HT001124C0011 GNAL 12-Mon Bridge JA-24-0059B Redacted.pdf

Status: Approved Cancel: No FOR OFFICIAL USE ONLY - Source Selection Information – See FAR 2.101 and 3.104

Justification and Approval (J&A) for Federal Acquisition Regulation (FAR) Subpart 6.3

Other Than Full and Open Competition Title: Global Nurse Advice Line J&A Number: JA-24-0059B Created By: Additional POCs:

1. Identification of the agency and contracting activity:

Professional Services Contracting Division

Defense Health Agency (DHA), Directorate of Procurement (DoP), Professional Services (PS) Contracting Division (CD), 7700 Arlington Blvd., Falls Church, VA 22042

2. Nature and/or Description of Action being Approved:

new contract Individual

Approval is being requested to award a Firm-Fixed Price (FFP) bridge contract for a 12-month period of performance consisting of one (1) 4-month base period and eight (8) one-month option periods including a six-month extension of services option to support the existing Global Nurse Advice Line (GNAL) level of effort.

Approval is being requested for a bridge with the incumbent – C to conduct work that is currently being performed under contract number HT001123C0072. The current contract provides professional services for the Defense Health Agency (DHA), Deputy Assistant Directorate (DAD) Healthcare Operations (HCO) and is expiring on 17 March 2024. The 12-month GNAL bridge effort will provide a short-term solution and prevent a gap in critical support to Tricare beneficiaries with the ultimate goal of awarding a long-term 5-year solution by 1 October 2024. This sole source bridge contract does not provide for new work.

3. Description of Supplies/ Services:

The contractor provides professional telehealth nurse triage services to all TRICARE beneficiaries across the globe 24/7/365. The GNAL provides services and personnel required to perform the requirements delineated below to include:

a.Continuous telehealth registered nurse triage based on evidence-based guidelines, algorithms or protocols to direct patients to the most clinically appropriate level of care including self-care, urgent care, and emergent care.

b. Specified Military Treatment Facility (MTF) appointing services,

c. Customized MTF transfers to support the MTF's capabilities,

d. Civilian TRICARE authorized urgent care referral services,

e. Civilian network provider and MTF locator support services, and

f. Customer service.

1) GNAL services and capabilities include: Services shall include customized internal processes to direct callers based on their beneficiary status (Active Duty, Active Duty Family Member, Retiree, and Retiree Family Member) and TRICARE health plan. More information on TRICARE health plans can be found at: http://www.tricare.mil/Plans/HealthPlans.aspx

2) Other capabilities include the ability to provide real time information sharing, business intelligence, reporting, and archiving of documented call encounters at a corporate, regional, and local level and interoperability with existing military applications and systems to include the Defense Enrollment Eligibility Reporting System (DEERS) and MHS GENESIS. Interoperability includes: 1) Using DEERS to verify caller eligibility to use the service, 2) Accessing Military Health System (MHS) GENESIS to make appointments with callers' Primary Care Manager, Primary Care Team, or Primary Care Clinic or submitting TRICARE authorized urgent care referrals, and documenting caller information, triage notes.

3) Eligible MHS beneficiaries shall access the GNAL, if they are physically located within the United States, by calling 1-800-TRICARE (1-800-874-2273), option 1. Once the MHS beneficiary selects option #1, the call will be transferred to the contractor's supplied telephone number. Services shall include toll free telephone phone numbers for the international countries listed below, or any other country with an established MTF.

i. Italy

ii. United Kingdom

iii. Germany

iv. TurkeyB

v. Belgium

vi. Bahrain

vii. Spain

viii. Greece

iv. Cuba

x. Puerto Rico

xi. Japan

xii. South Korea

xiii. Guam

TOTAL Contract Value

POP: From 3/18/2024 to 9/17/2025

Estimated Value

BASE

POP: From 3/18/2024 to 7/17/2024

Estimated Value

Type of Contract (Primary):

FAR 16.202 Firm-Fixed-Price

Options: Yes

Number of Options: 8

POP (All options): From 7/18/2024 to 3/17/2025

Estimated Value (all options):

Funding Type:

Operations & Maintenance (O&M)

Extension of Services: Yes

Clause: FAR 52.217-8 Extension of Services Option

Estimated Value:

