JA Exception to Fair Opportunity 4.15.25 Signed.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: Practice Improvement and Quality Measures Management Support (PIQMMS) Task Order for the Quality Payment Program (QPP)

Agency: Health and Human Services (HHS)/Centers for Medicare & Medicaid Services

(CMS)

Acquisition Year: 2025

Author: Heather Parr-Stewart Lang (CS) and Scott Filipovits (CO)

1. Description of Action:

A. Nature

New Requirement

Follow-On Order

Modification of Existing Purchase Order / Contract Number

B. Order Against Multiple Award IDIQ Contract Measure and Instrument Development and Support 75FCMC18D0025 Task Order 75FCMC25FJ027

C. Contract Type

Firm-Fixed Price Time and Materials

Cost Plus Fixed Fee (CPFF)

Term Completion

Cost Plus Award Fee (CPAF)

Other:

D. Projected Cost / Price of contract (Base & All Options): $3,600,000

E. The total estimated value of the proposed sole source action (for modifications only):

n/a

F. Funding Source (s): FMIB# 013013 – 0511: Program Operations_Direct:Disc - Program Support and Service Center-Non IT Portion- $3,600,000

G. Basis for Approval (Far 6.303-1(d))

Individual Basis

Class Basis

The purpose of this task order is to provide for the continuation of PIQMMS services during a protest. The PIQMMS task order was awarded on July 25, 2024 to Acumen.

On August 5, 2024, a protest was filed by General Dynamics Information Technology (GDIT) and a Stop Work Order was issued on August 13, 2024. CMS decided to take voluntary corrective action in response to the protest and on August 21, 2024, issued a six (6) month extension on the legacy task order(75FCMC18D0025 75FCMC19F0088) to avoid a lapse in service on the critical work. The extension was issued as Option Period 5 per FAR 52.217-9 and no further extensions are permissible.

On February 20, 2025, the corrective action was completed, and the Task Order (75FCMC25FJ027) was awarded to GDIT reversing the original decision. On March 3, 2025, Acumen filed a protest of the revised award decision.

Without the support from this contract, CMS will face serious ramifications due to non-compliance with the statutory requirements, as well as pose a negative impact to clinicians' annual payment adjustments. The contractor assists clinicians and other health care entities reporting data for incentive payments through the quality payment program. This contract has several key elements that must continue:

1. Support for clinicians reporting data used to calculate incentive payments. This work has a deadline of March 31, 2025.

2. Respond to service center tickets from clinicians requesting assistance.

a. There is currently a backlog of tickets which CMS expects will continue to increase. Without a contractor in place, clinicians will not receive the support necessary to meet the reporting deadline.

b. If support is not available and clinicians are unable to submit data, it will impact incentive payments.

c. The data is used by CMS to calculate quality improvement metrics which are linked to reimbursement.

3. The data submitted by clinicians is also used to formulate/calculate quality measures used for incentive payments in future years.

a. Failure to provide the support today will negatively impact the development of those quality measures and may result in CMS missing the statutory reporting deadline for the Calendar Year 2026 Physician Fee Schedule.

The work cannot be completed by CMS staff during this period due to significant volume of tickets and the other statutory required work being completed by staff. As a result, the impact of not having this task order in place includes:

1. The fast-approaching data submission deadline impacts both MIPS and Medicare

Shared Savings Program (SSP) data submission requirements which can impact clinicians' MIPS final scores, ultimately impacting payment adjustments, and SSP accountable care organizations’ (ACOs’) shared savings calculations.

2. Impacts to MIPS eligible clinicians, CMMI APM participants, and SSP ACOs.

With the development, evaluation, and maintenance of measures for MIPS, APMs, and SSP ACOs on pause, the identification of changes to measures and activities that need to be proposed and finalized in the CY2026 Physician Fee Schedule rule is delayed.

3. Pausing statistical analysis, benchmark methodology, and other analysis which identifies gaps to ensuring consistent and measurable performance across the board, could cause meaningful distinctions and improvements in performance to no longer be made. This does not leave any opportunity for continued improvement to drive quality improvement in areas where such improvement is possible and necessary.

4. The development and maintenance of additional MVPs for specialties deliver more value to physicians who participate in MVPs as well as their patients and significantly reduces provider burden. These MVPs provide clinicians with a more meaningful way to participate in the program by offering clinically relevant metrics that are directly in line with their clinical practice. Not issuing the TO will hinder CMS’ ability to investigate ways to tie billing claims to clinicians’ annual payment adjustment. This can negatively impact QCDRs and Qualified Registries.

The total value of the February 2025 award to GDIT was $35,945,921 with $7,107,793 obligated for the base year.

