JA_TAC-19-52704_FINAL.pdf

Insurance Card Buffer Software and Maintenance Control Number TAC-19-52704

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

1. Contracting Activity: Department of Veterans Affairs (VA) Office of Procurement, Acquisition, and Logistics

Technology Acquisition Center 23 Christopher Way Eatontown, NJ 07724

2. Description of Action: This proposed action is for a firm-fixed-price order issued under the National Aeronautics and Space Administration (NASA) Solutions for Enterprise-Wide Procurement (SEWP) V Governmentwide Acquisition Contract (GWAC) for the renewal of software license and maintenance support on existing Document Storage System (DSS) Insurance Capture Buffer (ICB) software.

3. Description of the Supplies or Services: VA, Veterans Health Administration (VHA), Office of Community Care (OCC), eBusiness Solutions Office has a requirement to renew 129 existing annual DSS ICB software licenses and maintenance support. The existing ICB software is installed and operational at 129 parent VA Medical Centers’ (VAMC) systems and all associated Community Based Outpatient Clinics (CBOC) and Consolidated Patient Account Centers (CPAC). The ICB software is an insurance card scanning and Veterans Health Information System and Technology Architecture (VistA) Insurance Verification Processor File update management system designed to enhance the insurance data collection and verification processes for VA facilities. The ICB Graphical User Interface contains out of the box integration with several VistA components such as Appointment Scheduling and the Patient Insurance File. VHA Directive 1910 mandates the use of ICB for requesting and verifying insurance information. As entry clerks collect insurance information and scan insurance cards provided by Veterans and other eligible patients, the data is used to populate the insurance buffer via the ICB software. As data entered in ICB is moved to VistA, the Electronic Insurance Verification module of VistA automatically sends and receives electronic inquiries in real-time from available third-party payers. These Electronic Data Interchange functions are in compliance with the mandated Health Insurance Portability and Accountability Act of 1996 (HIPAA) industry standards. The resulting electronic response can auto-update to the patient file or is available in ICB views for insurance verification staff processing. With ICB, VA is able to collect and store images of Veteran’s insurance cards, as these images are not able to be sent to or saved into VistA. ICB and/or ICBWeb is integral to the continuing ability for VA to collect revenue from third party insurance carriers to meet mandates of 38 United States Code (U.S.C) 1729A – Department of Veterans Affairs Medical Care Collections Fund. Title 38 U.S.C.

Section 1729 authorizes VHA to seek reimbursement from third-party health insurers for medical care provided by VA to insured Veterans for non-service connected (NSC) treatment or to service connected Veterans for their NSC conditions, referred to as Medical Care Collection Fund (MCCF). Additionally, OCC, eBusiness Solutions requires DSS ICB software maintenance support to continue to streamline the collection and verification of third party health insurance before billing and collection occurs. The Contractor shall provide update releases, emergency fixes, and patches via prescribed VA protocols, including FORUM and VA File Transfer Protocol (FTP) or direct installation where appropriate and directed by VA. VistA’s Optical Character

Recognition (OCR) does not have the ability to store or display picture files generated by scanners. The ICB software captures and verifies scanned insurance card information which allows for the collecting and verifying of Veterans’ third-party insurance information to perform revenue billing and is mandated by 38 U.S.C 1729.

Legacy ICB software is a client-server based product that is currently installed at VA.

ICBWeb software is the next generation of the existing ICB software which is a cloud server based product. Both products provide the exact same functionality and is interchangeable. The ICBWeb version shall seamlessly replace the legacy ICB software once it is made available with no effect to the licensing or maintenance support. The Contractor shall provide licensing and maintenance support for either the ICB client-server based product or the ICBWeb cloud based product. Software maintenance support shall include telephone help desk support from 8:00 am to 7:00 pm Eastern Standard Time, Monday through Friday; excluding Federal Holidays. The effort includes an optional task for enhanced maintenance support inherent to supporting a cloud-based solution that may be required depending on final VA cloud approvals for ICBWeb upon the replacement of the legacy ICB software. The enhanced maintenance support shall include but is not limited to management of virtual machine resources, management of image storage resources, configuration management control, security maintenance, security patches, and security scanning. The Contractor shall provide DSS ICB and/or ICBWeb software maintenance support including all upgrade releases, modifications to software, bug fixes, and periodic updates to the software for all VA sites.

