Attachment 2 - Agency Definitions and Acronyms.docx
DOCX document 24 KB Posted
- Attached to
- Actuarial Analysis & Consulting
- Solicitation number
- 26-478HFS-MEDPR-B-52728
- Issued by
- Illinois
About this file
This file is an attachment to a Request for Proposals issued by the Illinois Department of Healthcare and Family Services (HFS) for actuarial analysis and consulting services, identified as BidBuy #26-478HFS-MEDPR-B-52728 and Agency Reference Number 2026-36-001. The attachment provides comprehensive definitions of agency-specific terms and acronyms used throughout the solicitation documents. Key terms defined include foundational concepts such as Acceptance, Affiliates, and Agency; healthcare-specific terminology including Affordable Care Act Adult, Managed Care Organization (MCO), Medicaid, and Health Maintenance Organization (HMO); and program-specific definitions such as Care Coordination Entity (CCE), Integrated Care Program (ICP), and Shared Savings. The document also defines the Five Regions of the State, which organize Illinois counties into Northwestern (Region 001), Central (Region 002), Southern (Region 003), Cook County (Region 004), and Collar Counties (Region 005) for administrative purposes.
The file establishes standardized terminology and references for regulatory compliance, including definitions related to the Affordable Care Act, Centers for Medicare & Medicaid Services (Federal CMS), Health Insurance Portability and Accountability Act (HIPAA), and fee-for-service arrangements. Additionally, the document provides 22 acronyms commonly used throughout the solicitation, such as ACA, CCE, EHR, FOIA, HCBS, HFS, HMO, ILCS, MCO, and PMPM. This attachment serves as a reference guide to ensure consistent interpretation and understanding of terminology across all procurement documents, schedules, appendices, exhibits, and attachments associated with the actuarial services contract opportunity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| BEP Utilization Plan v.26.1~7.pdf | ||
| Commitment to Diversity - Vendor Guidance.pdf | ||
| Attachment 5 - State Security Requirements.docx | DOCX document | |
| Attachment 4 - HIPAA Business Associate Agreement.docx | DOCX document | |
| Commitment to Diversity - Vendor Answer Sheet.pdf | ||
| 2026-36-001 Actuarial Analysis and Consulting Services RFP REVISED.docx | DOCX document | |
| Attachment 3 - State Supplemental Terms and Conditions.docx | DOCX document | |
| Attachment 7 - Work Order Amendment Form.docx | DOCX document | |
| Vendor Disclosure form - formerly Forms A~1.docx | DOCX document | |
| Offer~6.pdf | ||
| IPG Active Registered Disclosure Form - formerly Forms B~1.docx | DOCX document | |
| BEP Waiver Request and Review form.pdf | ||
| Attachment 6 - Work Order.docx | DOCX document | |
| Attachment 1 - Required Deliverables and Reporting.docx | DOCX document | |
| 2026-36-001 Actuarial Analysis and Consulting Services Questions and Answers.docx | DOCX document |
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Actuarial Analysis and Consulting Services Attachment 2 Agency Definitions and Acronyms Department of Healthcare and Family Services BidBuy #26-478HFS-MEDPR-B-52728: |Agency Reference Number: 2026-36-001
G.1. Agency Definitions. Whenever used in this Solicitation including schedules, appendices, exhibits, and attachments to this Solicitation, the following terms will have the meanings defined below. Any objections or questions regarding the definitions shall be raised with the Department during the Solicitation process.
| G.1.1. | Acceptance: The point in time when the State indicates acceptance in writing. |
| G.1.2. | Affiliates: Any person, firm, corporation (including, without limitation, service corporation and professional corporation), partnership (including, without limitation, general partnership, limited partnership, and limited liability partnership), limited liability company, joint venture, business trust, association, or other entity that now or in the future directly or indirectly controls, is controlled by, or is under common control with Vendor. |
| G.1.3. | Affordable Care Act Adult: Any adult without dependent children who is not eligible for Medicaid. Under the Affordable Care Act (ACA), the “new Medicaid” clients will be adults 21- 64 years of age, who will qualify on the basis of income – 133% of federal poverty level. (Please note: the federally required income level is actually 138% of federal poverty level, as there is a 5% universal income disregard, and this higher number will have to be included in any Illinois statute or rule.) Additional information may be view at http://www2.illinois.gov/hfs/PublicInvolvement/AffordableCareAct/Pages/default.aspx |
| G.1.4. | Agency: The Department of Healthcare and Family Services or any successor agency, board, department or commission of State Government responsible for entering into the Contract, monitoring performance, receiving the benefits derived from the Contract, and making payments under the Contract. |
| G.1.5. | Benefit Plan Design: The level and scope of benefits offered through various plans administered by the State. |
| G.1.6. | Care Coordination Entity (CCE): A collaboration of providers and community agencies, governed by a lead entity that receives a care coordination payment in order to provide care coordination services for its Enrollees. |