Number of Months: 6

The 12-month bridge contract will be awarded to for a 4-month base period effective from 18 March 2024 to 17 July 2024 esimated at and eight

(8) 1-month option periods from 18 July 2024 to 17 March 2025 estimated at . In addition, if necessary, an up to 6-month extension of services option may be exercised from 18 March 2025 to 17 September 2025 estimated at . The total estimated value for the 18-month bridge is . FY24 Operations and Maintenance funds will be utilized for the 4-month base period and the first three (3) 1-month option periods from 18 July 2024 to 17 October 2024. FY25 Operations and Maintenance funds will be utilized for the remaining five 1-month options from 18 October 2024 to 17 March 2025 on this bridge contract.

4. Statutory and Regulatory Authority Permitting Other Than Full and Open Competition (see FAR 6.302), or the Specification of the Statutory and Regulatory Provision Providing Exception to 8(a) Program Competitive Requirements (see FAR 19.805-1):

10 U.S.C. 2304(c)(1) 6.302-1 -- Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements

5. Rationale Justifying Use of the Statutory Authority Cited:

Based on the authority of Federal Acquisition Regulation (FAR) 6.302-1(a) (2) (iii) for DoD, services may be deemed to be available only from the original source in the case of follow-on contracts for the continued provision of specialized services when it is likely that award to any other source would result in unacceptable delays in fulfilling the agency's requirements. The incumbent, possesses the operational infrastructure and knowledge required for successful performance. The contractor can continue to provide the support required during this bridge without a loss of efficiency and negative impact to GNAL functions. These services must continue uninterrupted in order to meet the needs of our TRICARE beneficiaries and avoid unacceptable delays in fulfilling the agency's requirements.

The Healthcare Optimization Division (HOD) have conducted Market Research and are finalizing the acquisition strategy/acquisition plan for the long-term recompete of this effort. Additional time is required, due to changed circumstances, to finalize the pre-solicitation documents, conduct Industry Day, finalize the PWS, issue the Request for Proposal (RFP), evaluate proposals, and award the new contract.

The COVID-19 pandemic resulted in multiple periods of time in which the call demand to the GNAL outpaced the contracted capacity. The excess calls resulted in a need to either increase capacity and/or a request for equitable adjustment when the demand had not been foreseen. With the next contract, it attempts to decrease the risk to the government if unforeseen circumstances should result in surge of calls to the GNAL.

The GNAL provides 24/7 services for TRICARE beneficiaries. Failure to fund GNAL would result in a gap in services. It would lead to non-compliance with the FY16 National Defense Authorization Act (NDAA) Section 725. Continued growth in purchased care spending for more expensive, fragmented, and episodic healthcare. It would also lead to variability and lack of standardization within Services and MTFs in delivering 24/7 urgent care advice and nurse triage resulting in an inconsistent patient experience for our TRICARE beneficiaries. Although there are other sources available that can meet the Government's requirements, none would have the infrastructure or expertise available to support the services needed for the GNAL without significant delays, lead-time, incurred costs, duplication of efforts, and substantial investments of time and resources by the Government.

6. Efforts to Obtain Competition:

A notice of contract action under this approval for other than full and open competition will be synopsized in accordance with FAR Subpart 5.2. Bids, proposals, or quotations have not been solicited from additional sources for the reasons specified in paragraph five above and paragraphs eight and nine below; however, a request for proposal is still being drafted for the long-term re-compete.

Upon issuance of the RFP, evaluation and completion of the source selection process a new contract will be awarded. The bridge contract extension under this approval for other than full and open competition will be synopsized in accordance with FAR 5.3.

A Request for Information Waiver for the GNAL Bridge effort was approved on February 22, 2024 and is attached herein.

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

The anticipated cost to the Government for the 12-month bridge contract will be reviewed for fair and reasonable pricing based on a comparison and price analysis between the offeror’s pricing and pricing from the Independent Government Cost Estimate (IGCE) created utilizing historical knowledge. In addition, negotiations with will be conducted in order to achieve a fair and reasonable price.

