External Quality Review Organization ( EQRO )

2026-11-03

The Contractor must provide External Quality Reviews ( EQRs ) of healthcare services provided to NH Medicaid beneficiaries by Department contracted Medicaid managed care entities ( MCEs ) including three Medical Care Organizations ( MCO ) and one Dental Organization ( DO ), and any MCEs that may be added during the course of the resulting contract . 1 . 2 . The Contractor must ensure services are available statewide . 1 . 3 . For the purposes of this Agreement , all references to business hours mean Monday through Friday from 8 : 00 am to 5 : 00 pm , EST . 1 . 4 . The Contractor must host a Secure FTP site for the Contractor , MCOs , DO , and DHHS to post / download documents , in accordance Exhibit E , DHHS Information Security Requirements and completed Appendix H , IT Requirements Workbook . 2 . External Quality Review Organization ( EQRO ) for Managed Care Organization ( MCO ) Contracts 2 . 1 . The Contractor must maintain all the qualifications of an External Quality Review Organization ( EQRO ) as outlined in 42 CFR 438 . 354 and complete EQRs in accordance with all applicable laws and regulations and current EQR Protocols . 2 . 2 . Review of MCO Contractual Compliance : 2 . 2 . 1 . The Contractor must conduct annual reviews for all sections of the Department ’ s most current contract with each MCO , pursuant to 42 CFR 438 . 358 ( b )( 1 )( iii ) and the current federal Centers for Medicare & Medicaid Services ( CMS ) EQR Protocol # 3 , to determine the MCO ’ s compliance with federal regulations and the state contract provisions relative to the quality , appropriateness , and the timeliness of , and access to care and services provided by the MCO to New Hampshire Medicaid enrollees ...

New Hampshire

2026-04-28