Request For Proposal # 18-95312
Mental Health External Quality Review Organization
The California Department of Health Care Services (DHCS), Mental Health Services Division (MHSD), is soliciting proposals from firms that are able to successfully perform the services of a federally-required Medicaid External Quality Review Organization (EQRO). The role of the EQRO under this RFP is to conduct, in accordance with Title 42, Code of Federal Regulations (CFR), Subpart E—External Quality Review (i.e. sub-sections 438.310 - 438.370) annual, independent reviews of the quality, timeliness and access to Medi-Cal Specialty Mental Health Services (SMHS) provided to DHCS by contracted Medi-Cal SMHS managed care plans. States’ External Quality Reviews (EQRs) must: (1) assess adherence of Medicaid managed care plans with the requirements of Title 42, CFR, Part 438, Subpart D—Quality Improvement and Performance Measurement (i.e. sub-sections 438.200 – 438.242); and (2) utilize the federal Centers for Medicare and Medicaid Services (CMS) most recent EQRO Protocols, currently dated September 2012. There are 56 Medi-Cal SMHS managed care plans in California which provide Medi-Cal SMHS services in a California county (in two cases, in two contiguous counties). All 56 Medi-Cal SMHS managed care plans are operated by county mental health departments. The 56 Medi-Cal SMHS county-operated managed care plans are referred to through the remainder of this RFP as county Mental Health Plans (county MHPs). The California statutes which enact the Medi-Cal SMHS program and county MHPs are Welfare and Institutions (W&I) Code Sections 14680 – 14685.1, 14700 – 14726, 14021.3, 14021.4, 14021.5, 14053.3, 14108.1, 14110.15, 14132.72, 14132.73 and 14456.5. In addition to the above federal law which requires that EQR be conducted annually for Medicaid Managed Care Plans, W&I Code Section 14702.5 requires that EQR be conducted for the county MHPs.
DHCS intends to make a single contract award to the most responsive and responsible firm earning the highest score. This procurement is open to all eligible firms and/or individuals that meet the qualification requirements, including commercial businesses, nonprofit organizations, State or public universities (including auxiliary organizations) and other entities.
Questions regarding this RFP should be submitted via email to:
You may view and/or download the RFP from the Cal eProcure / Fi$Cal website using the instructions referenced below.
Notice of Intent to Award Released||Notice of Intent to Award Released|
|12/13/2018||Administrative Bulletin||Administrative Bulletin 2, Addendum 2 released.|
|Administrative Bulletin||Administrative Bulletin 1, Addendum 1 released.|
The Office of Medi-Cal Procurement announces the release of Request for Proposal
# 18-95312 for the Mental Health External Quality Review Organization (EQRO) program.
IMPORTANT: This RFP has been officially released to the California State Contracts Register (CSCR) using the Cal eProcure/Fi$Cal website. Please use the instructions provided below to navigate to, and download, the RFP. All subsequent document releases for this RFP will also be made to the Cal eProcure/Fi$Cal website. As noted on the OMCP home page, it is highly recommended that all vendors wishing to contract with the State of California complete registration for the Cal eProcure/Fi$Cal system as it is the official location for RFP/IFB releases. Registration will also allow vendors to receive automatic notifications when contracting opportunities are posted for business categories of their choosing. If selected as a contractor, this system will be used for payments covered by the contract.
RFP View / Download Instructions
Mental Health EQRO Cal eProcure/Fi$Cal Event Code: 18-95312
Step 1: Visit the Cal eProcure website
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