8. Market Research:

Market Research Conducted? Yes When was it conducted? 12/15/2022 to 12/20/2022 Description:

The Government conducted market research as a routine course of action in pursuit of a logical follow-on contract. Research gained through the Market Research indicated an unrestricted solicitation is a viable and competitive option to procure the requested services. However, due to extensive and significant changes to the GNAL requirements to include in-sourcing telehealth nursing support, the Government now anticipates award of new GNAL contract by 1st Quarter FY25.

Market research was conducted by the GNAL Integrated Product Team (IPT) to identify potential vendors who possess the ability to provide GNAL service to MHS beneficiaries and to discover any new innovations. Along with industry familiarity, known competitors, procurement history, and gathered information from the capability statements, the IPT plans to use the information which determined the government’s ability to issue an unrestricted solicitation. The DHA’s market research began by submitting a market research notice emailed to 15-20 potential sources identified from past procurements from the Small Business Administration (SBA) small business dynamic website. The notices were issued from December 15-27th 2022, in which eleven vendors responded.

After reviewing the vendors’ responses, the IPT conducted a review of the capability statements and review of government resources such as Contractor Performance Assessment Reporting System (CPARS), FPDS-EZ Search, and SAM.GOV.

The IPT looked specifically for the following capabilities:

• Past Performance

• Nurse triage experience

• Process flow

• MTF appointing services

• Information sharing and business intelligence reporting and archiving abilities

• Health Call Center Accreditations

• Staffing qualifications

• Company’s use of subcontractors

Federal and Department of Defense procurement and performance history:

Government Wide Acquisition Contract (GWAC) - 8(a) Streamlined Technology Acquisition Resource for Services (STARS) III, which is publicly available Indefinite Delivery Indefinite Quantity (IDIQ), contracts that ANY federal agency can order task orders (services or supplies) from Small Business Opportunities:

In review of the capabilities, some of the vendors who expressed interest did not have any experience with nurse triage. Some of the vendors had no experience with call centers and were primarily interested in providing program management services. There appears to be limited opportunity for a small business to sustain and perform successfully given the magnitude of the requirement. Of the eleven responses received to the market research, four were identified as small businesses. Only Fonemed, a Small Business, was found to have met the technical requirements; however, the team could no t conclude any government past or current performance.

Based on the market research results and procurement history, the solicitation for the follow-on contract will be a full and open unrestricted competition. There were not two or more responsible small business concerns capable of meeting the government’s needs.

Based on the feedback received from the market research, the Global IPT members determined that a small business would be incapable of delivering GNAL services to the 9.4 million MHS beneficiaries, without partnering with larger companies to perform the majority of the work. The GNAL must be able to seamlessly integrate into our healthcare system to ensure a consistent patient experience. It requires the contractor to possess the capability to provide standardize telehealth nurse triage services with the ability to customize MTF appointing and hand off services on a grand scale. Therefore, the GNAL requirements cannot be segmented to include opportunities for small businesses.

Conclusions and Recommendations:

Based on the market research and current experience, a full and open unrestricted solicitation is a viable and competitive option to procure the requested services.

Market Research Techniques Used:

Formal email submitted to multiple vendors from December 15, 2022, through December 27, 2022. Additionally, a querying of General Services Administration (GSA) for contracts, vendors, and other procurement instruments intended for use by multiple agencies available at www.GSAadvantage.gov and other Government and commercial databases that provide information relevant to agency acquisitions per FAR 7.102(a), FAR Part 10. Techniques/methods used were adequate to establish the capability of potential sources to meet the Government's needs because like services were identifiable and current market rates were available.

Competition:

DHA PS-CD intends to compete the new GNAL requirement as full and open to all eligible vendors on SAM.gov. A pre-solicitation and solicitation will be posted via System for Award Management (SAM), the government point of entry, as to promote competition and include industry participation to the maximum extent practicable. All vendors with the applicable NAICS Code 541990 will be eligible to compete.

In addition, an industry day has been planned and will be conducted in early March 2024 to invite interested sources to participate and provide feedback regarding technological advances/solutions to improve the quality of the GNAL services to include Artificial Intelligence (AI) technology.

