36C24819D0079-001.pdf

OFOC SOP Revision 08 Page 1 of 4

Original Date: 03/22/11

Revision 08 Date: 04/18/2018

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A)

For

Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID: 36C248-19-AP-3609

1. Contracting Activity: Department of Veterans Affairs, Veteran Integrated service Network (VISN) 8, Caribbean Healthcare Systems (672), 10 Casia Street, San Juan, Puerto Rico, 00921. The purchase request number assigned to this requirement is 672-19-3-936-0105.

2. Nature and/or Description of the Action Being Processed: The Department of Veterans Affairs Caribbean

Healthcare System (VACHS) an urgent need for on-site Cardiology Physician and Perfusion /Autotransfusion services. The urgent need for the required critical services precludes full and open competition. A delay in award of a contract would result in the Caribbean VAHCS healthcare delivery capabilities of the critical, life-sustaining medical services to VA patients.

Required services will be acquired as a sole source procurement under authority FAR 6.302-2 Unusual and

Compelling Urgency.

Authority: Title 38 USC 8153, Health Care Resources (HCR) sharing Authority, FAR Part 12 – Acquisition of Commercial Items in conjunction with FAR Part 15 Contracting by Negotiation.

The proposed contract action is for a 12-month period with the purpose of maintaining continuity of medical care to VA patients. The Caribbean VACHS currently uses the required services of a cardiothoracic surgeon and cardiothoracic surgery team through an on-station fee and Community Care (under traditional non-VA care funds); however, under the VA Mission Act of 2018’s new criteria effective June 6, 2019, the Caribbean

VAHCS can no longer acquire the required services through these funds, effective June 5, 2019.

The customer was notified on April 11, 2019 that the required services could no longer be acquired through on station fee and Community Care (under traditional non-VA care funds), effective June 5, 2019 - on the same date Contracting was also involved to discuss developing a procurement package for the required services.

The planned type contract is a new contract with an estimated value of $500,000.00.

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The Caribbean VACHS has an urgent need for on-site cardiovascular open-heart surgery-cardiothoracic surgery (all-inclusive fee per patient which shall but not, be limited to the appropriate physician, or professional fee) perfusionists, equipment, disposables, equipment maintenance, cardiac monitoring, back up for interventional cardiology (PCI) (this includes perfusionist and cardiothoracic (CT) surgeon, cardiothoracic surgery consult (operation not recommended), permanent pacemaker implant (in emergency cases), pacemaker lead extraction (back up), pericardial window and/or pericardiectomy procedures and the contractor’s malpractice insurance to eligible beneficiaries of the Caribbean VAHCS. Contract personnel shall provide appropriate levels of patient care to the Veterans. The impending contract for cardiovascular open-heart surgery and cardiothoracic surgery physician (s) services include perfusionists (that will assist with the operating room procedures), and equipment

(cardiopulmonary bypass machine and heater and cooler device, equipment expendables and maintenance of the equipment.

4. Statutory Authority Permitting Other than Full and Open Competition:

() (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy

Agency Requirements per FAR 6.302-1;

(X) (2) Unusual and Compelling Urgency per FAR 6.302-2;

() (3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services per FAR 6.302-3;

() (4) International Agreement per FAR 6.302-4

OFOC SOP Revision 08 Page 2 of 4

Revision 08 Date: 04/18/2018

() (5) Authorized or Required by Statute FAR 6.302-5;

() (6) National Security per FAR 6.302-6;

() (7) Public Interest per FAR 6.302-7;

5. Demonstration that the Contractor’s Unique Qualifications or Nature of the Acquisition Requires the

Use of the Authority Cited Above (applicability of authority): The critical services requested herein are to provide care for veterans in need of cardiothoracic surgery consultation, evaluation and treatment. There is no other feasible alternative for the provision of these services to the VACHS patients. There is currently no provider onboard at the VACHS to provide these critical services.

The requiring office has estimated that the critical services described herein provided by the contractor are needed to perform an average of 90 cardiothoracic surgery procedures and provide approximately 200 consultations for a 12-month period to VACHS Veterans patients.

In addition to the urgent need for the critical on-site services described herein, the services are essential to comply and maintain compliance with the VACHS Chest Pain Center Accreditation and the American Council for Graduate Medical Education (ACGME) Accreditation for Cardiovascular supporting the main Cardiology

Fellowship Program available in the country.

Unusual and Compelling Urgency (FAR 6.302-2): - The required services currently performed at the

Caribbean VAHCS are provided under on-station fee basis and Community Care (under traditional non-VA care funds). The required services described herein are currently acquired through traditional non-VA Care;

however, with the implementation of the VA MISSION Act of June 6, 2019, the services cannot be acquired under traditional non-VA Care funds as June 05, 2019. The award of a contract in response to this requirement will ensure continuity of critical, life sustaining medical services to VA patients as well as an ongoing platform for teaching VACHS residents and fellows.

6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable:

The Contracting Officer has determined that this procurement is exempt from the requirements of FAR 5.201, Synopses of Proposed Contract Actions due to the following FAR authority:

FAR 5.202 (a) (2) Exceptions.

