Section 438.356 - [Effective 10/1/2025] State contract options for external quality review(a) The State- (1) Must contract with one EQRO to conduct either EQR alone or EQR and other EQR-related activities.(2) May contract with additional EQROs or other entities to conduct EQR-related activities as set forth in § 438.358 .(b) Each EQRO must meet the competence requirements as specified in § 438.354(b) .(c) Each EQRO is permitted to use subcontractors. The EQRO is accountable for, and must oversee, all subcontractor functions.(d) Each EQRO and its subcontractors performing EQR or EQR-related activities must meet the requirements for independence, as specified in § 438.354(c) .(e) For each contract with an EQRO described in paragraph (a) of this section, the State must follow an open, competitive procurement process that is in accordance with State law and regulations. In addition, the State must comply with 2 CFR parts 200 and 300 as it applies to State procurement of Medicaid services. 81 FR 27852, 5/6/2016; 89 FR 80069 , 10/1/2025