| G.1.7. | Centers for Medicare & Medicaid Services (Federal CMS): The agency within DHHS that is responsible for the administration of the Medicare program and, in partnership with the states, administers Medicaid, the State Children’s Health Insurance Program (CHIP), and the Health Insurance Portability and Accountability Act (HIPAA). |
| G.1.8. | CMS: The State of Illinois Department of Central Management Services and any successor organizations. |
| G.1.9. | Code: The Illinois Procurement Code, 30 ILCS 500/1-5 et seq. Unofficial versions of the Code and Standard Procurement Rules 44 III. Adm. Code 1), which are applicable to this procurement, may be viewed at http://www.purchase.state.il.us/. |
| G.1.10. | Confidential Information: any material, data, or information disclosed by either Party to the other that, pursuant to agreement of the Parties or the State’s grant of a proper request for confidentiality, is not generally known by or disclosed to the public or to Third Parties including, without limitation: (a) all materials, know-how, processes, trade secrets, manuals, confidential reports, services rendered by State, financial, technical and operational information, and other matters relating to the operation of a Party’s business; (b) all information and materials relating to Third Party vendors of State that have provided any part of State’s information or communications infrastructure to State; (c) software; and (d) any other information that the Parties agree should be kept confidential. See also section E.2. of this RFP, “Public Records and Requests for Confidential Treatment.” |
| G.1.11. | Dual Eligible: A Client who receives services through both the Medicare and the Medicaid Programs. |
| G.1.12. | Encounter Data: Records of health care services for which MCOs pay and the amounts MCOs pay to providers of those services. Encounter data is conceptually equivalent to the paid claims records that state Medicaid agencies create when they pay providers on an FFS basis. |
| G.1.13. | Execution: The point at which all the parties have signed the Contract between the Contractor and the State. |
| G.1.14. | Federally Qualified Health Center (FQHC): A health center that meets the requirements of 89 IL Admin Code 140.461(d). |
| G.1.15. | Fee-For-Service: The method of billing under which a Provider charges for each encounter or service rendered. |
| G.1.16. | Filing: Where applicable, an instrument or document submitted to a regulatory body for review and approval to allow Vendor(s) to make the Services contained therein available for consumption. |
| G.1.17. | Health Insurance Portability and Accountability Act (HIPAA): The Federal Health Insurance Portability and Accountability Act, Public Law 104-191, and all regulations promulgated pursuant to authority granted therein as set forth in 45 C.F.R. parts 160-164, and as hereinafter amended. HIPAA was enacted by the U.S. Congress in 1996 (42 U.S.C. §§ 300gg et seq., P.L. 104-191). Title II, Subtitle F, of HIPAA, known as the Administrative Simplification provisions, requires the establishment of national standards for electronic health care transactions and national identifiers for Providers, health insurance plans, and employers. The Administrative Simplification provisions also address the security and privacy of health data. These provisions are promulgated in the Code of Federal Regulations (CFR) at Sections 45 CFR Part 160, 45 CFR Part 162, and 45 CFR Part 164 as amended, including HIPAA Omnibus regulations. Omnibus regulations include modifications to the HIPPA Privacy, Security, Enforcement and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act. |
| G.1.18. | Health Maintenance Organization (HMO): A health maintenance organization as defined in the Health Maintenance Organization Act (215 ILCS 125/1-1 et seq.). |
| G.1.19. | Healthcare and Family Services or HFS: The Illinois Department of Healthcare and Family Services or any successor agency, board, department, or commission of State Government responsible for entering into the Contract, monitoring performance, receiving the benefits derived from the Contract, and making payments under the Contract. |
| G.1.20 | Illinois Compiled Statutes (ILCS). An unofficial version of the ILCS can be viewed at http://www.ilga.gov/legislation/ilcs/ilcs.asp. |
| G.1.21. | Integrated Care Program (ICP): The program under which the Department contracted with HMOs to provide the full spectrum of Medicaid Covered Services through a risk-based integrated care delivery system to Seniors and Adults with Disabilities who are eligible for Medicaid but are not eligible for Medicare. |
| G.1.23. | Managed Care Organization (MCO): An HMO or MCCN as defined herein that is under contract with the Department. |
| G.1.24. | Medicaid: The program under Title XIX of the Social Security Act that provide medical benefits to groups of low-income people. |
| G.1.25. | National Committee for Quality Assurance (NCQA): A private 501(c) (3) not-for-profit organization dedicated to improving health care quality and has a process for providing accreditation, certification, and recognition, e.g., health plan accreditation. |
| G.1.26. | Offer: the Offer consists of the Technical Proposal, Price Proposal, and all required forms and certifications—completed, signed, and returned by Vendor. |
