractors to provide External Quality Reviews (EQR) which analyze and evaluate aggregated information on quality, timeliness, and access to healthcare services provided under the Managed Care Entity (MCE) programs. The work involves assessing healthcare outcomes and drug trends as part of clinical project management. The procurement is managed by the Indiana Department of Administration and is intended to support the Office of Medicaid Policy and Planning (OMPP).

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