JA Exception to Fair Opportunity NPPES_Redacted.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: National Plan & Provider Enumeration System (NPPES) Operations & Maintenance

Agency: Centers for Medicare & Medicaid Servies (CMS)

Acquisition Year: 2025

Authors: REDACTED

1. Description of Action:

A. Nature

☐ New Requirement

☒ Follow-On Order

☐ Modification of Existing Purchase Order / Contract Number

Order Against Multiple Award IDIQ Contract Strategic Partners Acquisition Readiness Contract (SPARC): HHSM-500-2017-00045I

B. Contract Type

☒ Firm-Fixed Price

☐ Time and Materials

☐ Cost Plus Fixed Fee (CPFF)

☐ Term

☐ Completion

☐ Cost Plus Award Fee (CPAF)

☐ Other:

C. Projected Cost / Price of contract (Base & All Options): $8,545,739.27

D. The total estimated value of the proposed sole source action (for modifications only): N/A

E. Funding Source (s): Project # 000139; Funding Source: 0511: Program Ops_Direct:Disc

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

☒ Individual Basis

☐ Class Basis

The Strategic Partners Acquisition Readiness Contract (SPARC) Indefinite Delivery, Indefinite Quantity (IDIQ) contract contains ordering procedures which are described in Section G.1 – Task Order Procedures. The procedures provide for sole source task orders conducted under the procedures described at FAR 16.505 (b), such as the order described in this justification.

CMS intends to issue a task order under the SPARC IDIQ which will serve as a continuation of services currently delivered under task order HHSM-500-2017-00045I, 75FCMC20F0002 with Reli Group Inc. The legacy order was competed among small businesses under the CMS SPARC IDIQ using the fair opportunity procedures under FAR 16.505. There have been no prior limited competition or sole source awards issued for this effort.

Name of the Incumbent contractor:

Reli Group Inc.

5520 Research Park Drive Suite 105 Catonsville, MD 21228

The current contract value, period of performance (POP) and total obligated amount to date is as follows:

CLIN Description Total FFP Total Funded

POP

0001 Base Period REDACTED REDACTED 09/30/2020 – 09/29/2021

0002 Option Period 1 REDACTED REDACTED 09/30/2021 – 09/29/2022

0003 Option Period 2 REDACTED REDACTED 09/30/2022 – 09/29/2023

0004 Option Period 3 REDACTED REDACTED 09/30/2023 – 09/29/2024

0005 Option Period 4 REDACTED REDACTED 09/30/2024 – 06/29/2025

0006 Option Period 5 Transition Out REDACTED REDACTED 06/30/2025 – 09/29/2025

TOTAL REDACTED REDACTED

2. Description of Supplies or Services:

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L. 104-191) required the Secretary of Health and Human Services (HHS) to adopt national standard identifiers for health care providers and health plans for use in the health care system.

This delegation included the adoption of the National Provider Identifier (NPI) and the development of the National Plan and Provider Enumeration System (NPPES). NPPES accepts applications from providers (Type 1 – Individuals and Type 2 – Organizations) for assignment of NPI numbers.

NPI applications can be submitted directly over the web, through a paper form to the NPI Enumerator, or through an Electronic File Interchange (EFI) process carried out by authorized EFI organizations (EFIO). NPPES then processes the applications and assigns unique NPI to each provider. Applicants are informed of their NPI numbers by NPPES or the EFI organization responsible for handling their applications either electronically or via postal mail depending on their application method. NPI holders or their authorized representatives can update information associated with the NPI record in NPPES, as necessary.

In May 2007, CMS published a Notice in the Federal Register that described the process by which NPPES data would be disseminated. The Notice explained that the disclosable information in NPPES under the Freedom of Information Act (FOIA), will be disseminated to the public in two ways: 1) Through the NPI Registry (a system whereby anyone can “look up” a health care provider’s NPI), and 2) In monthly files that can be downloaded from the Internet.

Beginning May 2008, NPIs became required health care provider identifiers in all electronic health transactions, including claims transactions. The regulation that adopted the NPI and established the NPPES requires that NPPES disseminate health care provider information upon approved requests (45 CFR 162.408(f)). In March 2010, the Patient Protection and Affordable Care Act and the Reconciliation Act of 2010 (Affordable Care Act) were enacted. This legislation included new regulatory requirements related to HIPAA: §1104 Administrative Simplification.

The task order contemplated by this Justification will require the delivery of severable services for twelve months in total (base plus option periods) including the following tasks:

• Operations, Maintenance, Support and Enhancements for the NPPES and all its subsystems, interfaces and processes.