CLIN/SLIN Description POP Cost Fixed-

Fee Total CPFF

Funded Amount

CLIN 0002 Base Period February 23, 2025, to

January 22, 2026 $6,642,797 $464,996 $7,107,793 $7,107,793

CLIN 0003

Option Period 1

January 23, 2026, to January 22, 2027

$7,244,915 $507,114 $7,752,059

CLIN 0004

Option Period 2

January 23, 2027, to January 22, 2028

$6,993,970 $489,578 $7,483,548

CLIN 0005

Option Period 3

January 23, 2028, to January 22, 2029

$6,599,331 $461,953 $7,061,284

CLIN 0006

Option Period 4

January 23, 2029, to January 22, 2030

$6,113,306 $427,931 $6,541,237

TOTAL $35,945,921 $7,107,793

GDIT was also the incumbent on the previous iteration of this task order which ended February 22, 2025. The total value of the previous contract was $38,524,025.

CLIN

Contract Period

Period of Performance

Est. Cost Fixed Fee Total CPFF Funded Amount

0001 Base Period 08/23/2019 – 08/22/2020 $7,114,850 $569,188 $7,684,038 $7,684,038 0002 Option Period 1 08/23/2020 – 08/22/2021 $5,617,555 $449,404 $6,066,959 $6,066,959

0003 Option Period 2 08/23/2021 – 08/22/2022 $6,397,459 $511,796 $6,909,255 $6,909,255 0004 Option Period 3 08/23/2022 – 08/22/2023 $6,540,521 $523,242 $7,063,763 $7,063,763 0005 Option Period 4 08/23/2023 – 08/22/2024 $6,666,992 $533,359 $7,200,351 $7,200,351 0006 Option Period 5 08/23/2024 – 02/22/2025 $3,333,017 $266,642 $3,599,659 $3,599,659

TOTAL $38,524,025 $38,524,025

2. Description of Supplies or Services:

The purpose of this task order is to support CMS with managing the measure, Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs), and Improvement Activities (IA) selection process for the MIPS implementation. This requirement was established by Section 101 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and supports services for the QPP to include maintenance and support of the quality measures using analytic services and implementation support for measures within QPP, including non-CMS owned measures used for reporting and performance assessment. .

This task order provides CMS implementation support related to:

1. Managing the inventory of MIPS quality measures, MVPs, QCDR measures, PI measures and IAs, including maintaining and updating all technical documents for these measures and activities (including non-CMS owned quality measures used in QPP) and for MVPs,

2. Providing support for policy development with respect to such measures, activities, and MVPs,

3. Managing the review and approval process for QCDRs and qualified registries (including taking enforcement actions due to non-compliance with CMS’ requirements for third party intermediaries);

4. Supporting communications with interested parties related to MIPS measures and activities, MVPs, and QCDR measures, and

5. Supporting the public reporting of information related to MIPS measures and activities, MVPs, and QCDR measures.

This task order requires the contractor is to collect and coordinate suggestions for:

1. Changes to quality measures

2. The development of new quality measures

3. The termination of quality measures that are no longer deemed appropriate

In managing the measures, the Contractor holds meetings with quality measure stewards to get feedback on these measures and synthesizes this back to CMS in a useable format. The Contractor then manages the repository of roughly 1,300 measures, or measure requirements, that are used to identify quality care for statutorily required payment modeling. Once the measure inventory is identified annually, the contractor assists with Federal Register posting of annual updates as required by statute.

As stated, the March 31, 2025 deadline for the support for clinicians reporting data is used to calculate incentive payments and feeds into the analysis of quality levels by providers and data validation auditing. Failing to meet this deadline would likely cause underperformers to be overpaid and overperformers to be underpaid. This would require additional effort to ensure funds were appropriately recovered and redistributed, at a later date, rather than following the statutorily required annual schedule.

Although this work could potentially be completed by any of the MIDS IDIQ holders, it is imperative that this task order be awarded to the incumbent, GDIT, to ensure that there is not a gap in service as this is MACRA required work. GDIT has the expertise and experience to complete this work without any additional delays. As the incumbent, there would be no need to transition the work and performance can begin immediately.

The agency need for these services is so urgent that providing a fair opportunity would result in unacceptable delays. By issuing this task order to GDIT, CMS is ensuring that critical programmatic and statutorily mandated needs can continue to be met during the protest review by GAO.

The Period of Performance for this Task Order will be divided into a 4-month period with 2 1-month options to allow sufficient time to complete the protest and a new award decision:

Base Period: April 15, 2025 – August 14, 2025 Option Period 1: August 15, 2025 – September 14, 2025 Option Period 2: September 15, 2025 – October 14, 2025

The Requirements Number is TBD once the J&A and AP are approved.

