HFS UPP Change Order Request APO SPO UPP.pdf
PDF 545 KB Posted
- Solicitation number
- 25-478HFS-MEDPR-B-47717
- Issued by
- Illinois
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Change Order Request for Participation or Piggyback Contract State of Illinois Chief Procurement Office General Services Change Order Request for Participation or Piggyback Contract v.24.2 Page of Section I - General Information Section II - Change Order Information
1. Provide the original contract description:
2. Provide a detailed description and explanation for the change required:
3. The completion date will be
4. The Cost will be
5. The circumstances said to necessitate this change was not reasonably foreseeable at the time the contract was signed.
The change is germane to the original contract as signed.
APPROVAL SIGNATURES
Agency Purchasing Officer Approval I know and understand the contents of this Change Order Request and attest that all statements are true and correct.
State Purchasing Officer Recommendation Based on my review of the provided information, with the requested change(s) for the following reason(s):
Unified Procurement Program Review and Recommendation Based on my review of the provided information, in the best interests of the State to allow the requested change(s) to the existing contract for the following reason(s):
Chief Procurement Officer Approval Based on my review of the provided information, I determine in the best interests of the State to allow the requested change(s) to the contract for the following reason(s):
6.5.0.20190320.2.935878.932721
| CurrentPage: |
| PageCount: |
| AGENCYDROPDOWN: HFS - Health and Family Services |
| TextField1: Medicaid Enterprise Systems – Provider Services Module |
| TextField2: Medicaid Enterprise Systems – Provider Services Module |
| TextField3: Acentra Health LLC |
| TextField4: 3/30/2025 - 5/31/2025 |
| TextField5: $18,022,184.84 ($1,236,359.47 Initial / $16,785,825.37 Extension(s)) |
| DropDownList1: Piggyback |
| TextField6: 25-478HFS-MEDPR-P-78341:0 |
| TextField7: 25-478HFS-MEDPR-R-263505 |
| TextField8: HFS is seeking to procure Maintenance and Operations services for the continued support of the IMPACT Provider Enrollment (PE) module. The PE module enables the Illinois Medicaid program to verify providers seeking to provide services to Illinois Medicaid customers. The system ensures the providers have met all federal and state eligibility and enrollment requirements, including validating required licensure and background screening information. The PE module also enables Illinois state staff and enrolled providers to maintain their enrollment information with the state and periodically revalidate their enrollment. In addition, the system is required to generate event-driven notices and communications to providers regarding their enrollment activity. Having those processes automated in an information system reduces potential for errors, federal audit findings for program non-compliance, and greatly increases the efficiency with which providers can enroll to provide services to the Medicaid population and the ability of the state to manage the provider enrollment area of the Medicaid program. Additionally, to process a Medicaid claim, the provider must be active in the PE module on the dates billed services were provided. The PE module currently contains 246,597 active providers. |
| TextField9: Change Order required for HFS to exercise the allowable extension(s) within the contract to align with the lead State of Montana. |
| CheckBox1: 1 |
| CheckBox2: 0 |
| CheckBox3: 0 |
| DateField1: 2028-05-31 |
| CheckBox4: 0 |
| CheckBox5: 0 |
| CheckBox6: 1 |
| TextField10: |
| : |
| SignatureField1: |
| TextField11: Monique Wantland |
| DateField2: 2025-04-09 |
| DropDownList2: I agree |
| explanationfield: Extension of contract was identified as part of the original solicitation as originally bid. This extension allows the State to continue to provide important services obtained through a competitive process through NASPO joint purchase and continue to receive federal match for this project. |
| spoSignatureField2: |
| spoprintedname: Jennifer Klein |
| DateField3: 2025-05-30 |
| DropDownList3: it is |
| TextField12: it allows for the continuation of a contract that is meeting an extremely critical need. |
| SignatureField2: |
| TextField13: Joshua Sergent |
| DateField4: 2025-05-30 |
| DropDownList4: it is |
| TextField15: The extension provides maintenance and operations of a system that is vital to Illinois' Medicaid program. |
| SignatureField3: |
| TextField16: Ellen H. Daley by Jan E. Morrow |
| DateField5: 2025-05-30 |
File details come from the government source that posted it. Updated .