JA Exemption to Fair Opportunity - 210337.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: Evaluations Contractor to Analyze Medicare Appeals Demonstration to Conduct Telephone Discussions and Re-openings with Suppliers/Providers

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

B. Order Against

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

HHSM-500-2011-00013I

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: $4,836,795.57

E. Funding Source (s): Center for Medicare (CM) Medicare Appeals Demonstration (FMIB- 3899)

CMS seeks consideration to award a one (1) year period of performance extension of Option Period 4 from July 01, 2021 – June 30, 2022 for the following Task Order:

Evaluations Contractor to Analyze Medicare Appeals Demonstration to Conduct Telephone Discussions and Re-openings with Suppliers/Providers aka Qualified Independent Contractor (QIC) Demonstration Evaluation Contractor (QDEC).

Award of a 1-year period of performance extension is requested after consideration of the following:

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 QDEC task order (HHSM-500-2011-00013I/HHSM-500-T0014)was competed amongst the Small Business Research and Demonstration (SBRAD) IDIQ in December 2015.

QDEC Task Order (HHSM-500-2011-00013I/HHSM-500-T0014

The subject task order was awarded in March 2016 to IMPAQ International (IMPAQ). The total funding obligated on the task order to date is $15,720,921.08

The current period of performance is as follows:

Base Period: April 01, 2016 – March 31, 2017 Renewal Period 1: April 01, 2017 – March 31, 2018 Renewal Period 2: April 01, 2018 – March 31, 2019 Renewal Period 3: April 01, 2019 – March 31, 2020 Renewal Period 4: April 01, 2020 - June 30, 2021

The revised period of performance is:

Base Period: April 01, 2016 – March 31, 2017 Renewal Period 1: April 01, 2017 – March 31, 2018 Renewal Period 2: April 01, 2018 – March 31, 2019 Renewal Period 3: April 01, 2019 – March 31, 2020 Renewal Period 4: April 01, 2020 - June 30, 2022

2. Description of Supplies or Services:

The estimated value of the proposed action is $4,836,795.57

The proposed extension is necessary for IMPAQ to continue to evaluate the impact of the Medicare Appeals Demonstration to Conduct Formal Discussions with Suppliers/Providers, specifically on how suppliers/providers submit claims, the rate of claims denials, and the number of claims that go through Level 2 and Level 3 reconsiderations. This work is necessary to determine whether further engagement between suppliers/providers and the QIC improves the understanding of the reasons for claim denials.

The Demonstration was originally a 5-year effort that initially began in the Durable Medical Equipment Qualified Independent Contractor (DME QIC) Jurisdiction on January 1, 2016. Upon approval from the Office of Management and Budget (OMB), the Demonstration expanded into the Part A East QIC Jurisdiction effective May 1, 2019. All Demonstration activities were to conclude on December 31, 2020; however, recently CMS received approval from OMB for a 1-year extension to the existing Demonstration activities. The Demonstration is now scheduled to end on December 31, 2021. As such, the evaluation of those Demonstration activities must continue as well. The evaluation of all Demonstration activities will extend beyond the December 31, 2021 timeframe, as there is an inherent timeframe lag as it relates to data collection efforts, deliverables, and completion of final reporting.

The QDEC is tasked with, at a minimum:

Monitoring the QICs’ performance and providing CMS a monthly and annual report on the QICs’ effectiveness in meeting the Award Fee criterion;

Providing CMS with a Semi-Annual data report to OMB on Demonstration activities, Providing CMS with a Semi-Annual report on Effectiveness of QIC discussions in Meeting Demonstration objectives by conducting a mixed methods evaluation to assess whether the Demonstration is associated with changes in the outcomes of interest and to develop recommendations related to the appeals process.

*All statistical and methodological approaches were designed/created by IMPAQ.

The APP number is 210337.

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 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)];

QDEC Task Order (HHSM-500-2011-00013I/HHSM-500-T0014

The activities under the proposed period of performance extension are essentially the same as the above listed QDEC task order scope of work. As described in Section 2 above, the proposed period of performance extension of the QDEC task order is necessary to continue all evaluation activities (data collection, analysis, and reporting) as it relates to the Demonstration activities currently conducted by the Part A East QIC under HHSM-500-2004-00005I/HHSM-500-T0008 and DME QIC under HHSM-500-2004-00007I/ 75FCMC18F0001. As mentioned above, the Demonstration was set to end on December 31, 2020. However, OMB approved a 1-year extension of all Demonstration activities through December 31, 2021. As the result of this extension, it is in the best interest of the government to continue, through completion of this effort, the Demonstration evaluation activities, which are performed under this task order.

Potential onboarding of a new contractor during the final months of the Demonstration yields significant risk to the completion and integrity of the evaluation of all Demonstration activities.

While CMS created the research questions, IMPAQ designed the evaluation framework, statistical methodology, the survey materials, protocols, etc. There would not be enough time or available resources to transition this workload as a new contractor would essentially have to start over and rebuild the entire framework and operations of evaluating the Demonstration. An evaluation of the Demonstration is required under OMB Demonstration Authority and CMS is obligated to provide OMB with data reports created by IMPAQ on a semi-annual basis. As such, any disruption to this work would be detrimental to the success of the evaluation and would place CMS at risk of not being able to provide OMB with agreed upon deliverables.

