JA_36C79119D0005 P00003_36C79119D0006 P00013_Urgent Care R2 and R3 FINAL_Redacted.pdf

JUSTIFICATION AND APPROVAL

FOR OTHER THAN FULL AND OPEN COMPETITION

PURSUANT TO FAR SUBPART 6.302-1(a)(2)

1. Contracting Activity: Department of Veterans Affairs (VA) Office of Procurement, Acquisitions, and Logistics (OPAL) Strategic Acquisition Center (SAC) 10300 Spotsylvania Ave Suite 400 Fredericksburg, VA 22408

2. Description of Action:

This class Justification and Approval (J&A) is to execute modifications to firm-fixed-price contracts, Community Care Network (Region 2) 36C791-19-D-0005 and (Region 3) 36C791-19-D-0006 awarded on December 28, 2018 with Optum Public Sector Solutions, Inc. (Optum) (large business) 800 King Farm Blvd, Ste 500, Rockville, MD 20850. The scope of this modification implements Section 105 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018. The Veterans Community Care Program (VCCP) includes specific healthcare elements that pertain to

Veterans Health Administration (VHA) delivering medical care to Veterans. Section 105 of the MISSION Act, as codified in 38 U.S.C. §1725A, Access to Walk-In Care, establishes that the Secretary shall develop procedures to ensure that eligible Veterans are able to access walk-in care from qualifying non-Department entities or providers. This modification implements 38 U.S.C. §1725A by extending access to medical care and select services to eligible Veterans. The modification will ensure availability of Urgent Care and services which will enhance the quality of care provided to Veterans under the existing awarded contracts referenced above.

3. Description of the Supplies or Services:

The services to be acquired, Access to Urgent Care, also referred to as Urgent and Walk-

In Care (UC), ensures access for eligible veterans enrolled in the healthcare system throughout Regions 2 and 3, encompassing 25 States and U.S. Territories (North Carolina, Ohio, Kentucky, Indiana, Illinois, Missouri, Kansas, Nebraska, Iowa, Wisconsin, Michigan, Minnesota, North Dakota, South Dakota, Oklahoma, Arkansas, Louisiana, Tennessee, Mississippi, Alabama, Georgia, South Carolina and Florida, Puerto Rico and U.S. Virgin Islands). In addition to accessibility, Veterans will now experience continuity of care which includes a mechanism to not only receive medical records from their walk-in care experience, but also provide providers access to pertinent patient medical records to facilitate the right medical treatment. In addition, it will drive updates to eligibility information, claims processing and provider training and education for UC providers on Veteran's eligibility and medical documentation submission to Veteran Affairs Medical Center (VAMC).

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(a)(2) entitled, "Only one responsible source and no other supplies or services will satisfy agency requirements."

5. Rationale Supporting Use of Authority Cited Above:

In accordance with 38 U.S.C§1725A SEC. 105. Access to Walk-In Care, the Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non-Department entities or providers. The authority for procuring this effort is 38 U.S.C. 8153, Sharing of Healthcare Resources; and 48 CFR Part 873, Simplified

Acquisition Procedures for Healthcare Resources.

In accordance with FAR 6.302-1(a)(2), Optum is the only reasonable source to implement the MISSION Act Section 105 Urgent Care requirements. Optum is currently providing

Urgent Care services under the VA Community Care Network (CCN) for Region 1 and will leverage its call center services, network operations, Information Technology (IT) in CCN

Regions 2 and 3. Utilizing Optum to provide Urgent Care services in Regions 2 and 3 provides Veterans with the greatest opportunity for continuity of care, which will improve clinical outcomes. If a new contractor is awarded Urgent Care for Regions 2 and 3, there will be various negative impacts to VA such as increase in cost, delay in providing healthcare, and inability to provide consistent healthcare because of a bifurcated approach to healthcare services, causing non-adherence to the Mission Act.

Under Region 1, Optum’s provides a dedicated UC call center. This call center includes staff that handles incoming and place outgoing calls by phone to include video capability, perform research, confirm Veteran eligibility and supports the UC pharmacy process.

Creating and managing a new call center for UC CCN under Regions 2 and 3 would greatly impact auditing efforts, require new operational processes, and will need additional hiring and training causing further delays to Veterans healthcare services. The Government will pay an increased cost to bring in a new contractor for call center services that are currently operational instead of using opportunities where resources can be immediately leveraged.