• NPI Enumeration and user support services

• Transition Out to a new contract

The planned 12-month performance period will be divided to support these tasks as follows:

Description Period of Performance

NPPES O&M and Support 06/30/2025 to 12/30/2025

NPI Enumeration and User Support 06/30/2025 to 12/30/2025

NPPES O&M and Support 12/31/2025 to 03/31/2026

NPI Enumeration and User Support Transition Out 12/31/2025 to 03/31/2026

NPPES O&M and Support Transition Out 04/01/2026 to 06/29/2026

CALM Requirement No.: 250894J

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)];

N/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 is in the process of acquisition planning for a long-term, follow-on contract to the one currently supporting NPPES. However, the agency determined that before award of such an action, it should first re-structure certain elements of the program to better align with CMS’s strategic priorities of reducing fraud, waste and abuse in federal spending and improve operational efficiencies. Doing so would greatly improve the outcome of any future competitive acquisition by reducing incumbent advantage and refining the government’s objectives prior to establishing a new long-term, contractual arrangement.

This re-alignment includes the following activities:

• Enumerator Operational Process Reigineering o Compile detailed volume metrics to identify top drivers of the incoming contacts volume and specific user/stakeholder pain points and develop approach for addressing root causes. Take action to resolve volume drivers.

o Assess the entire existing operational framework for NPI enumeration helpdesk, identify any process gaps, risks and opportunities for improvement and efficiencies and shall develop and deliver a proposed Operational Optimization Strategy detailing specific proposed changes to the enumeration procedures that will lead to cost savings and improve customer experience o Assess the possibility to configure NPI enumerator services with other similar efforts within CMS to realize efficiencies and cost savings.

o CMS estimates that this effort will take approximately 6-9 months to complete a full transition.

• Restructuring the NPPES system prior to recompete to allow for cost efficiencies, improve provider experience.

o There are opportunities to realize cost savings by removing outdated or inefficient processes, reducing system software and hosting costs, reducing the burden created by inaccurate or obsolete data for NPPES and other systems and processes that consume NPI data, and reduce transition costs by ensuring the source code is of high quality and well documented.

• Assess the current Identity and Authentication (I&A) module supporting NPPES user onboarding, management, and the Surrogacy function.

o User onboarding includes non-traditional identity management and authentication for various provider applications. The Surrogacy function authorizes users to access provider applications and allows provider users to manage and delegate administrative and operational duties per CMS policies.

o CMS's IDM solution is based on Okta and provides APIs for application integration.

The assessment is expected to take 3-4 months. The outcome should be a deliverable outlining a plan to migrate NPPES user management and authentication functions into the CMS IDM system and define Surrogacy as a module supporting provider applications. Upon CMS’s review and approval of the migration plan, the

Contractor shall undertake the migration, which is expected to take approximately 9 months.

• Assess cost-saving and system performance and user-experience benefits of latest Cloud technologies. While NPPES has already migrated to cloud hosting and uses multiple cloud products, it’s still reliant on several costly 3rd party products. CMS is looking to assess if more cost-effective cloud-based alternatives that equivalently meet system requirements are available. Assess the current hosting infrastructure for scalability should system requirements for NPPES expand to include collection of additional data, broaden data dissemination to support new use cases, or/and implement more rigorous real-time data validation and screening analytics. Review NPPES architecture and software and services stack for potential optimizations.

• Transition to a CMS provided ServiceNow instance from a non-CMS-provided instance of ServiceNow ticketing and case management software that houses 5-years’ worth of valuable operational information. It is essential that this information is transitioned into a CMS hosted tool, in a properly referenced and usable form, where CMS and successor contractors can access and use it. Due to differences in configurations and definitions between the contractor’s and CMS’s instances of service now, this will involve considerable effort, which the current contract and transition period do not reflect.

• Improve source code documentation to ensure that all of NPPES source code is 1) is properly stored in CMS GitHub repositories; 2) is of high quality and well annotated; 3) accompanied by fully updated documentation of sufficient level of detail. CMS will conduct an independent code and documentation quality assessment; the Contractor will address all significant adverse findings that result from such assessment.

Furthermore, NPPES has assessed several cybersecurity vulnerabilities in the current user identity management process which require rapid remediation. Transition to another contractor would introduce unacceptable delays to realizing immediate opportunities towards these goals. The incumbent contractor has exclusive operational knowledge of the most recent five years of program delivery and the most current knowledge of NPPES system design and architecture. Therefore, it is best positioned to complete these tasks in an economical and efficient way. While the incumbent contractor is expected to complete these tasks within six to nine months, any other source would likely require an additional several months, perhaps up to a year, to gain the insights necessary to plan and execute the required tasks.

☐ 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 current task order was originally competed and awarded using fair opportunity procedures under FAR

16.505. The follow-on task order contemplated in this justification is a relatively short-term effort that will enable CMS to immediately address new strategic initiatives and high-risk security challenges while simultaneously planning a new, long-term procurement using fair opportunity. Award of the task order contemplated by this justification will remove barriers to future competition by greatly reducing cost and performance risk of any contractor awarded the longer-term contract to follow. CMS will conduct market research to validate solicitation strategies along with the requirements.

5. State any other facts supporting the justification:

None.

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.

REDACTED

Contracting Officer Representative (COR) / Date

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: The firm-fixed price will be analyzed upon receipt of contractor proposal. The forthcoming analysis and any negotiations (if applicable) will ensure best value for the Government and a fair and reasonable price.

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.

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