FY27 EMERGENCY EXTENSION for: Quality Improvement and Utilization Management

The Agency requests an extension from October 25, 2026, through March 31, 2027, to maintain continuity of services while completing a competitive Invitation for Bid (IFB) procurement and transitioning to the resulting contract.

This procurement involves statewide Medicaid utilization management and quality assurance services subject to federal oversight. [...] These activities collectively support the State's surveillance and utilization control program in accordance with 42 CFR Part 476.

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.

Emergency extension, not a solicitation

• Vendor: Keystone Peer Review Organization, LLC dba Acentra Health.
• Expected extension term: **Oct 25, 2026** to **Mar 31, 2027**.
• Amount of extension contract: **$750,000** (estimated).
• BEP participation is not included in this emergency contract.

The Agency is developing an Invitation for Bid (IFB) to replace the emergency contract. These activities must be completed in time for services under the competitively procured contract to begin April 1, 2027.