9. Other Facts:

a) Historical data. This contract was previously awarded to . The issue date of solicitation for HT0011-17-C-0017 was December 16, 2016. The contract was awarded on September 17, 2017. The six-month transition period was from September 17, 2017- March 17, 2018. The start of healthcare delivery was on September 18, 2018. The first option year was exercised in March 2019. Contract HT001117C0017 was a 5-year contract with a period of performance from September 17, 2017 to onth period of performance consisting of a 3-month base period effective March 18, 2023 to June 17,2023. In addition, three 3-month options periods have been exercised from June 18, 2023 to March 17,2024.

10. Interested Sources:

11. Actions to overcome barriers:

A long-term FFP contract is currently in the pre-solicitation phase. It is anticipated that the Request For Proposal will be issued in late 2nd Quarter FY24 with an estimated award date of the follow-on contract in early 1st Quarter FY25.

Coordination & Approval

12. Technical/Functional Representative:

I certify that the information provided in this justification is accurate and complete to the best of my knowledge and belief.

Name: Title: Contracting Officer Representative

Approved: - 14 Feb 2024, 07:50:34

Comments:

13. Requirements Certification:

I certify that the information provided in this justification is accurate and complete to the best of my knowledge and belief

Name: Title: Chief, Healthcare Operations

J-Directorate Office: HC Operations (J10), HC Optimization Division, Integrated Referral Management and Appointing Center (IRMAC) Branch

Approved: - 20 Feb 2024, 15:08:25

Comments:

14. Fair and Reasonable Cost Determination:

Current contract prices will be utilized for determination of fair and reasonable pricing. The IGCE and knowledge of the Contracting Officer will further support this decision. In addition, price negotiations will be conducted in order to achieve a fair and reasonable price. Certified cost and price data is not required for this contract subject to exception in FAR 15.403-1 (c)(3).

I have determined that the anticipated cost to the Government for this contract action is fair and reasonable.

I have determined that the anticipated cost to the Government for this contract action is fair and reasonable.

Name: Title: Contracting Officer, Professional Services Contracting Division

Approved: - 20 Feb 2024, 16:31:07

Comments:

15. Legal Review:

I have reviewed this justification and have found it to be legally sufficient.

Name: Title: Office of General Counsel

Approved: - 21 Feb 2024, 14:13:34

Comments:

16. Contracting Officer:

I certify that this justification is accurate and complete to the best of my knowledge and belief.

I certify that this justification is accurate and complete to the best of my knowledge and belief.

Name: Title: Contracting Officer, Professional Services Contracting Division

Approved: - 21 Feb 2024, 14:34:12

Comments:

17. Competition Advocate: Based on the foregoing justification, I hereby approve the procurement of Global Nurse Advice Line on an other than full and open competition basis pursuant to the authority of 10 U.S.C. 2304(c)(1) 6.302-1 -- Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements, subject to availability of funds, and provided that the supplies and/or services herein described have otherwise been authorized for acquisition.

Name: Title: Competition Advocate (DAD-P&C)

Approved: - 23 Feb 2024, 07:58:22

18. Head of Contracting Activity (or designee): Based on the foregoing justification, I hereby approve the procurement of Global Nurse Advice Line on an other than full and open competition basis pursuant to the authority of 10 U.S.C. 2304(c)(1) 6.302-1 -- Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements, subject to availability of funds, and provided that the supplies and/or services herein described have otherwise been authorized for acquisition.

Name: Title: Head of the Contracting Activity (HCA) (DAD-P&C)

Approved: - 23 Feb 2024, 10:19:34

Comments:

19. Director of Defense Health Agency, Senior Procurement Executive: Based on the foregoing justification, I hereby approve the procurement of Global Nurse Advice Line on an other than full and open competition basis pursuant to the authority of 10 U.S.C. 2304(c)(1) 6.302-1 -- Only One Responsible Source and No Other Supplies or Services Will Satisfy Agency Requirements, subject to availability of funds, and provided that the supplies and/or services herein described have otherwise been authorized for acquisition.