IMPAQ’s past performance on Task Order HHSM-500-2011-00013I/HHSM-500-T0014 has been of high quality.

Additional Justification for the Period of Performance Extension:

As detailed above, an extension of this task order supports a seamless continuation of the ongoing Demonstration evaluation activities conducted by IMPAQ (and required by OMB) as it relates to the Part A East and DME QIC Telephone Discussion and Reopening Process Demonstration. The 1-year extension will allow continuation of the related Demonstration evaluation activities through the new Demonstration end date of December 31, 2021. As noted above, the evaluation contract extends beyond the end date as there is an inherent timeframe lag as it relates to data collection efforts and reporting that can not be completed until after the Demonstration ends.

Because this work is considered to be non-severable and therefore a completion effort, CMS requires the current evaluation contractor, IMPAQ, to continue the Demonstration evaluation work until completion to ensure the Government receives the full value of this project, approving a separate Justification for Exemption to Fair Opportunity for the extension of QIC Part A East, HHSM-500-2004-00005I/HHSM-500-T0008, on August 20, 2020. The QDEC contractor specifically conducts evaluations of the work C2C does under HHSM-500-2004-00005I/HHSM- 500-T0008 and MAXIMUS under HHSM-500-2004-00007I/ 75FCMC18F0001. Once the Demonstrations are complete under these two task orders, there will no longer be any barriers to the competition of this work, should a future program iteration be required.

Therefore, CMS requires IMPAQ to continue evaluating their work through the completion of the Demonstration and produce the required annual report of findings. Conducting a competitive request for proposal (RFP) and potentially transitioning to another contractor would put the success of the Demonstration at significant risk. As mentioned above, while CMS established the minimum requirements of this task order, IMPAQ designed the demonstration evaluation framework, methodologies, protocols, report templates, surveys, etc. Onboarding a new contractor in the last few months of the Demonstration would jeopardize the evaluation and data collection efforts completed to date and the ability to complete these activities and submit the final report/analysis to OMB as a new contractor would essentially have to start over in building their own processes and framework. Under the Demonstration Authority, CMS is also required to provide OMB with semi-annual data reports, which are produced by IMPAQ. A contractor change would likely affect CMS’ ability to successfully meet this OMB requirement.

CMS is also challenged with the ongoing public health emergency (PHE) related to COVID-19. A contractor transition during or shortly after this PHE adds additional risk in potentially transitioning to a new contractor prior to the completion of the Demonstration. In addition, Division of Appeals Operation (DAO) staff are providing considerable support for appeals guidance, questions, and direction related to COVID-19. We anticipate this will continue during and after resolution of the PHE. This support is necessary to ensure the Agency’s due diligence in supporting CMS stakeholders during this PHE, thus challenging and limiting the resources available for this procurement.

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:

As detailed in the “Additional Justification for the Period of Performance Extension” section above, once the demonstration is complete there will no longer be any barriers that lead to the exception to fair opportunity.

5. State any other facts supporting the justification:

N/A – Please see the “Additional Justification for the Period of Performance Extension” section above.

Approvals:

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

Program/Project Manager (P/PM) / Date

Lynnsie Kelley Digitally signed by Lynnsie Kelley Date: 2020.09.30 10:47:28 -04'00'

Michael T.

Torrisi -S

Digitally signed by Michael T. Torrisi -S Date: 2020.09.30 08:05:50 -07'00'

Best Value Determination. 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 SBRAD IDIQ was awarded in 2011. CMS has generated a strong base of knowledge in regard to fair and reasonable pricing under the IDIQ. The proposal submitted by IMPAQ will be evaluated against the pricing that was determined to be fair and reasonable under the existing QDEC task order and the Independent Government Cost Estimate the program staff will produce. The evaluation of the proposal against those items will enable CMS to make a fair and reasonable determination of the contractor’s price.

Taking into account the information provided in the paragraph above, the Contracting Officer has determined that the anticipated cost to the Government of the QDEC task order extension will be fair and reasonable.

Contracting Officer Certification: 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.

Matthew Waskiewicz, Contracting Officer Division of Medicare and Marketplace Contracts / Date

Digitally signed by Matthew C.

Waskiewicz -S Date: 2020.09.30 11:10:59 -04'00'

Additional OAGM Approvals:

I hereby confirm the circumstances described above apply and approve the Justification for Exception to Fair Opportunity.

Mark Smolenski, Director Division of Medicare and Marketplace Contracts / Date

Juanita Wilson, Director Medicare Support Contracts Group / Date

Head of Contracting Authority (HCA) Approval:

I hereby confirm that the circumstances described above apply and approve this Justification for Exception(s) to Fair Opportunity.

Melissa Starinsky Head of Contracting Authority / Date

Mark Smolenski - S

Digitally signed by Mark Smolenski -S Date: 2020.09.30 13:06:54 -04'00'

Digitally signed by Juanita P.

Wilson -S Date: 2020.10.14 15:40:50 -04'00'

Derrick L. Heard -S Digitally signed by Derrick L.

Heard -S Date: 2020.10.23 15:06:46 -04'00'

For: