HCA Signed NCO 1 PG_Part8063_Atch9_FAR6_JA_OVER_SAT 2 Signed DR (1) (7)_Redacted.pdf

Attachment 9: Request for Sole Source Justification Format >SAT Acq Plan: 36C241-24-AP-0552

VHAPG Part 806.3 OFOC Page 1 of 5 Revision: 01 Effective Date: 04/01/23

DEPARTMENT OF VETERANS AFFAIRS

Justification and Approval (J&A) For

Other Than Full and Open Competition (>SAT)

Acquisition Plan Action ID: 36C241-24-AP-0552

1. Contracting Activity: Department of Veterans Affairs, VISN 1, NCO 1 on behalf of VA Boston Medical Center. The purchase request number is 523-24-1-7044-0001.

2. Nature and/or Description of the Action Being Processed: Ensuring veterans access to care is a priority. For veterans that are admitted to the acute setting, we work to achieve this by ensuring veterans have access to the right care at the right time in the right setting. By improving our access to Medicaid services at the time of admission to the acute setting, we ensure that veterans will have a payer source to assist with discharge planning when they are medically ready to leave the hospital.

This will help us provide an appropriate length of stay to veterans and timely transition to the next level of care. This requirement had a previous Medicaid Application Contract 36C24119C0024 Service at VA Boston. The VAMC Boston Healthcare System is seeking to renew the Medicaid contract under Social Work Service. The previous contract, 36C24119C0024, was successful over a period of 5 years (base plus 4 1-year options) that spanned from 2/1/2019-1/31/2024. The line-item structure of this requirement would be the same as the previous contract with firm fixed prices. Line item one would include the first half payments for applications initially submitted to Medicare. The second line item would include the second half of payment for applications that are approved by Medicare. A third line item would be 15-minute increments meeting consultations, in which the submission of the application cannot be completed by no fault of the vendor (ineligible, death, etc.).

The requirement is anticipated to be approximately for base year and four 1-year options.

3. Description of Supplies/Services Required to Meet the Agency’s Needs: The contractor shall provide assistance with the completion of Medicaid applications. Medicaid has various names, based on the state administering the program. For purposes of this agreement, the contractor will be able to navigate the Medicaid application process to completion for states served within the VISN as noted above. The contractor shall provide personal assistance and resources to VABHS staff, patients, and caregivers, who have been identified as needing to complete this application to access additional community-based resources that Medicaid can provide. Individuals are identified through a screening process completed by VABHS staff. The contractor will make a dedicated effort to continue to follow-up on pending Medicaid applications, which will help to ensure applications are processed in a time efficient manner. The contractor will be proactive with contacting the Medicaid office to receive timely updates on the status of applications. The contractor will continue to follow-up with VHABHS staff, patients, caregivers, and the Medicaid office until a decision is made by Medicaid regarding eligibility. This may also include appealing Medicaid decisions. Completing these applications will permit successful transitions from acute and subacute care for the many patients in need of long-term care. It will also enable a reduced length of stay and decreased healthcare costs.

Our current contract ends on 1/31/2024 and we would like to continue providing these services without interruption given that they are critical to managing patient flow through our inpatient units, and discharging and placing Veterans in the community quickly saves the VA millions of dollars every year in cost avoidance. This contract has been so successful that it has been (or is in the process of being) replicated at several other VA sites.

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

(X) (1) Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements per 41 USC §3304(a)(1) as implemented by FAR 6.302-1;

( ) (2) Unusual and Compelling Urgency per 41 USC §3304(a)(2) as implemented by FAR 6.302-2;

( ) (3) Industrial Mobilization, Engineering, Developmental or Research Capability or Expert Services per 41 USC §3304(a)(3) as implemented by FAR 6.302-3;

( ) (4) International Agreement per 41 USC §3304(a)(4) as implemented by FAR 6.302-4

( ) (5) Authorized or Required by Statute per 41 USC §3304(a)(5) as implemented by FAR 6.302-5;

( ) (6) National Security per 41 USC §3304(a)(6) as implemented by FAR 6.302-6;

( ) (7) Public Interest per 41 USC §3304(a)(7) as implemented by 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 original award was the first of its kind for the VA. Upon acceptance of the previous contract, it took 6 months to onboard the contractor to set up accounts, complete VA mandatory trainings, obtain laptop, and have active security clearance. Once the contractor, Symphony Application Specialists, started meeting with veterans, the first year consisted of orientation and adjustment for the vendor to work within the VA system, and to fine tune the performance process. At this time, award to a new vendor, other than the incumbent, would significantly impair the current Medicaid application process in place.

Examples consist of substantial duplication of time, effort, and cost to the VA BHS, and resulting in significant delays to the veterans of 6 months plus to obtain the proper Medicaid coverage for care and placement in the community. These examples would cause substantial delays, costing the VA around one million dollars inpatient beds and days of care in the first year alone, which would not be recouped in subsequent option years.

The chart below (data from previous contract) shows the progress made in efficiency and access that grew continuously over the last 5 years of the contract in the number of Veterans who were able to be served. In FY21, the Medicaid application services were increased to help serve among the most frail and vulnerable outpatient Veterans. This was a preventative measure to ensure veteran’s had coverage in place for potential future hospitalizations to speed up the discharge process.

Currently, the VABHS is experiencing a stressful environment, where veteran community care placement options have been decimated as a result from the COVID-19 pandemic. There continues to be several days each week where the VABHS had no open beds, are on a “treat and transfer” basis, and this results in additional VA funding to pay for veteran’s community care. The incumbent contractor has built a formidable reputation with local community providers, which allows the VA to strongly compete for the extremely limited hospital community beds that will take Medicaid Insurance. This has resulted in the community hospitals having high confidence in accepting our sick and disabled veterans, even when Medicaid insurance is in pending status. They are accepting our veteran simply because, the hospitals know the incumbent vendor will ensure Medicaid is in place and not question receipt of payment. Again, a new contractor, would take 1-3 years to rebuild these types of relationships with local medical care and would be detrimental for our sick veterans.

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6. Description of Efforts Made to ensure that offers are solicited from as many potential sources as deemed practicable: A sources sought notice was posted on SAM.gov contract opportunities for 2 weeks (12/8/2023-12/20/2023). This notice resulted in one SDVOSB vendor that resides in Texas showing interest. The incumbent, Symphony Application Specialists, is an SB vendor. The previous contract 36C24119C0024 posted a sources sought notice with no results. Then was solicited as a SB and resulted in one quote received.

7. Determination by the CO that the Anticipated Cost to the Government will be Fair and Reasonable: The previous contract was a first of its kind at the VA. Only two contracts are available to compare pricing, the previous contract 36C24119C0024 and VA Charleston 36C24721P0799 (Which was modeled after the previous contract. The contract start date is anticipated to be 2/1/2024.

During the previous contract, the prices increased each option year, and it is anticipated that the new requirement will be similar with annual increases. The contract quantities will be increased prior to award, to be as realistic as possible using previous contract data, since the original contract quantities were increased several times during the life of the previous contract. The pricing will be negotiated with the vendor. The prices after negotiation attempts will be considered fair and reasonable.

8. Description of the Market Research Conducted and the Results, or a Statement of the Reasons Market Research Was Not Conducted: Market research was conducted. A search on VIP using the NAICS in Massachusetts revealed no potential SDVOSB/VOSB vendors. A VetCert search using the NAICS revealed 104 possible SDVOSB/VOSB vendors, of these only one is in Massachusetts. This one vendor specialized in bulk data and API services. An SBA DSBS search using NAICS in Massachusetts revealed 5 potential SB vendors. Of the 5 vendors, one is the incumbent, and 4 others.

The 3 others SB vendors were emailed to see if they could meet this requirement resulting in no responses. A sources sought notice was posted for 2 weeks, which resulted in only one response from SDVOSB vendor Global Resolutions, Inc of Hamilton, TX. The customer reviewed the response and determined that the vendor is ineligible because they are not located in the Boston area and are a staffing company. Due to potential occasions where vendor must meet with the veteran and family in person at bedside in the VA hospital. During most veteran appointments, the vendor converses with veterans via Microsoft teams from government issued laptop. The customer is requesting a sole source to the incumbent SB vendor DBA Symphony Application Specialists based on the VA potentially losing approximately $1 million in lost time and detrimental effect on veterans losing valuable hospital beds. At this time, the rule of two could not be met for SDVOSB/VOSB vendors. At this time, the rule of two could not be met for SB vendors. It is in the best interest of the government to sole source to Symphony Application Specialists based on the nature of this requirement.

9. Any Other Facts Supporting the Use of Other than Full and Open Competition: This requirement must meet with veterans and families regularly in person to collect data for Medicaid application services, therefore the vendor must reside in a reasonably proximity to the VA BHS, MA.