Illinois BidBuy #27-478HFS-FINAN-B-54675

Illinois Medicaid Quality Improvement and Utilization Management Services Extension

Illinois HFS approved an emergency extension to keep statewide Medicaid quality-improvement and utilization-management services in place. - Government buyer: Illinois Department of Healthcare and Family Services (HFS), Medical Programs Department, Bureau of Quality Management. - Vendor: Keystone Peer Review Organization, LLC, doing business as Acentra Health. No product manufacturer or OEM is identified; this is a services award. - Services: Medicaid medical-necessity and continued-stay reviews; utilization oversight across inpatient and outpatient hospitals, psychiatric residential treatment, long-term acute care, integrated health homes, and community-based settings; pre-payment and post-payment reviews; appeals and reconsiderations; quality-of-care investigations; authorization-platform operation and support; provider outreach, training, and technical assistance; reporting; and directed special projects. - Notable requirement: Support the state’s Medicaid surveillance and utilization-control program in accordance with 42 CFR Part 476. - Extension quantity: One service line item. No product part numbers or quantities are specified. - Estimated extension value: $750,000. The extension maintains continuity while HFS prepares a replacement procurement.

Description

This notice republishes an emergency contract extension for Quality Improvement and Utilization Management; it explicitly states that it is not a solicitation. The extension is intended to continue quality assurance and utilization review services, including in the fee-for-service hospital inpatient setting and other settings and levels of care. The attached approval describes Medicaid utilization management and quality assurance work across multiple care settings, including medical necessity and continued-stay reviews, appeals, provider support, reporting, and quality-of-care investigations. The listed extension term is October 25, 2026, through March 31, 2027, while HFS develops a competitive replacement procurement.

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