| G.1.27. | Offer Firm Time: offers shall remain firm and unaltered after opening for the number of days identified in this RFP. An Offer may be accepted, subject to successful contract negotiations, at any time during the Offer Firm Time. |
| G.1.28. | Offeror: The person submitting an Offer or Proposal. |
| G.1.29. | Order: any written request from CMS or an Agency for services or products or equipment pursuant to the Contract. Parties: the State of Illinois and Vendor. |
| G.1.30. | Parties: the State of Illinois and Vendor. |
| G.1.31. | Performance Guarantee: Vendor’s commitment to place some or all its entire fee at risk contingent upon the Department’s satisfaction with the work to be performed. |
| G.1.32. | Person: Any individual, corporation, proprietorship, firm, partnership, trust, association, governmental authority, vendor, or other legal entity whatsoever, whether acting in an individual, fiduciary, or other capacity. |
| G.1.33. | Physician: A Person licensed to practice medicine in all its branches under the Medical Practice Act of 1987. |
| G.1.34. | Plan: a specifically designed program of health benefits. |
| G.1.35. | Primary Care Provider (PCP): A Provider, including a WHCP, who within the Provider's scope of practice and in accordance with State certification requirements or State licensure requirements, is responsible for providing all preventive and primary care services to his or her assigned Enrollees in the CCE or MCCN. |
| G.1.36. | Proposal: A Bidder’s response to the Solicitation, consisting of the technical Proposal and all required forms and certifications. All required forms and certifications must be completed, signed, and returned by the Bidder. |
| G.1.37. | Provider: A Person enrolled with the Department to provide Covered Services to a Client. |
| G.1.38. | RFP: the Request for Proposals including addendums. |
| G.1.39. | Responses: when used in association with the term “RFP”, Responses refer to Vendor’s (s’) replies, clarifications, revisions, and additions to the Department’s Request for Proposals. |
| G.1.40. | Shared Savings: Shared savings is a model in which entities who manage and coordinate care which is paid for in a fee-for-service system are rewarded with payments representing some portion of the costs saved as a result of their management and coordination of the services. It requires comparing the actual cost of care for a cohort of beneficiaries they are responsible for managing with the projected cost of care for that cohort in the absence of their coordination services by using historical baseline costs trended forward or a control group. |
| G.1.41. | State: the State of Illinois, as represented through any agency, department, board, or commission. |
| G.1.42. | Solicitation: This document plus any additional documents and clarifying questions and answers the State may publish. |
| G.1.43. | Vendor: The entity awarded a contract. |
| G.1.44. | Five Regions of the State: |
G.1.44.1. Northwestern Illinois - 001 Region: Boone, Bureau, Carroll, DeKalb, Fulton, Henderson, Henry, Jo Daviess, Knox, La Salle, Lee, Marshall, Mercer, Ogle, Peoria, Putnam, Rock Island, Stark, Stephenson, Tazewell, Warren, Whiteside, Winnebago, and Woodford.
| G.1.44.2. | Central Illinois – 002 Region: Adams, Brown, Calhoun, Cass, Champaign, Christian, Clark, Coles, Cumberland, De Witt, Douglas, Edgar, Ford, Greene, Hancock, Iroquois, Jersey, Livingston, Logan, Macon, Macoupin, Mason, McDonough, McLean, Menard, Montgomery, Morgan, Moultrie, Piatt, Pike, Sangamon, Schuyler, Scott, Shelby, and Vermilion. |
| G.1.44.3. | Southern Illinois - 003 Region: Alexander, Bond, Clay, Clinton, Crawford, Edwards, Effingham, Fayette, Franklin, Gallatin, Hamilton, Hardin, Jackson, Jasper, Jefferson, Johnson, Lawrence, Madison, Marion, Massac, Monroe, Perry, Pope, Pulaski, Randolph, Richland, Saline, St. Clair, Union, Wabash, Washington, Wayne, White, and Williamson. |
| G.1.44.4. | Cook County - 004 Region: Cook. |
| G.1.44.5. | Collar Counties - 005 Region: DuPage, Grundy, Kane, Kankakee, Kendall, Lake, McHenry, and Will. |
G.2. ACRONYMS. Whenever used in this Solicitation including schedules, appendices, exhibits, and attachments to this Solicitation, the following acronyms will have the meanings identified below.
| G.2.1. | ACA: Affordable Care Act |
| G.2.2. | CCE: Care Coordination Entity |
| G.2.3. | CFR: Code of Federal Regulation |
| G.2.4. | DHHS: The United States Department of Health and Human Services |
| G.2.5. | EHR: Electronic Health Record |
| G.2.6. | Federal CMS: Centers for Medicare & Medicaid Services |
| G.2.7. | FFS: Fee-for-Service |
| G.2.8. | FOIA: Freedom of Information Act |
| G.2.9. | FQHC: Federally Qualified Health Center |
| G.2.10. | HCBS: Waivers: Home and Community-Based Services Waivers |
| G.2.11. | HFS: The Illinois Department of Healthcare and Family Services |
| G.2.12. | HIPAA: Health Insurance Portability and Accountability Act |
| G.2.13. | HMO: Health Maintenance Organization |
| G.2.14. | ICEB: Illinois Client Enrollment Broker |
| G.2.15. | ILCS: Illinois Compiled Statutes |
| G.2.16. | LOI: Letter of Intent |
| G.2.17. | LTC: Long-term Care |
| G.2.19. | MCO: Managed Care Organization |
| G.2.20. | NCQA: National Committee for Quality Assurance |
| G.2.21. | PCP: Primary Care Provider |
| G.2.22. | PMPM: Per Member Per Month |
File details come from the government source that posted it. Updated .