3. Authority and Rationale:

The Contracting Officer shall give every awardee a fair opportunity to be considered for a delivery/task order exceeding $3,500 unless one of the following statutory exceptions applies.

FAR 16.505(b)(2). Mark the applicable exception:

The agency need for the supplies or services is so urgent that providing a fair opportunity would result in unacceptable delays [FAR 16.505(b)(2)(i)(A)];

Contract 75FCMC18D0025 Task Order 75FCMC25FJ027

The original solicitation was open to all MIDS IDIQ holders and we received proposals from three offerors. As stated above, the original award to Acumen was protested and, after corrective action, a revised award decision was issued to GDIT. During the protest period for the original award, CMS extended the legacy contract in accordance with FAR 52.217-9.

The revised award decision was protested and the task order contemplated by this justification allows CMS to continue the critical services during the protest period.

It is imperative that this Task Order be awarded to the incumbent, GDIT, to ensure that any impact from the gap in service is sufficiently mitigated and the critical services outlined in this justification can resume. GDIT has been completing this work since 2019 and is well versed on the requirements of the Statement of Work. Absent approval of the requested task order, the Agency risks significant damage as a result of a lapse in service.

As outlined above, a sustained lapse in this work could be detrimental to CMS and the provider community. CMS would be unable to meet the annual rule promulgation deadlines related to the MACRA statutory requirements to operationalize the MIPS program. If the lapse in service continues, the data collection and analysis of quality measures and activities, crucial to the operations of the program, would not be completed which may impact payments to providers.

With the award of the task order to the incumbent, CMS is guaranteed to have an immediate resolution to the lapse in service and critical work can continue without further delays. The approach mitigates any delays that have already been realized. Attempting to solicit multiple sources or awarding to any other contractor would further delay this project, resulting in missed deadlines, and pose an unacceptable risk to the Government.

Only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services are unique or highly specialized [FAR 16.505(b)(2)(i)(B)];

The order must be issued on a sole-source basis in the interest of economy and efficiency because it is a logical follow-on to an order already issued under the contract, provided that all awardees were given a fair opportunity to be considered for the original order [FAR 16.505(b)(2)(i)(C)]; or

It is necessary to place the order to satisfy a minimum guarantee [FAR 16.505(b)(2)(i)(D)].

A statute expressly authorizes or requires that the purchase be made from a specified source.

[FAR 16.505(b)(2)(i)(E)].

4. Provide a statement of the actions, if any, the agency may take to remove or overcome any barriers that led to the exception to fair opportunity before any subsequent acquisition for the supplies or services is made:

The period of performance for this effort is limited to 6 months, including a base period of 4 months and 2 renewal periods of 1 month each. Within this period, CMS anticipates that GAO will issue a decision regarding a protest.

5. State any other facts supporting the justification:

GDIT has been successful in the performance of the work under previous iterations of this task order since 2019. It is expected that they will continue to provide the same high-quality support of this important statutorily mandated program and successfully support CMS.

Approvals:

1. Program Office Certification. This is to certify that portions of this justification have been developed by the undersigned program office personnel, including supporting information and/or data verifying the Government’s minimum needs, schedule requirements and other rationale for Exceptions to Fair Opportunity, which form the basis for this justification.

Contracting Officer Representative (COR) / Date

2. Contracting Officer Certification and Best Value Determination:

This is to certify that the justification for the proposed acquisition has been reviewed and that to the best of my knowledge and belief, the information and/or data provided to support the rationale and recommendation for approval, is accurate and complete.

By my signature below, after review of the relevant documents, I have determined that the order subject to this Justification represents the best value for the Government as set forth in FAR 16.505(b)(2)(ii)(B)(5), and constitutes a fair and reasonable price. The basis for my determination is as follows:

Contracting Officer / Date

3. CMS Competition Advocate Approval I have reviewed this Exception to Fair Opportunity and find that it adequately supports other than full and open competition.

Name / Date

4. Head of Contracting Activity (HCA) Approval I hereby confirm that the circumstances described above apply and approve this Justification for Exception to Fair Opportunity.

__________________N/A________________________________ HCA Name / Date

5. Office of Small and Disadvantaged Business Utilization

______________________N/A_____________________________ Name / Date

6. OGC Legal Review

_______________________N/A____________________________ Name / Date

7. HHS Competition Advocate Approval

________________________N/A___________________________ Name / Date

8. Senior Procurement Executive (SPE) Approval Based on the foregoing justification, I hereby confirm the circumstances described above apply and approve the Justification for Exceptions to Fair Opportunity.

_______________________N/A__________________________ SPE Name / Date