JA Exception to Fair Opportunity for HIOS FINAL.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: Health Insurance Oversight System (HIOS) Agency: Center for Consumer Information and Oversight (CCIIO) Acquisition Year: FY2025 Author: Michael Verhanovitz, Contracting Officer Representative (COR) and Evelyn Dixon, Contracting Officer (CO)

1. Description of Action:

A. Nature

☐ New Requirement ☐ Follow-On Order ☒ Modification of Existing Purchase Order / Contract Number

B. Order Against: CMS Strategic Partners Acquisition Readiness Contract (SPARC), IDIQ Contract - HHSM-500-2016-00054I/75FCMC20F0001

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): $81,221,466 E. The total estimated value of the proposed sole source action (for modifications only):

$8,804,567 F. Funding Source (s): CMS/CCIIO/ Marketplace Information Technology Group (MITG) and

CMS/Center for Clinical Standards and Quality (CCSQ):

o Project Fund 000767, PBM Module o Project Fund 7452, NST All Sections - Gag Clause Module; Agent/Broker Compensation

Data Collection Module; Air Ambulance Data Collection Module o Project Fund 7454, NST Section 204 Drug Data Collection – RX-Data Collection Module o Project Fund 001943 – 0511: Federal Exchange Direct:Disc – Marketplace Quality

Management Module

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

☐ Class Basis

Project Background:

Section 1103 of the Patient Protection and Affordable Care Act (PPACA) calls for the U.S.

Department of Health and Human Services (DHHS) to develop and implement a consumer-facing Internet website portal, Healthcare.gov, to assist consumers with identifying affordable and comprehensive health insurance coverage options that are available in their State.

The Health Insurance Oversight System (HIOS) is a web-based application that allows the government to collect data from states and individual and small group market issuers, which is aggregated with other data sources and made public on a consumer-facing website. The principal function of HIOS is to serve as the government's primary data collection vehicle and staging area for data provided by various external sources for display on Healthcare.gov and for other purposes related to the Affordable Care Act (ACA). These data sources submit their data directly into HIOS by securely logging into HIOS via the Internet. In its role as the primary data collection vehicle, HIOS also serves as the entry point for the Federally-Facilitated Marketplace (FFM) efforts. Efforts would include but not limited to CMS/CCIIO collecting from participating health plans required plan offering information for the upcoming ACA Enrollment Period; enrollment and financial data for prior enrollment periods; clinical data for required ACA clinical measurement reporting. HIOS collects all Assister/Navigator Organization data for the entities that will be participating in the Enrollment Period and is a repository of historical Assister/Navigator participation. More importantly, HIOS handles all user management functions and manages user role provisioning across multiple CCIIO systems.

HIOS is continuing to develop as new provisions of the ACA unfold and more recently the No Surprise Act, including Sec 204 Rx-DCM; Sec 201- Attestation for Gag Clauses; Sec 202(c) - Agent/Broker Compensation Data Collection Module (A/BCDCM), (Sec. 202 CRAB) Module; and Sec 106 - Air Ambulance Data Collection (AADC).

Continuation of Ongoing Contract/Task Order:

Name of Incumbent Contractor: Solutions by Design II, d/b/a Evolver Federal, Inc.

Current Period of Performance (POP): April 15, 2020 – October 14, 2024 Transition-Out: October 15, 2024 - April 14, 2025

Extension Period - Transition-Out: April 15, 2025 – October 14, 2025

Total Dollar Amount Obligated to Date: $72,416,899

Initial Award was competed under the CMS Strategic Partners Acquisition Readiness Contract (SPARC), Indefinite Delivery/Indefinite Quantity (lDlQ).

2. Description of Supplies or Services:

The Acquisition Procurement Plan (APP) Number 250293 is created to extend the services of the HIOS for six (6) additional months in accordance with FAR 52.219-8.

The Contractor will be required to continue the annual Operations and Maintenance (O&M) of the HIOS twenty-two (22) independent and unique modules, and to some degree, further development of the No Surprises and Transparency Act (NST) workstreams. O&M responsibilities include all compliance tasks for system security requirements per prevailing HHS/NIS standards, including the Authority to Operate (ATO), HIOS FISMA System Access Data Call, and HIOS HHS Zero Trust Updates Data Call.

