NCQA_Justification_and_Approval.pdf

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN

COMPETITION

Acquisition Title: Implementation of the HEDIS® Medicare Health Outcomes Survey Agency: Centers for Medicare & Medicaid Services Acquisition Year: 2019 Author: Kim DeMichele, Lakisha Holly and Mark Smolenski

1. Description of Action:

Nature

____ New Requirement __X_ Follow-On Order ____ Modification of Existing Contract Number

Contract Type __X_ Firm-Fixed Price ____ Time and Materials ____ Cost Plus Fixed Fee (CPFF)

• ____ Term

• Completion

____ Cost Plus Award Fee (CPAF) ____ Other: ___________

Projected Cost / Price of contract (Base & All Options):

Base Period: $1,266,308.00 Option Period 1: $1,302,479.00 Option Period 2: $1,333,299.00 Option Period 3: $1,362.356.00 Option Period 4: $1,395,541.00 Total Cost: $6,659,983.00

The total estimated value of the proposed sole source action (for modifications only): N/A Funding Source (s): TBD

_X_: Basis for Approval (FAR 6.303-1(d))

__X__: Individual Basis

____: Class Basis

Name of Proposed Contractor(s): National Committee for Quality Assurance (NCQA) Street Address: 1100 13th Street Suite 1000, NW City, State, Zip: Washington, DC 20005

2. Description of Services or Supplies:

The Medicare Health Outcomes Survey (HOS) was implemented nationally in 1997 as a significant extension of the range of health care services being evaluated known as the HEDIS. The HOS uses the Veterans RAND 12 Item Health Survey (VR-12), a self-reported measure of functional health, to assess the physical and mental health statuses of beneficiaries enrolled in Medicare managed care at two-year intervals. Each year, a random sample is drawn from each MAO to create a new baseline cohort. A two-year change score is calculated for each beneficiary who completes a Baseline and Follow-up survey, accounting for risk-adjustment factors. Summary HOS results are calculated for each MAO based on aggregated member outcomes. Additionally, the HOS-M is used to assess annually the frailty of the population in PACE and some Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs).

Annually, MAO-specific HOS baseline and two-year performance measurement reports are created for each participating health plan after completion of each annual HOS fielding. MAO-specific performance measurement data are made available after the completion of each two-year HOS cohort. Similarly, annual HOS-M summary reports and data are created for participating PACE plans. HOS results are currently being used to target quality improvement activities and resources;

monitor health plan performance and reward top performing health plans; monitor frailty and adjust plan payment rates; help beneficiaries make informed choices; and advance the sciences of functional health outcome measurement and health related quality of life (HR-QOL).

Section 722 of the Medicare Prescription Drug, Improvement, and Modernization act of 2003 mandates the collection, analysis, and reporting of health outcomes information. This legislation also specifies that data collected on quality, outcomes, and beneficiary satisfaction to facilitate consumer choice and program administration must utilize the types of data collected prior to November 1, 2003. Collected since 1998, the Medicare HOS therefore remains a critical part of assessing health plan quality.

3. Authority and Rationale:

This justification is based upon the authority of 41 U.S.C. 253(c)(1), as implemented by FAR 6.302-1, only one responsible source and no other supplies or services will satisfy agency requirements.

Actions other than simplified acquisition procedures (select only one and provide an explanation):

_X_: FAR 6.302-1: Only one responsible source and no other supplies or services will satisfy agency requirements, 41 U.S.C. 253(c)(1)

NCQA owns the proprietary rights to the system that collects HEDIS® data and is the only organization authorized to add measurements and to provide technical assistance to the health plans and auditors in the use of the measurements. NCQA performs this function by convening a number of interdisciplinary multi-stakeholder panels and groups. These groups are all widely respected by the managed care industry and have stakeholder representation. Since NCQA develops the measures and makes all of the updates to HEDIS®, it is uniquely qualified to provide the needed technical assistance to health plans and auditors during data collection.

As the organization that maintains and evolves HEDIS®, NCQA is the only responsible source for this activity. In 1993, NCQA released HEDIS 2.0 that quickly became the “industry standard” performance measurement set. Originally designed for private employers' needs as purchasers of healthcare, HEDIS® has been adapted for use by public purchasers, government compliance monitors, and managed care consumers. HEDIS data submission tools and detailed technical specifications are developed and maintained by NCQA. Since 1997, CMS has contracted with NCQA to develop additional HEDIS® performance measures to assess HOS measures. NCQA retains sole title to and ownership of the HEDIS® Medicare HOS data.

4. Bridge Contracts: N/A

5. Actions to Increase Competition:

This action will not be competed. FAR 6.302-1(b)(2) authorizes application of a contract to one sole source based on the existence of limited rights in data, so CMS has determined that, for the reasons previously cited, only NCQA has the necessary capabilities to successfully perform this work. In accordance with FAR 5.201, CMS posted a notice of intent to contract on a sole source basis with NCQA on the FBO.gov website on December 11, 2018 to see if there were any other organizations that had an interest in this work or believed they were capable of performing the work. CMS did not receive any responses that challenged the sole source designation of this work or from organizations that were interested or believed they were capable of doing this work.

6. Market Research:

A notice of intent to contract on a sole source basis with NCQA was posted on FBO.gov on December 11, 2018. Organizations that wanted to challenge the sole source designation were given until December 28, 2018 to respond. As stated in Section 6 above, there were no responses received from industry.

7. Procurement History:

HHSM-500-2014-00022G (September 29, 2014 – September 28, 2019) NCQA HHSM-500-2009-00051C (September 29, 2009 – September 28, 2014) NCQA HHSM-500-2004-00015I (September 29, 2005 – September 28, 2009) NCQA 500-00-0055 (September 29, 2000 – September 28, 2004) NCQA Purchase order or contract number: N/A Was Action Competed? ____Yes _X_ No

FAR 6.302-1 (b)(2) authorizes application of a contract to one sole source based on the existence of limited rights in data, so it was determined by CMS that only NCQA has the necessary capability to successfully perform this work.

8. Additional Information to support the justification

As stated above, NCQA retains sole title to and ownership of the HEDIS® Medicare HOS data.

CMS currently has a limited rights licensed data license agreement with NCQA, which allows

CMS to use HEDIS HOS data without restriction and royalty free for internal purposes, including health care quality improvement initiatives, consumer information strategies, demonstration and research projects, and health plan enforcement activities. The term of the limited rights licensed data license agreement for CMS to use HOS HEDIS data is coextensive with NCQA’s contract to implement the HEDIS® Medicare Health Outcomes Survey.

10. Listing of the sources, if any, that expressed, in writing, an interest in the acquisition.

No challenges of requirement was received in response to publicizing the Government intent to award a sole source contract that was posted on FBO on December 11, 2018.

11. A statement of the actions, if any, the agency may take to remove or overcome any barriers to competition before any subsequent acquisition for the supplies or services required

Upon expiration of this contract and if this requirement still exists, CMS will conduct market research to see if there are any companies capable of doing this work.