EMERGENCY PURCHASE: 4TH Quality Improvement and Utilization Managemen

The Illinois Department of Healthcare and Family Services has declared a third 90-day emergency contract to continue quality assurance and utilization review services across Medicaid fee-for-service settings, with an award made to Keystone Peer Review Organization, LLC dba Acentra Holdings, LLC (Contract B-27-478HFS-MEDPR-B-53500) effective July 27, 2026, and a proposal due date of August 13, 2026.

This is the fourth successive emergency procurement. The prior competitively procured contract with eQHealth Solutions, LLC (Contract No. 2021-35-001) expired October 29, 2025. HFS determined that obtaining required external approvals and Business Enterprise Program compliance certifications for contract renewal was not achievable, and that transitioning to a new vendor — requiring system implementation, data access, transfer, staff training, and operational readiness validation — posed unacceptable service-disruption risk within the available timeframe. Competition was found not practicable.

The scope encompasses utilization management and quality assurance across hospital inpatient, outpatient, psychiatric residential treatment facilities, long-term acute care hospitals, integrated health homes, and community-based treatment settings. Deliverables include medical necessity determinations, prior authorization and utilization reviews, quality-of-care reviews, inpatient continued-stay reviews, pre-payment and post-payment reviews, appeals and reconsideration reviews, quality investigations, web-based referral and authorization platform operations, provider outreach and training, and special projects. Services must comply with 42 CFR Parts 475 and 476.

The estimated contract value is $450,000 for the 90-day term, funded through federal and state appropriated sources. Business Enterprise Program participation goals, previously set at 5%, were determined not practicable for the limited emergency period. The incumbent vendor was retained to ensure continuity of critical functions.