Emergency Purchase Statement 5.1.26 R v.25.2~1.pdf

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EMERGENCY PURCHASE STATEMENT

State of Illinois Chief Procurement Office for General Services Emergency Purchase Statement V.25.2 Page of

EMERGENCY PURCHASE STATEMENT

Page of State of Illinois Chief Procurement Office for General Services Emergency Purchase Statement V.25.2 Emergency Purchase Details Emergency Category (select the appropriate option from the drop-down menu below):

Reason for selection of this particular vendor:

Description of supplies or services to be provided:

Emergency procurements shall be made with as much competition as is practicable under the circumstances, and agencies shall utilize best efforts to include contractors certified under the Business Enterprise Program in its emergency procurement process. 30 ILCS 500/20-30(a).

List the actions taken by the agency that constitute its best efforts to include contractors certified under the Business Enterprise Program in this emergency purchase:

Is there an existing State contract available for the required supplies or services?

If Yes is checked above, explain why the existing contract does not meet the need:

Actual or Estimated*:

*Estimated end date and cost will be reported later.

Select the type of funding to be used:

Signature This emergency purchase was made with as much competition as is practicable under the circumstances. Best efforts were utilized to include contractors certified under the Business Enterprise Program in the process.

I am authorized to make this emergency purchase, and I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

11.0.0.20130303.1.892433.887364

The incumbent vendor will maintain the original pricing established under the competitively procured RFP for the duration of the emergency term, ensuring both cost stability and supplier diversity commitments remain intact while the State conducts a competitive procurement. The emergency contract will be issued to the legal entity name: Keystone Peer Review Organization, LLC dba Acentra Holdings, LLC.

ExplanationSuppliesServices: The Quality Improvement Organization (QIO) vendor must provide utilization management and quality assurance services for Medicaid members across multiple levels of care. This includes medical necessity determinations and continued stay reviews for inpatient hospital care, as well as review and oversight for hospital outpatient services, psychiatric residential treatment facilities, long-term acute care hospitals (LTAC), integrated health homes (IHHs), and other community-based treatment settings. The vendor will also conduct pre-payment and post-payment utilization reviews, appeals and reconsideration reviews, and investigations into potential quality of care concerns. The vendor will operate and support the web-based referral and authorization platform, provide provider outreach, training, and technical assistance, complete standard and ad hoc reporting, and perform special projects as directed by the Department. These activities collectively support the State’s surveillance and utilization control program in accordance with 42 CFR Part 476. Additionally, HFS requires this Vendor to transition all files/data related to this contract to the Vendor awarded under the competitive procurement.

TextField1: This emergency procurement is a bridge to prevent disruption in critical utilization review services while the State completes a full competitive procurement. Under the previous competitively procured contract, the vendor was required to maintain a 5% BEP participation goal. While the vendor did not meet the 5% participation level during the contracted term, the State conducted a Good Faith Effort review during the renewal evaluation period in accordance with 30 ILCS 500/20-60(f). The vendor provided documentation of outreach and engagement efforts; however, the amount of work that could be subcontracted was materially lower than originally projected and required. A new BEP goal was calculated for the renewal period, resulting in an 8% participation goal.

The emergency term is limited to continuation of existing work in order to avoid service disruptions. Because the vendor was unable to meet the initial contract goal of 5%, the goal for the previous two emergencies was not increased to the new calculated percentage, it remained at 5% (P-89214 & P-92134) and was agreed upon by all parties. The Agency requested continuation of the 5% goal through the 3rd emergency period, however, the Vendor has requested removal of the BEP goal due to the short contract term, internal staffing and sub-contractor availability. Accordingly, the Agency made its best efforts to obtain a goal for this emergency but was unable to obtain agreement from the Vendor.