The contracting officer need not submit the notice required by 5.201 when –

(a) The contracting officer determines that –

(2) The proposed contract action is made under the conditions described in 6.302-2 (or, for purchases conducted using simplified acquisition procedures, if unusual and compelling urgency precludes competition to the maximum extent practicable) and the Government would be seriously injured if the agency complies with the time periods specified in 5.203;

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable:

The Contracting Officer anticipates cost to the Government will be considered fair and reasonable due to the basis of the Independent Government Estimate ($500,000.00) for the required services are Current Procedural

Technology (codes describing the service being provided) rates established by Center of Medicare and

Medicaid (CMS). Since services will be provided under a per-procedure contact and required services will be provided at a VA facility- the Current Procedural Technology rates used to develop the IGCE should only include the work and malpractice component of the Medicare Part B (physician) rate.

Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market

Research Was Not Conducted:

Vendor Information Portal: Market research was conducted online via Government website, General Service

Administration (GSA)/Federal Supply Schedule (FSS) eLibrary.

A review of the eLibrary yielded similar description of required services under FSS 621 I Professional and

Allied Healthcare Staffing Service, Special Item Number (SIN) 621-003, Physician – Internal Medicine (Not

Classified elsewhere) (Includes: Cardiovascular Diseases; Gastroenterology; Pulmonary Disease; Oncology;

https://www.acquisition.gov/?q=/browse/far/6 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/05.htm#P58_9307 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/06.htm#P120_17278 http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/05.htm#P89_14929

OFOC SOP Revision 08 Page 3 of 4

Revision 08 Date: 04/18/2018

Nephrology; Hospitalist; Invasive Internal Medicine; Critical Care; Rheumatology; Endocrinologist; Infectious

Disease; Allergist; Other). Seventy-one (71) contractors were identified under the mentioned FSS/SIN.

A review of services under FSS 621-I Professional and Allied Healthcare Staffing Services, SIN 621-007

Physician -Cardiology (includes: General and Pediatric; Invasive and non-invasive; Surgery and No Surgery) yielded similar description of required services -twenty-five (25) contractors were identified.

A review of services under FSS 621-I Professional and Allied Healthcare Staffing Services, SIN 621-036

Perfusionist / Perfusion Technologist yielded similar description of required services- eleven (11) contractors were identified.

Although, similar/like services were identified under the above FSS/SINs due to the urgent, intermittent need of the critical services under this requirement, the Acquisition Planning Team (APT) agreed that an award of

Health Care Resource (HCR) Indefinite Delivery Indefinite Quantity (IDIQ) contract for one (1) year as a sole source procurement with Bayamon Cardiovascular Surgery, Inc. is the best alternative because it will satisfy the Caribbean VAHCS immediate contractual need for the required, critical services.

8. Any Other Facts Supporting the Use of Other than Full and Open Competition:

Members of the APT discussed and agreed that the only feasible option is to award an HCR IDIQ contract for one (1) year to meet the immediate contractual need for the required, critical services.

The APT discussed if there were any other feasible alternatives, including use of in-house resources and award of IDIQ contracts against an open and continuous (O&C) solicitation based on full and open competition. The

APT agreed the required services cannot be met within a VA facility located within the catchment area. The

Caribbean VAHCS is the only VA Facility in the catchment area and there is limited access to Open Heart

Surgery (OHS) services in the community. Further consideration was given to sending patients to another VA facility outside the catchment area; however, sending Veterans patients to another VISN is a logistic challenge due to the geographical location (non-contiguous United States (US) Territory) of veteran patients receiving care under the Caribbean VAHCS. Transporting a Veteran patient to another VA facility outside the catchment area to a VISN located in the contiguous US would require additional resources and logistics currently not in place. Additionally, this would impact a veteran population with medical condition (s) that are susceptible to deteriorating rapidly. Transferring a Veteran patient to a mainland VA facility poses a risk to the patient’s life.

Patient (s) are also at a high risk of developing complications from surgical procedures and it is nearly impossible to manage complications from procedures performed by another physician not available.

Due to the urgent, intermittent need of the critical services under this requirement, the APT agreed that an award of Health Care Resource (HCR) IDIQ contract for one (1) year as a sole source procurement is the best alternative because it will satisfy the Caribbean VAHCS immediate contractual need for the required, critical life sustaining services.

9. Listing of Sources that Expressed, in Writing, an Interest in the Acquisition: Not Applicable

10. A Statement of the Actions, if any, the Agency May Take to Remove or Overcome any Barriers to

Competition before Making subsequent acquisitions for the supplies or services required:

Members of the APT discussed and agreed that the only feasible option is to award an HCR IDIQ contract for

12 months to meet the urgent, immediate need for the critical, life sustaining required services.

The APT also agreed there is and will be a continuous need for the required services.

In the future, the Government anticipates developing a competitive procurement that will result in a long-term contractual vehicle for the required services. A Sources Sought may be publicized to collect and analyze information about interested vendors within the market and their capabilities to satisfy the Government’s needs.

OFOC SOP Revision 08 Page 4 of 4

Revision 08 Date: 04/18/2018

11. Requirements Certification: The Certification Approval memorandum for Health Care Resources dated, May

16, 2019 certifies and includes a justification that this requirement is a Bona Fide Need of the Department of

Veterans Affairs. All required VA facility certifications and approvals were obtained for the Certification

Approval memorandum for Health Care Resources.