JA Exemption to Fair Opp-A East 210164 Posting.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: Part A East Jurisdiction (APP 210164) Qualified Independent Contractor (QIC)

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

Acquisition Year: 2021 Authors: Matthew Waskiewicz and Mark Smolenski

1. Description of Action:

A. Nature

a. New Requirement

b. Follow-On Order

c. Modification of Existing Contract/Task Order (HHSM-500-T0008)

B. Order Against

a. Multiple Award Indefinite Delivery Indefinite Quantity (IDIQ) Contract Number

HHSM-500-2004-00005I

C. Contract Type

a. Firm-Fixed Price

b. Time and Materials

c. Cost Plus Fixed Fee (CPFF)

i. Term

ii. Completion

d. Cost Plus Award Fee (CPAF)

e. Other:

D. Projected Cost / Price: $25,558,755.92

E. Funding Source (s): Medicare Operations (FMIB 1539), Recovery Audit Contractor (FMIB 6782), Medicare Appeals Demonstration (FMIB 3899), and QIC Participation in ALJ (FMIB 2960) Funds

CMS seeks consideration to award a one (1) year period of performance extension of Renewal Period 2 from January 1, 2021 – December 31, 2021 in the following QIC jurisdiction:

Part A East QIC

Award of a 1-year period of performance extension is requested after consideration of FAR 16.505(b)(2)(i)(B) which states that only one awardee is capable of providing the supplies or services required at the level of quality required because the supplies or services ordered are unique or highly specialized.

The Part A East QIC task order (HHSM-500-2004-00005I/HHSM-500-T0008)was competed amongst all the QIC IDIQ contract holders. The Medicare Appeals Demonstration activities were incorporated into the task order Statement of Work in April 2019 via Modification P00006 and effective May 2019. This work was authorized by the Office of Management and Budget (OMB) and extended to continue for an additional year through 2021. This work is highly specialized and must be completed in its entirety by C2C Innovative Solutions (Inc.)

Part A East QIC Task Order (HHSM-500-2004-00005I/HHSM-500-T0008):

Awarded in December 2016 to C2C. The total funding obligated on the task order to date is approximately $81.3 million.

The current period of performance is as follows:

Transition Period: December 13, 2016 – February 13, 2017 Base Period: February 14, 2017 – February 13, 2018 Renewal Period 1: February 14, 2018 – February 13, 2019 Renewal Period 2: February 14, 2019 – December 31, 2020

The revised period of performance is:

Transition Period: December 13, 2016 – February 13, 2017 Base Period: February 14, 2017 – February 13, 2018 Renewal Period 1: February 14, 2018 – February 13, 2019 Renewal Period 2: February 14, 2019 – December 31, 2021

2. Description of Supplies or Services:

The estimated value of the proposed action is $25,558,755.92.

The purpose of the proposed Part A East QIC task order extension is to process reconsiderations requested as a result of Medicare Administrative Contractors (MACs) redeterminations of Medicare Part A claims. This workload includes processing reconsideration requests for, at a minimum, hospital inpatient, home health, skilled nursing home, hospice, and other Part A services and claims.

It also includes Part B services billed through MACs (sometimes referred to as “Part B of A”).

It shall be noted that the QIC is also responsible for reconsiderations based on “initial determinations” regarding Medicare Secondary Payer (MSP) recovery claims against beneficiaries or providers/suppliers where the redetermination was processed by a MAC. Such recovery claims against beneficiaries routinely include both Part A & Part B claims.

In addition, the Part A East task order includes activities which support the QIC Appeals Telephone Discussion and Reopening Demonstration. The demonstration began in January 2016 as a 5 year effort with plans to conclude on December 31, 2020. The Demonstration is a 6 year project that was initially implemented in the DME QIC jurisdiction, and was expanded to the Part A East jurisdiction effective May 1, 2019. CMS recently received approval from the Office of Management and Budget (OMB) for a one-year extension on existing activities. The Demonstration is now scheduled to end on December 31, 2021. In support of the Demonstration, the Part A East QIC shall continue to offer and conduct telephone discussions with providers, on reconsideration requests received, prior to the issuance of the reconsideration decision. As applicable, the Part A East QIC shall also review previously adjudicated unfavorable reconsideration decisions, largely pending in the appeals backlog at the Administrative Law Judge (ALJ) within the Office of Medicare Hearings and Appeals (OMHA) to identify claims that can now be resolved favorably through a reopening under the Demonstration. The additional activities related to the Demonstration increase the level of effort in the administrative appeals process to support the reconsiderations process already occurring under the Part A East QIC scope of work. That is, the continued activities relative to the appeals demonstration will support and enhance the activities conducted by the Part A East QIC to improve the administrative appeals process.

The APP number is 210164.

3. Authority and Rationale:

The Contracting Officer shall give every awardee a fair opportunity to be considered for a delivery/task order exceeding $3,000 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 [FAR16.505(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)(ii)(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)];

Part A East QIC Task Order (HHSM-500-2004-00005I/HHSM-500-T0008):

The activities under the proposed period of performance extension are essentially the same as the above listed Part A East QIC task order scope of work. As described in Section 2 above, the proposed period of performance extension of the Part A East QIC task order is necessary to continue to process reconsideration requests for, at a minimum, hospital inpatient, home health, skilled nursing home, hospice, and other Part A services and claims. It also includes Part B services billed through MACs (sometimes referred to as “Part B of A”). In addition, the proposed period of performance extension will continue to include activities performed under this TO in support of the QIC Appeals Telephone Discussion and Reopening Demonstration. The Demonstration, which was initially scheduled to end on 12/31/2020, has recently been extended by the OMB for 1 year and is now scheduled to end 12/31/2021. As a result of this extension, it is in the best interest of the government to continue, through completion of this effort, the Part A East QIC Demonstration activities which are performed under this effort.

Potential onboarding of a new contractor during the final months of the demonstration yields risk of