Optum’s Network Operations is responsible for accurate and timely upload of network provider files and maintenance of provider records throughout the life of the contract. A new contract would hamper VA’s ability to retain or use current providers under Optum, causing confusion for Veterans and VA staff. The time required for a new contractor to demonstrate to VA they are postured and capable of acquiring multiple, committed providers in their network, to perform and fully provide services to cover Regions 2 and 3, despite any delays or complications related to business operations during the national COVID-19 pandemic where resources and providers are currently limited, may cause additional delays to healthcare for Veterans. A new network will also impact UC processes causing a strain on

VA staff and has the potential to impact Veterans care, data, and positive clinical outcomes.

Optum’s Region 1 Information Technology validates providers UC referrals, process claims, provides customer relationship management and provides enhancements to database schema amongst other functions. Optum’s IT solution is applicable to all regions at this juncture and VA is able to leverage the same functionalities under Regions 2 and 3 without duplicating cost or additional time to develop new processes, create eligibility file links, or confirm data transfer. Using Optum’s current IT system reduces any cost that would take months to develop, test and implement with a new contractor.

Continuity of Care for Veterans is also a huge concern for VA. Veterans that live along the geographical border of Region 1, will be impacted by divided processes resulting in delays in care and potential cost impacts directly to Veterans. Secondly, Veterans would receive healthcare services from a non-CCN provider. Therefore, there is no guarantee that communication or medical documentation would be properly returned back to VA or to the

Veterans CCN primary care provider using a secure system or in a timely manner causing further delays in appointments and overall care. VA would need to establish new clinical quality requirements, that may not align or provide the same level of clinical quality oversight as CCN. Lastly, Veterans would not receive acceptable follow-up care. If care was provided by CCN previously, the new contractor would have to submit the patient/referral directly to VA. This delay in process impacts the Veterans access to follow-up care causing VA to review and adjudicate the request before they could refer to another

CCN provider.

Overall, the Department of Veteran Affairs would expend duplicate and unnecessary costs for any other contractor to build, staff, provide training and implement new processes and systems if the UC requirement is awarded to any other contractor. In addition, the inability to leverage cost and capabilities across Regions 1-3 would discontinue continuity and negatively impact to Veteran Care. The UC modification is specifically being executed to address UC access and to adhere to the legislation required by the Mission Act timely. The current requirement under PC3 expires in the first quarter of FY21 and the costs to extend while a separate contract is competitively solicited for UC Regions 2 and 3, significantly surpasses the cost to execute the modification to include UC requirement into the existing

Regions 2 and 3 IDIQ contract and would negatively delay healthcare services for our nations Veterans.

6. Efforts to Obtain Competition:

Market research was conducted as set forth in paragraph 8 of this document, and those efforts did not yield any additional sources that can meet the Government's requirements.

Urgent Care requirement includes a variety of benefits such as flu shots and provides immediate medical service offering outpatient care for the treatment of acute and chronic illness or injury. Additionally, finding suitable competition to implement a robust network and to deploy Urgent Care services without substantial duplication of cost that could not be expected to be recovered through competition and undue risk or delay to our nations

Veterans in a timely manner was not concluded.

This justification will be published on Contract Opportunities under beta.sam.gov page in accordance with FAR 6.305(c).

7. Determination of Fair and Reasonable Price: In accordance with FAR 15.404-1 (b)(2), the Government may use various price analysis techniques and procedures to ensure a fair and reasonable price before making any award.

8. Market Research:

Market research was conducted to ensure no other contractor could fulfil the Urgent Care requirement. VetBiz databases (IAW VAAR 810.001-70) was queried on June 10, 2020 using keywords "managed healthcare" and NAICS code 524114, VetBiz resulted in total of

30 Service-Disabled Veteran Owned Small Businesses (SDVOSBs) and Veteran Owned

Small Businesses (VOSB). Each contractor's website was reviewed, and it was determined that the contractor's capabilities were not within the scope of this requirement. Additionally, GSA e-library databases query (IAW VAAR 810.001-70) was queried on June 10, 2020 using keywords "managed healthcare" and NAICS code 524114, this search resulted in 4 vendors under the title Professional Services Schedule. The published schedules were reviewed, and it was determined that the contractors’ capabilities were not within the scope of this requirement. Furthermore, A query of Dynamic Small Business Search (DSBS) was completed on June 18, 2020 (IAW VAAR 810.001-70) using NAICS code 524114 and key words “managed healthcare” resulted in zero contractors who could meet the scope, size and cost of the Urgent Care requirement .