The contractor shall continue the support, development, testing, implementation, maintenance, and enhancement of HIOS to collect required data. There are base modules of HIOS in a production environment that provide data collection, acceptance, and review capabilities from private health insurers, States, and/or the NAIC (on behalf of States), and other entities. The contractor shall support and maintain these processes, as well as continue the development, testing, and implementation of enhancements to HIOS. Maintenance and support activities shall include the coordination and administration of a monthly release cycle of software changes, enhancements, refinements, software bug fixes, data cleanups, special projects, and technical improvements.

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)];

☐ 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 [FAR16.505(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

CMS competitively awarded the existing task order (HHSM-500-2016-00054I/75FCMC20F0001) providing a fair opportunity to SPARC IDIQ holders. It was competed in FY20 with a POP of April 15, 2020 – April 14, 2025. This is the first time this exception has been used. Rather than award a new task order using fair opportunity, it is more economical and efficient to award a modification to Solutions By Design for the continuation of essential services during open enrollment and completion of transition-out services.

The Health Insurance Oversight System (HIOS) contract, supporting the Affordable Care Act (ACA) administered by CMS/CCIIO/Marketplace Information Technology Group (MITG), is scheduled to expire October 14, 2024. This date is just two weeks before the ACA Marketplace begins the annual open enrollment period for the ACA program to the American public. HIOS is one of the key IT systems that supports the overall operations of the ACA. HIOS must be fully operational for the open enrollment period; otherwise, the open enrollment would not be able to operate, and 22 million Americans would be delayed and/or could not enroll in the ACA for health care insurance coverage.

During the Open Enrollment Period, CCIIO’s Enrollment & Eligibility program makes an automated web service call to HIOS that validates select data on each enrollment application for that day. The applications would not be processed/completed for a final determination accordingly if HIOS was not functioning/operating as required to complete the enrollment determination.

Due to the potential risks noted above associated with transitioning from one contractor to another during the open enrollment period, it is essential to extend the HIOS contract for 6 months, October 15, 2024 – April 14, 2025, accordingly. Introducing the possibility of a new contractor at this juncture would introduce undue risk of harm to the Government and jeopardize successful performance of the work. A new contractor would need time to become familiar with the existing system, and to successfully manage HIOS Data Collection. There is not enough time to get familiar with the system and support the forthcoming Open Enrollment. The extension period would cover current essential HIOS operations that are currently in progress. The extension period would be awarded as a modification to the current HIOS contractor as there is no other contractor capable of operating HIOS in the limited timeframe.

☐ 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:

MITG and OAGM will begin a procurement to re-compete the HIOS contract with an award date of April 15, 2025. The Transition-Out Period will be revised to 4/15/25 through 10/14/25. By extending the POP at this time, it will eliminate these issues for all future procurements. CMS/CCIIO/MITG does not have the authority to modify the dates of the ACA Open Enrollment period and operations.

5. State any other facts supporting the justification:

The current contractor has held the contract since the inception of the ACA/HIOS (approximately 12.5 years). As the follow-on procurement is anticipated to be set-aside for Small Businesses (SB), the incumbent other-than-small business will likely not be the awardee. This would increase transition risk from oversights and delays, and therefore reinforces the need to extend as a risk mitigation measure.

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.

Digitally signed by Michael A. Verhanovitz -S Date: 2024.08.22 10:52:56 -04'00'

Contracting Officer Representative (COR) / Date

8/23/2024

X Mgr, DIOTA Signed by: Brian M. James -S

Program/Project Manager (P/PM) / 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:

This extension is for continuation of services for six (6) additional months at a FFP. These services are offered under the SPARC IDIQ which incorporates the contractor’s T&M rates. As this is a FFP task order, these rates have been useful in comparison for labor categories/rates. In previous modifications, these labor categories/rates have also been compared to the contractor’s GSA labor categories/rates and found to be fair and reasonable. By placing an extension against the SPARC IDIQ contract/task order using the procedures in FAR 15.404-1(b) and (c), I have concluded that this extension represents the best value (as defined in FAR 2.101) and results in the lowest overall price alternative (considering price, discounts, special features, administrative costs, etc.) to meet the Government’s needs.

Contracting Officer / Date

3. CMS Competition Advocate Approval

Michael A. Verhanovitz -S

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

6. OGC Legal Review

7. HHS Competition Advocate Approval

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.

SPE Name / Date