Attachment 7 - Work Order Amendment Form.docx
DOCX document 23 KB Posted
- Attached to
- Actuarial Analysis & Consulting
- Solicitation number
- 26-478HFS-MEDPR-B-52728
- Issued by
- Illinois
About this file
This is a Work Order Amendment Form issued by the Illinois Department of Healthcare and Family Services for actuarial analysis and consulting services under BidBuy #26-478HFS-MEDPR-B-52728 and Agency Reference Number 2026-36-001. The form serves as a template for amending existing work orders related to the provision of actuarial services to support the review, advisement, policy development, and establishment of actuarially sound rates for Managed Care Organizations participating in Illinois Medicaid or related medical programs. The amendment form allows for modifications to completion dates, compensation methods, project costs, staffing assignments, and the scope of supplies or services to be provided. Changes may be documented as extensions or shortenings of timelines, adjustments to hourly rates or fixed fees, increases or decreases in overall project costs, and revisions to work order requirements and deliverables.
The amendment requires justification for any proposed changes, with options to indicate whether circumstances necessitating the change were unforeseeable at contract execution or whether the change remains germane to the original work order. The form includes provisions for documenting project staffing assignments with designated roles, hourly rates, estimated hours, and total estimated costs, with a specific line item for a "Not to Exceed" budget amount. All amendments are subject to the Illinois Procurement Code (30 ILCS 500) and associated administrative rules governing change orders and amendments, with conflicting terms in the amendment superseding the original work order provisions. The form requires signature authorization from both the vendor and the Illinois Department of Healthcare and Family Services to become effective.
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| Attachment 4 - HIPAA Business Associate Agreement.docx | DOCX document | |
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| 2026-36-001 Actuarial Analysis and Consulting Services RFP REVISED.docx | DOCX document | |
| Attachment 3 - State Supplemental Terms and Conditions.docx | DOCX document | |
| Attachment 2 - Agency Definitions and Acronyms.docx | DOCX document | |
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| IPG Active Registered Disclosure Form - formerly Forms B~1.docx | DOCX document | |
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| 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 |
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Text version
ATTACHMENT 7 Agency Contract Number Work Order Number Actuarial Analysis and Consulting Services Attachment 7 Work Order Amendment Form
ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
BidBuy #26-478HFS-MEDPR-B-52728:|Agency Reference Number: 2026-36-001
WORK ORDER # AMENDMENT
The Illinois Department of Healthcare and Family Services (“Agency”) and ENTER VENDOR NAME. have entered into a Contract for Services (ENTER CONTRACT NUMBER). The contract provides for the use of individual Work Orders to effectuate the provisions of that contract. The following shall amend the Work Order referenced herein. All terms and conditions set forth in the original work order, not amended herein, shall remain in full force and effect as written. In the event of conflict, the terms of this AMENDMENT shall prevail. All terms and conditions of the original Work Order and this amendment are specified within the contract. This Work Order shall be conducted in accordance with all procedures and requirements established under the Illinois Procurement Code (30 ILCS 500) and associated administrative rules governing change orders and amendments.
DESCRIPTION OF AMENDMENT (Check all that apply, complete blanks and explain as necessary):
|_| a. the completion date will be |_| extended, |_| shortened or |_| remain the same.
| Original completion date: |
| Revised completion date: |
|_| b. the method of determining compensation (e.g., hourly rate, fixed fee, etc.) will |_| stay the same or |_| change as follows:
|_| c. the cost will be |_| increased, |_| decreased or |_| remain the same.
| Original cost: |
| Amount of change: |
| Revised cost: |
Project Staffing:
| Staff Member |
| Title |
| Role |
Estimated Project Budget – Not to Exceed $NNNN:
| Project Role |
| Hourly Rate |
| Estimated Hours |
| Total Estimated Cost |
Total Estimated Cost
|_| d. the supplies or services to be provided will |_| stay the same or |_| be changed as follows:
Work Order requirements and compensation for the amended services shall be in accordance with the attached exhibits, listed below:
WHY IS CHANGE NEEDED? (Check all that apply and explain.)
| |_| a. | The circumstances said to necessitate the change in performance were not reasonably foreseeable at the time the contract was signed. |
| |_| b. | The change is germane to the original job order as signed. |
IN WITNESS WHEREOF, the parties hereto have caused this amendment to be executed by their duly authorized representatives.
ENTER VENDOR NAME.
Illinois Healthcare and Family Services
Signature:
Signature:
Printed Name:
Printed Name:
Title:
Title:
Date:
Date:
File details come from the government source that posted it. Updated .