36C10B21C0031 J_A_Redacted.pdf

Claims Adjudication Software Support & Maintenance Control Number VA-21-00035280

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION

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

Technology Acquisition Center 23 Christopher Way

Eatontown, New Jersey 07724

2. Description of Action:

The proposed action is for the award of a firm-fixed-price contract to purchase monthly support and maintenance for 75 Plexis Care Manger (PCM) licenses, with two optional quantities to purchase monthly support and maintenance for 15 additional licenses each, from Plexis Healthcare Systems, Inc., 340 Oak Street, Ashland, OR 97520.

3. Description of Supplies or Services:

Software licenses are required for VA personnel to use the PCM software to process medical claims; therefore, VA-FSC has a requirement for PCM software maintenance to support all medical claims processing transactions. PCM is an integrated Microsoft Structured Query Language (SQL) Server-based healthcare information system providing complete benefit administration, medical and vision claim processing, and reporting features for organizations in a competitive healthcare Information Technology (IT) environment. PCM is one of two claims adjudication systems to process medical claims on behalf of the VA and our Other Government Agency partners in accordance with industry and Medicare standards, and in accordance with the Prompt Pay and VA Mission Acts. VA-FSC currently has 250 seat licenses on the current contract 36C10B19C0002 and will decrease the requirement to 75 licenses for this follow-on action; thus VA-FSC has a requirement for monthly maintenance and support of the 75 licenses. The VA-FSC has purchased PCM licenses and maintenance on previous VA contracts 36C10B19C0002, with a period of performance of 10/1/2018 – 9/30/2021; VA118- 15-C-0079, with a period of performance of 10/1/2014 – 9/30/2018; and GS07T11BGC0002 (via GSA), with a period of performance of 10/1/2012 – 9/30/2014.

Maintenance shall consist of the maintenance required to support all the software and licenses in the PCM defined above, including upgrade assurance and technical support services. Maintenance and support is required 24 hours a day, 7 days a week. The period of performance for this action will be from October 1, 2021 through September 30, 2022 with three 12-month option periods and two optional quantities for 15 additional licenses.

Plexis Claims Manager Additional Licenses Control Number VA-21-00035280

4. Statutory Authority:

The statutory authority permitting other than full and open competition is 41 U.S.C.3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1 entitled, “Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements.”

5. Rationale Supporting Use of Authority Cited Above:

As a franchise fund organization within the VA Franchise Fund, the VA-FSC must sustain its operations through charges to federal customers on a fee for service basis. In order to support the VA-FSC's customer, the Veterans Health Administration (VHA), and the Veteran Access to Care Act of 2014 (H.R. 4810;

113th Congress), the VA-FSC must maintain and support its PCM software. The VA-FSC already owns PCM Software and through this action they are seeking to continue monthly support and maintenance for 75 client licenses, with optional quantities up to a total of 105 licenses, of the PCM software, support, and maintenance for the period of one base year and three option years.

When the first contract for claims adjudication software was awarded, an extensive search led to the benefits and claims administration solution offered by Plexis. Plexis had the best combination of features and because the VA-FSC had unique requirements in addition to the need for more efficient claims processing and benefit administration, Plexis created a custom system that integrated an efficient document management system with an imaging system and enhanced reporting to support call center needs. Plexis, furthermore, enabled the development of a web based front-end for accepting referrals and authorizations from 800 detention centers along the borders of the United States. Now all claims can be imaged in the VA's document management system, and a Document Locator Number (DLN) is assigned to every record so that electronic images are instantly retrieved. The VA-FSC also had special implementation requirements that only Plexis could achieve.

The VA-FSC has a considerable vested interest in processing healthcare claims.

If the VA-FSC is not allowed to purchase software and maintenance from Plexis, the costs of migrating to a replacement healthcare claims processing software would be extensive and not a cost-effective use of VA-FSC funding. VA-FSC estimates the cost of migrating the existing product lines to the replacement system to be . This would also impede the VA-FSC from being able to provide healthcare claims processing services to VHA in accordance with Veteran Access to Care Act of 2014 (H.R. 4810; 113th Congress).

A delay in the award of a contract to purchase support and maintenance for the 75 Plexis licenses, with two options up to a total of 105 licenses, and associated maintenance support will result in serious financial injury to the VA-FSC. If

Plexis Claims Manager Additional Licenses Control Number VA-21-00035280 another software manufacture is selected, additional risk would be incurred as the new contractor’s staff would not fully understand the intent and context of the complex requirements included in this application. Furthermore, another source would require a steep learning curve while gaining familiarity with VA-FSC’s healthcare claims processing systems. This delay with the new vendor may hinder the VA-FSC’s ability to pay provider’s medical claims in accordance with the Prompt Pay and VA Mission Acts; and thus providers may then charge the Veterans for services provided.

Finally, the VA-FSC’s healthcare claims processing is based on the PCM software. Only Plexis can provide PCM software, maintenance, and support.

PCM software coding is proprietary in nature and is not released to any other party. Any source must have access to this code to ensure the services provided are properly configured and the updates are properly developed and pushed to the software. No other software provider has the capability to develop and issue software updates, patches, and fixes for PCM software necessary to support existing requirements without access to Plexis’s proprietary software code. Due to the nature of the intellectual property and software codes to perform the needed support services, along with the proprietary copyrighted PCM Software, no other software products would offer the same capability.

6. Efforts to Obtain Competition:

Market research was conducted, details of which are in the market research section of this document. This effort did not yield any additional sources that can meet the Government’s requirements. There is no competition anticipated for this acquisition. Additionally, the proposed action will be synopsized on the Contract Opportunities Page in accordance with FAR 5.201. Any proposals that are received shall be evaluated.

7. Actions to Increase Competition:

The Government will continue to conduct market research to ascertain if there are changes in the marketplace that would enable future actions to be competed.

8. Market Research:

In January 2021, the VA-FSC searched GSAAdvantage, the National Aeronautics and Space Administration Solution for Enterprise-Wide Procurement (NASA SEWP), Contract Opportunities, and Federal Procurement Data System– Next Generation (FPDS-NG) web-based databases and no other vendors were found. The procurements found in FPDS-NG for this product were not competed and were sourced under other than full and open competition. In addition, previous contract history reveals General Services Administration (GSA) Assisted Acquisitions, as well as VA sourced contracts, indicate that Plexis is the only vendor currently providing these product requirements. Finally, in a letter to the undersign contracting officer dated January 14, 2021, Plexis confirmed that