JA Limited Source Justification APP 240350-final.pdf

FEDERAL SUPPLY SCHEDULE LIMITED-SOURCES JUSTIFICATION

Acquisition Title: Implementation of the HEDIS® Medicare Health Outcomes Survey Agency: Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) Acquisition Year: 2024 (APP 240350) Author: Alyssa Rosen, Contracting Officer’s Representative (COR), Carlos Delgado-Sanchez, Contract Specialist (CS) and Mark Smolenski, Contracting Officer (CO).

1. Description of Action:

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

Contract Type Firm-Fixed Price Time and Materials Cost Plus Fixed Fee (CPFF)

Term Completion

Cost Plus Award Fee (CPAF) Other:

Total Projected Cost / Price:

Base Year: $1,108,328.00 Option Year 1: $1,098,568.00 Option Year 2: $1,121,705.00 Option Year 3: $1,145,363.00 Option Year 4: $1,169,553.00 Total Cost: $5,643,517.00

Funding Source (s): 0511: Program Operations Direct: Disc

Name of Proposed Contractor(s): National Committee for Quality Assurance (NCQA)

Street Address: 1100 13th Street Suite 1000, NW City, State, Zip: Washington, DC 20005

2. Description of Supplies or Services:

The estimated value of the proposed action, including all options, is: $5,643,517.00

The Medicare Health Outcomes Survey (HOS) was implemented nationally in 1997 as a significant extension of the range of health care services being evaluated known as the HEDIS. The HOS uses the Veterans RAND 12 Item Health Survey (VR-12), a self-reported measure of functional health, to assess the physical and mental health statuses of beneficiaries enrolled in Medicare managed care at two-year intervals. Each year, a random sample is drawn from each MAO to create a new baseline cohort. A two-year change score is calculated for each beneficiary who completes a Baseline and Follow-up survey, accounting for risk-adjustment factors. Summary HOS results are calculated for each MAO based on aggregated member outcomes. Additionally, the HOS-M is used to assess annually the frailty of the population in PACE and some Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs).

Annually, MAO-specific HOS baseline and two-year performance measurement reports are created for each participating health plan after completion of each annual HOS fielding. MAO-specific performance measurement data are made available after the completion of each two-year HOS cohort. Similarly, annual HOS-M summary reports and data are created for participating PACE plans. HOS results are currently being used to target quality improvement activities and resources; monitor health plan performance and reward top performing health plans; monitor frailty and adjust plan payment rates; help beneficiaries make informed choices; and advance the sciences of functional health outcome measurement and health related quality of life

(HR-QOL).

Section 722 of the Medicare Prescription Drug, Improvement, and Modernization act of 2003 mandates the collection, analysis, and reporting of health outcomes information. This legislation also specifies that data collected on quality, outcomes, and beneficiary satisfaction to facilitate consumer choice and program administration must utilize the types of data collected prior to November 1, 2003. Collected since 1998, the Medicare HOS therefore remains a critical part of assessing health plan quality. The contractor is responsible for updates or modifications to improve the HOS and HOS-Modified (HOS-M) survey procedures, trainings and associated materials, data submission procedures, potential timeline adjustments, other updates and modifications deemed necessary for implementing the surveys.

3. Authority:

:ORDER AGAINST FSS: Authority of the Multiple Award Schedule Program, Title III of the Federal Property and Administrative Services Act of 1949 (41 U.S.C. 251, et seq.); Title 40 U.S.C. 501, Services for Executive Agencies; and Section 803 of the National Defense Authorization Act of 2002 (PL 107-107) and implemented by FAR 8.405-6. Mark the applicable exception and for each discuss how the cited authority applies in accordance with FAR 8.405-6(c)(2)(iv).

