Health Care Financing Administration 7500 Security Blvd., Baltimore, MD. 21244-1850

R -- DEVELOP A SET OF REVIEW PROTOCOL FOR INDEPENDENT QUALITY REVIEW ORGANIZATIONS TO USE WHEN MONITORING SERVICES PROVIDES TO MEDICAID BENEFICIARIES ENROLLED IN MANAGED CARE ORGANIZATIONS POC Herman L. Harris, Contract Specialist, (410)786-9104 The Health Care Financing Administration (HCFA) is seeking to identify potential qualified contract sources to develop a set of national quality review protocols for independent quality review organizations to use when monitoring services provided to Medicaid beneficiaries enrolled in managed care organizations (MCOs). The protocols will be used in Medicaid independent quality review conducted on and after January 1, 1999. Some of the tasks the contractor selected will be expected to perform include: performing a literature search, convening one or two panel meetings of experts in the field, developing the components, scope, and design of the protocols, developing a protocol user manual, printing copies of the manual and disseminating copies to HCFA identified agencies and organizations. The potential contractor must be able to meet the following criteria: be a national independent quality review organization recognized by HCFA and the managed care industry; have specific experience in developing and using national protocols to assess the performance of managed care organizations, preferably Medicaid MCOs; have experience working with State Medicaid programs; and have the ability to complete the statement of work within 5 months of the contract award date. This contract is part of the implementation of Section 4705(a) of the Balanced Budget Act of 1997, whereas, the Secretary of DHHS must contract with an independent quality review organization to develop protocols for assessing care provided to Medicaid beneficiaries by managed care organizations (MCOs). Protocols to be used in external independent reviews are statements of the procedures and standards which the external independent review entity is to use for the review of MCOs. A protocol will define the components and/or scope of an External Quality Review (EQR), include types of information to be gathered, procedures for gathering information, and absolute or relative standards to be employed in assessing the MCO's performance. Independent Quality Review is required for all MCOs (covered under Section 1903 of the Act) that contract with state Medicaid agencies. This synopsis is for information purposes only, does not constitute an RFP, and is not to be construed as a commitment by the Government. The information you provide will be evaluated to identify capable potential sources. Your response should be limited to 20 pages or less and must document your background, experience and capability to perform this effort. Your organization must respond within 10 business days of the publication of this notice. Respondents will be included on any mailing list for any RFP that may result from this notice. The Government will not pay for any information solicited. Organizations must specify a name and telephone number of a point of contact and indicate their size status under Standard Industrial Code 8741, see FAR 19.102. Please state whether your organization is a large business, small business, or an 8(a)firm. Please be advised, that if an RFP is issued the Government reserves the right to award to a small business or an 8(a) set aside organization depending upon the respondents. Interested prospective sources should submit appropriate documentation on their capability and qualifications to perform this effort to HCFA, Attn: Herman L. Harris, Contract Specialist, C2-21-15, 7500 Security Blvd., Baltimore, MD 21244. (0083)

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