Please note: This is a Sole Source Notification. SCDHHS is required to contract with a Quality Improvement Organization (QIO) to ensure medical and utilization reviews are conducted to safeguard against unnecessary or inappropriate use of medical services and excess payments. The Services are required for SCDHHS to meet the requirements set forth by the Centers for Medicare and Medicaid Services (CMS) to receive federal funding. Effective June 1, 2022, this vendor will assume responsibilities for utilization reviews for services related to Autism Spectrum Disorder. SCDHHS has historically utilized the KEPRO system for these reviews while maintaining dedicated staff to perform the utilization reviews. Moving the entire functionality to KEPRO will allow SCDHHS to leverage professional and certified staff already in place, reducing duplicity between KEPRO/SCDHHS staff, and ensuring that staffing volume is adequate to provide uninterrupted care to beneficiaries. KEPRO is currently the QIO vendor performing medical and utilization reviews to safeguard against the inappropriate use of medical services and excess payments. KEPRO was initially awarded the contract as the QIO to perform these reviews pursuant to a competitive procurement, and the contract expired on February 28, 2017. Due to the Department’s ongoing efforts to replace the State’s aging Medicaid Management Information System (MMIS), SCDHHS determined it was not in the best interest of the state (financially or in the use of its human resources) to issue a separate new procurement for these services once the initial contract with KEPRO expired. The serious and critical need for the continuation of the provision of the medical and utilization reviews performed by KEPRO is necessary to meet federal requirements for services provided under the State Medicaid program. The lack of these reviews could result in the inappropriate use of medical services and excess payments, which are prohibited by federal regulations. Without this contract, SCDHHS would be out of compliance with federal law which could jeopardize federal Medicaid funding. It is essential and of paramount importance that the continuity of these operations are maintained without interruption to comply with federal law. KEPRO is currently the only vendor that can provide these services without interruption until a determination for the best solution for procuring these services is made and a new contract is awarded and implemented.