T1619 - Medical Consulting: External Quality Review Organization, DMAHS

Background
This Bid Solicitation is issued by the State of New Jersey's Department of the Treasury, Division of Purchase and Property on behalf of the Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS).
The purpose is to engage a Contractor, known as an External Quality Review Organization (EQRO), to conduct quality assurance activities for Managed Care Organizations (MCOs) managing healthcare for NJ FamilyCare/Medicaid beneficiaries.
The contract aims to ensure compliance with federal and state regulations while improving healthcare quality for low- to moderate-income individuals enrolled in these programs.

Work Details
The Contractor will be responsible for designing and conducting mandatory and voluntary quality assurance activities, including:
1. Conducting comprehensive annual assessments of MCO operations, ensuring compliance with contractual, federal, and state requirements.
2. Developing an Annual Work Plan (AWP) that outlines program activities across Core Medicaid, MLTSS, and FIDE SNP.
3. Performing core Medicaid/MLTSS reviews for compliance with managed care regulations.
4. Validating MCO performance measures and conducting focused quality studies.
5. Preparing detailed reports that assess each MCO’s strengths and weaknesses, including recommendations for improvement based on nationally recognized standards of care.
6. Ensuring all reports are compatible with DMAHS systems and include accurate descriptions of care delivered to beneficiaries.

Period of Performance
The contract period is expected to commence upon award and will include multiple deliverables over a specified timeline outlined in the Annual Work Plan, which will be updated monthly as needed.

Place of Performance
The Contractor's office must be centrally located to the DMAHS office in Mercerville, New Jersey, ensuring availability for meetings and consultations.