The period of performance shall be for 12-months from December 15, 2018 through December 14, 2019 with seven 6-month option periods and an optional task for enhanced maintenance support. It is anticipated that the new Electronic Health Record Modernization (EHRM) solution, which is anticipated to replace VistA, will begin testing in 2019/2020 and then to be rolled out over several years. The new EHRM solution is expected to be capable of performing the functions of the current ICB solution and as such, DSS ICB is anticipated to be phased out as the EHRM solution is phased in.

Option Periods extend into the expected transition into the EHRM solution.

4. Statutory Authority: Pursuant to Federal Acquisition Regulation (FAR) Subpart 16.505(a)(4), the following brand name requirement is being justified and approved as an exception to fair opportunity under the statutory authority of Section 41 U.S.C.

4106(c)(2) as implemented by FAR Subpart 16.505(b)(2)(i)(B), entitled “Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services ordered are unique or highly specialized”.

5. Rationale Supporting Use of Authority Cited Above: Based on extensive market research, as described in section 8 of this document, it was determined that limited competition is available among resellers of the brand name DSS ICB software licenses and maintenance support. Brand name DSS ICB software is currently installed and operational at 129 parent VAMC systems and all associated CBOCs and CPACs. VA has a critical need to continue the existing DSS ICB software licenses and maintenance support. No other brand name insurance card scanning software is currently interoperable or compatible with the current VistA infrastructure. Specifically, the current VistA infrastructure is only coded to function with the existing DSS ICB software for all of Vista’s insurance card scanning requirements. In addition, only the DSS ICB software can meet all of VA’s functional requirements. Specifically, the DSS ICB software is the only brand name software that provides OCR capability that is integrated with VistA and can store scanned data and images of insurance card information.

Implementing another software solution would require substantial duplication in effort to include development, testing and implementation of the new solution at all affected VA health care facilities and duplication in cost which would not be recovered through competition. A replacement software solution would need to be collaboratively developed under the agile based, Veteran-focused Integration Process methodology.

This would include, but is not limited to, writing VistA Massachusetts General Hospital Utility Multi-Programming System based Application Programming Interfaces, VistA re-development to accommodate any new solution code, new web services, new server architectural design and development, testing and approval of a VA Authority to Operate (ATO), replacement of existing infrastructure, replacement of over 25 individual screen designs that are currently utilized and approximately six reports, quality assurance testing, and extensive re-writing and revisions to VA manuals and business processes.

After these duplicated efforts of development, testing, and implementation, any new solution would require a roll-out to each individual 129 VAMCs. Unique hands-on training would need to be provided to almost 1,000 hospitals and sites, requiring up to 7,000 individuals to be trained. Based on similar VA procurements, it is estimated that the entire aforementioned implementation of a new solution would take a minimum of two to four years with duplication of costs of at least $6.5 million per year. This would not be recovered through competition. VA has already invested in the DSS ICB software solution, which has been tested, implemented, given VA ATO status, and rolled out to the VAMCs through previous efforts.

VA’s current DSS ICB software and support ends on December 14, 2018. Any break in the DSS ICB software would halt VA’s ability to collect and verify Veteran insurance information. VA would be unable to properly bill a Veteran’s third-party insurance carrier for non-service connected care and additional federal appropriations would be necessary to ensure continued delivery of world class healthcare to our nation’s Veterans. Veterans receiving non-service connected care would no longer be able to receive financial benefits from VA offsetting the Veteran’s VA required co-payment “dollar for dollar” from the third-party insurance carrier’s payment. Additionally, VistA has no OCR capabilities and if the DSS ICB software were to halt due to another software development or implementation, VA would need to make physical photocopies of insurance information for every Veteran and other eligible patients. Photocopies would contain sensitive information such as Social Security Numbers and need to be documented by hand and either physically mailed to insurance verifiers or set up a shared digital drive where the photocopies could be scanned. This creates unacceptable levels of security risk for sensitive information in addition to human error.

Without ICB software licenses in place consistently across the 129 VAMCs, VA would be required to decommission its only insurance collection and insurance verification interface to VistA, significantly impeding VA’s ability to meet mandated MCCF collection levels. Furthermore, VHA Directive 1910 mandates the use of ICB for requesting and verifying insurance information as detailed in paragraph 3 above. As such, only DSS ICB software meets the Government’s requirements.

Finally, maintenance is required for software updates and patches to VA’s current DSS ICB software. DSS owns the proprietary rights to the ICB software and based on market research it has been determined that only DSS through its resellers have the required access to the source code and other proprietary data to provide the licenses and maintenance support for its ICB software and meet the Government’s needs.