Name: Title: Senior Procurement Executive (SPE)

Approved: - 27 Feb 2024, 11:51:00

Comments:

Request for Bridge Action Approval J&A Tracking Number: JA-24-0059B

Date: 2/13/2024 CAE #: 20240208-022614

Contract Information - Bridge Action Contractor Name:

Procurement Instrument Identifier (PIID): HT001124R0017

Period of Performance: From 3/18/2024 to 9/17/2025

Contract Type: FAR 16.202 Firm-Fixed-Price

Contracting Officer

Contracting Office: Professional Services Contracting Division

Program Manager/Project Officer/COR:

Program Office (JDIR): HC Operations (J10), HC Optimization Division, Integrated Referral Management and Appointing Center (IRMAC) Branch

Contract Information - Predecessor Contract(s) J&A Tracking No. (if applicable) PIID Number Contractor Name Duration (Months)

JA-23-0098B HT001123C0072 12

Bridge Action Background Reason for Bridge Action: Late Acquisition Planning Documents

RFI Completed: No

Waiver Needed: Yes

Bridge Action Duration (months, to include FAR 52.217-8, Option to Extend Services) 18

Anticipated Award Date for Follow-on Contract (i.e., Competitive Follow-on Acquisition, not the Bridge Action)

10/1/2024

Previous Bridge Action? Yes

Number of Prior Bridge Actions: 1

FUNDS

Total Amount of Funds - Previous Bridge Action (if applicable):

Total Amount of Funds - This Bridge Action Request:

Total Amount Spent - This Scope of Work:

Total Cost Variance (+/-): %

Funding Type: Operations & Maintenance (O&M)

Funding Fiscal Year: 24

PROGRAM RISK IMPACT

Risk Scale of Importance: Critical

Impact if Not Executed:

The GNAL provides 24/7 services for TRICARE beneficiaries. Failure to fund GNAL would result in a gap in services and lead to non-compliance with the FY16 NDAA Section 725. Many of our military medical treatment facilities do not provide 24/7 services. Without the GNAL to call after-hours, these beneficiaries may elect to go to an emergency room or urgent care center for simple things that could have been treated at home. Over half of the call volume to the GNAL can be handled with self-care and patient education assistance. Additionally, a negative impact to not having GNAL services would result in a continued increase in purchased care spending for more expensive, fragmented, and episodic healthcare. In addition, the variability and lack of standardization within the Armed Services and MTFs in delivering 24/7 urgent care advice and nurse triage would result in inconsistent patient experiences for our TRICARE beneficiaries.

Impact if Executed to a Lesser Amount (Scalability):

Executing to a lesser amount would adversely affect meeting the needs of the TRICARE beneficiaries. Each of the CLINs on the contract are vital to the service. However, contract negotiations will be conducted in order to obtain a fair and reasonable price.

Mitigation Strategy for Preventing Further Bridge Actions:

At the present time, efforts are in progress for the follow-on contract for the GNAL. Market Research Report is being finalized to include a planned industry day and RFI. In addition, the pre-solicitation documents are being finalized for approval in order to issue the solicitation for a long-term 5-year contract by late 2nd Quarter FY24. The future GNAL program is in the planning phases to revamp the GNAL requirements using Digital Front Door capabilities under the Virtual Health (VH) platform which cannot be accomplished in the time remaining before this support expires on 17 March 2024 nor can the long-term recompete effort incorporate these changes at time of estimated award. The VH Platform solution will take at least 2 years to come to fruition.

REVIEWING OFFICIALS/APPROVAL AUTHORITY

Program Manager or Functional Service Manager Name:

Approved: - 14 Feb 2024, 07:51:25

Program Director Name:

Approved: - 21 Feb 2024, 13:22:34

Comments:

Contracting Officer Name:

Approved: - 21 Feb 2024, 14:34:21

Comments:

Chief, Contracting Office Name:

Approved: - 21 Feb 2024, 16:24:03

Comments:

Head of the Contracting Activity Name:

Approved: - 23 Feb 2024, 10:19:48

Comments:

Senior Procurement Executive Name:

Approved: - 27 Feb 2024, 11:51:05

Comments:

Attachments GNAL 1-Yr Bridge RFI WAIVER 20240208-022614 revised 20240222_HCA SIGNED.pdf Delete GNAL One-Year Bridge JA-23-0098B Appvd.pdf Delete GNAL One-Year Bridge JA-23-0098B BAAR Appvd.pdf Delete

Version: 599.0 Created at 1/8/2024 10:57 AM by Last modified at 2/27/2024 3:59 PM by Workflow on behalf of

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