---
kind: "section"
citation: "42 C.F.R. § 438.356"
title: "42"
number: "438.356"
heading: "State contract options for external quality review."
url: "https://uscodex.org/cfr/42/438.356"
---

# §438.356. 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](/cfr/42/438.358.md).
- (b) Each EQRO must meet the competence requirements as specified in [§ 438.354(b)](/cfr/42/438.354.md?p=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)](/cfr/42/438.354.md?p=c).
- (e) For each contract with an EQRO described in [paragraph (a)](#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](/cfr/2/part200.md) and [300](/cfr/2/part300.md) as it applies to State procurement of Medicaid services.

## Notes

### Amendments

[81 FR 27853, May 6, 2016, as amended at 89 FR 80069, Oct. 2, 2024]

### Source

Source: 81 FR 27853, May 6, 2016, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 67 FR 41095, June 14, 2002, unless otherwise noted.

### Amendments

[81 FR 27853, May 6, 2016, as amended at 89 FR 80069, Oct. 2, 2024]