Access to this code is required to develop and push updates to the Vista system and access to this code is required to ensure all services provided are properly configured.

ICB software maintenance support ensures that all support services are performed and properly configured to integrate with VistA which can only be provided by those who have access to the proprietary software code. The maintenance support for ICB software is critical to ensure the software continues to work with VistA. Since VistA undergoes periodical changes, the ICB software must continuously be updated and patched to ensure compatibility and interoperability. If the ICB software was not maintained, the scanned image of an insurance card cannot be viewed which would leave the hardware scanning devices useless since VistA’s OCR viewing ability is non-existent. VistA does not have the ability to store or display picture files generated by scanners. Using these scanned images through the ICB software solution provides a complete and interoperable solution that ties in the processes of capturing and verifying insurance information. Collecting and verifying Veterans’ third-party insurance information to perform revenue billing is mandated by 38 U.S.C 1729. VA’s ability to conform to the laws and regulations regarding mandated MCCF billing is directly tied to the ability to systematically collect and verify Veteran’s third-party insurance information.

Furthermore, all MCCF collections are directed back to the VAMCs for additional patient care delivery and MCCF collections goals are set annually by Congress as a required offset of Federal appropriations. If the DSS ICB software is not available it would significantly and negatively impact the annual $3.8 billion dollars of revenue generated by these processes.

6. Efforts to Obtain Competition: Market research was conducted, details of which are in section 8 of this justification. This effort did not yield any additional sources that can meet the Government's requirements. However, the undersigned VA technical representative determined that limited competition is available among resellers for brand name DSS ICB software maintenance support. In accordance with FAR 16.505(a)(4)(iii)(A)(1), this justification will be provided with the solicitation to all appropriate NASA SEWP V GWAC holders. Furthermore, in accordance with FAR 5.301, 16.505(b)(2)(ii)(D), and 16.505(a)(4)(iii), the award notice for this action will be synopsized on the Federal Business Opportunities (FBO) website and this justification will be made publicly available within 14 days of award.

7. Actions to Increase Competition: The Government will continue to conduct market research to ascertain if there are changes in the market place that would enable future actions to be competed. It is anticipated that the new EHRM solution, which will replace VistA, will begin testing in 2019/2020 to be rolled out over several years in accordance with the EHRM contract. The new EHRM solution is expected to be capable of performing the functions of the current ICB solution and as such the ICB solution is anticipated to be phased out as the EHRM solution is phased in.

8. Market Research: Government technical experts conducted market research during September through October 2018, by reviewing other similar software products to ascertain if these products could meet VA’s requirements. Similar software reviewed included Inuvio OCR and MedicScan OCR. Based on review of these products, the Government’s technical experts determined that only DSS ICB/ICBWeb software and software maintenance can meet the Government’s requirements as no other existing product can interoperate with the current VistA infrastructure that supports the insurance data collection and verification processes for VA facilities without extensive duplication of effort and cost. Additionally, only DSS ICB/ICBWeb software is interoperable with the existing OCR scanned insurance information data that is integrated with VistA. Furthermore, the market research indicated that no other software providers have access to the source code or other proprietary data to provide the required software maintenance for the DSS ICB software. Based on the above, only DSS ICB software and maintenance meets all of the Government’s requirements.

Additional market research was conducted in October 2018 utilizing the NASA SEWP V SEWP V Quote Request Tool by posting a RFI, number 103265, with Government minimum salient characteristics for an ICB software solution. On October 9, 2018, the RFI closed and one response from a small business was received for the brand name DSS ICB software licenses and associated maintenance support services.

Finally, additional market research was conducted during October 2018 by utilizing the NASA SEWP GWAC Provider Lookup tool. The Provider Lookup Tool yielded five contract holders, two of which are Group B(2) Service-Disabled Veteran-Owned Small businesses (SDVOSB) offering DSS brand products. The NASA SEWP V GWAC has a dynamic catalog where line items can be added based on customer requests; therefore, as long as the required item or service is within scope of the NASA SEWP V GWAC, items and services can be added to the catalog on a daily basis. This requirement has been found to be within scope of the NASA SEWP V GWAC in a separate determination. There is reasonable expectation that limited competition exists on the NASA SEWP V GWAC amongst Group B(2) SDVOSB concerns for DSS ICB software maintenance.

9. Other Facts: None.