9. Any other facts supporting this Justification:

In June of 2018, the MISSION Act of 2018 law was passed in order to give Veterans greater access to health care in VA facilities and the community, expand benefits for caregivers, and improve VA's ability to recruit and retain the best medical providers. The original contract was not designed with the MISSION Act of 2018 in mind and, as a result, the contract must be modified.

VHA is home to the United States' largest integrated health care system consisting of 152 medical centers, over 850 community-based outpatient clinics, community living centers, Vet Centers and Domiciliaries. Together, these health care facilities and the more than 53,000 independently licensed health care practitioners who work within them provide comprehensive healthcare to more than 8.3 million Veterans each year. VHA provides methods to access community based medical care to eligible Veterans when VA facilities are not available. Federal laws, which set forth eligibility criteria, govern the use of community based medical care and other policies that specify when and why care may be used. Prior approval for treatment in the community is required for community based medical care unless the medical event is an emergency. VHA continues to spend over $10 billion per year purchasing healthcare services in the community, through a variety of methods to include fee-for-service, individual provider agreements as authorized by law, local contracts and national contracts. Any delay in the procurement of the MISSION Act Section 105 Urgent Care requirement would greatly impact the quality and continuity of medical care and services throughout the VA network.

Optum Public Sector Solutions, Inc., was ultimately awarded contracts 36C791-19-D0005 and 36C791-19-D0006, known as Community Care Network (CCN) contracts for Regions 2 and 3 in December 2018 and established healthcare delivery by June 22, 2020. The requirement was originally solicited under the policy in effect at that time. Had the agency canceled the requirement and/or delayed negotiations in June 2018, the risk of not having a supporting contract in place ahead of the CCN award would have been catastrophic. If the supporting acquisitions for the CCN contracts were not awarded in a timely manner, the operation of the United States' largest integrated health care system would have been crippled. To mitigate this risk, the agency determined it was in the best interest of 8.3 million Veterans to continue with award.

10. Listing of interested sources:

Optum Public Sector Solutions, Inc. (Optum)

800 King Farm Blvd, Ste 500

Rockville, MD 20850

11. Actions to Increase Competition:

At this time there are no other actions that can be taken to increase competition. The requirement for Urgent Care, and related services is consistent with the VCCP authorized by the MISSION Act of 2018. 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. All future requirements will be handled on a case-by-case basis to determine any future acquisition strategy.

12. Technical and Requirements Certification:

I certify that the supporting data under my cognizance, which form the basis of and are included in this justification, are accurate and complete.

Tom Grahek 8/18/2020 Name Date

Director Provider Relations & Services

Title Signature

13. Administrative Contracting Officer Certification:

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

Joy Garrett-Bey 08/25/2020 Name Date

Joy R. Garrett-Bey

Digitally signed by Joy R. Garrett- Bey 1538064

Contracting Officer 1538064 Date: 2020.08 25 08:27:24 -04'00'

Title Signature

THOMAS A. GRAHEK

684709

Dig tally signed by THOMAS A. GRAHEK 684709

Date 2020.08.18 15 47 08 -04'00'

Approval

Based on the foregoing justification, I hereby approve the out-of-scope modification to implement Section 105 of the MISSION Act, as codified in 38 U.S.C. § 1725a SEC 105

Access to Walk-in Care, which establishes that the Secretary shall develop procedures to ensure that eligible veterans are able to access walk-in care from qualifying non- Department entities or providers of contracts 36C791-19-D-0005 and 36C791-19-D-0006 with Optum Public Sector Solutions Inc., in the estimated amount of for

Region 2 and for Region 3, for combined estimated value of on an other than fair opportunity basis, pursuant to the authority cited in 41

U.S.C. § 3304(a)(1) as implemented by the Federal Acquisition Regulation (FAR) Subpart 6.302-1(a) (2) entitled, "Only one responsible source and no other supplies or services will satisfy agency requirements", subject to availability of funds, and provided that the services herein described have otherwise been authorized for this acquisition.

Date: Signature:

Phillip W. Christy

Head of Contracting Activity

Office of Procurement, Acquisition, and Logistics

Christy, Phillip

Digitally signed by Christy, Phillip Date: 2020.09.02

08:50:01 -04'00'