An urgent and compelling need exists, and following the procedures would result in unacceptable delays (FAR 8.405-6(a)(1)(i)(A)); or

Only one source is capable of providing the supplies or services required at the level or quality required because the supplies or services are unique or highly specialized (FAR 8.405-6(a)(i)(B));

or

NCQA owns the proprietary rights to the system that collects HEDIS® data and is the only organization authorized to technically support administration of the HEDIS® Medicare HOS and develop new HEDIS® measures. NCQA performs this function by convening a number of interdisciplinary multi-stakeholder panels and groups. These groups are all widely respected by the managed care industry and have stakeholder representation. Since NCQA develops the measures and makes all of the updates to HEDIS®, it is uniquely qualified to provide the needed technical assistance to health plans and auditors during data collection.

As the organization that maintains and evolves HEDIS®, NCQA is the only responsible source for this activity. In 1993, NCQA released HEDIS 2.0 that quickly became the “industry standard” performance measurement set. Originally designed for private employers' needs as purchasers of healthcare, HEDIS® has been adapted for use by public purchasers, government compliance monitors, and managed care consumers. HEDIS data submission tools and detailed technical specifications are developed and maintained by NCQA. Since 1997, CMS has contracted with NCQA to develop additional HEDIS® performance measures to assess HOS measures. NCQA retains sole title to and ownership of the HEDIS® Medicare HOS data.

In the interest of economy and efficiency, the new work is a logical follow-on to an original Federal Supply Schedule order provided that the original order was placed in accordance with the applicable Federal Supply Schedule ordering procedures. The original order or BPA must not have been previously issued under sole-source or limited sources procedures (FAR 8.405-6(a)(1)(i)(C)); or

An item peculiar to one manufacturer can be a particular brand name, product, or a feature of a product, peculiar to one manufacturer). A brand name item, whether available on one or more schedule contracts, is an item peculiar to one manufacturer. (FAR 8.405-6(b);

4. Market Research:

We received emails from different organizations submitting their capability statements: Code 360, Inc, Red Hill Consulting, LLC, vTech Solutions, Inc and, Reedemption Consulting, LLC. However, none of these organizations submitted a response to the posted notice stating they were capable of performing the work.

Therefore, none of these organizations will be considered since they did not challenge the sole source designation of this work.

5. Actions to Increase Competition:

This action will not be competed. FAR 8.405-6(a)(i)(B); authorizes application of a contract to one sole source based on the existence of limited rights in data, so CMS has determined that, for the reasons previously cited, only NCQA has the necessary capabilities and proprietary rights to successfully perform this work. In accordance with FAR 5.201, CMS posted a notice of intent to contract on a sole source basis with NCQA on the SAM.gov website on January 29, 2024 to see if there were any other organizations that had an interest in this work or believed they were capable of performing the work. CMS did not receive any responses that challenged the sole source designation of this work or from organizations that were interested or believed they were capable of doing this work.

6. Any other facts supporting the justification: N/A

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, which form the basis for this Limited Source Justification.

Alyssa Rosen - Contracting Officer Representative (COR) / Date

Sarah Gaillot - 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 Limited-Sources Justification represents the best value for the Government as set forth in FAR 8.404(d), and constitutes a fair and reasonable price.

The basis for my determination is as follows:

NCQA has been performing work under this program since 1997. NCQA retains sole title to and ownership of the HEDIS® Medicare HOS data. GSA has already determined pricing to be reasonable, however CMS will evaluate the pricing that is submitted against the current task order and Independent Government Cost Estimate (IGCE) that the program staff will produce. The evaluation of the quote against those items will enable CMS to make a fair and reasonable determination of the contractor’s pricing.

Mark Smolenski - Contracting Officer / DMMC Division Director/ Date

I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

Juanita Wilson - MSCG Group Director / Date

Alyssa B. Rosen -S Digitally signed by Alyssa B. Rosen -S Date: 2024.03.05 16:09:52 -05'00'

Sarah J. Gaillot -S Digitally signed by Sarah J. Gaillot -S Date: 2024.03.05 16:17:57 -05'00'

Mark Smolenski -S Digitally signed by Mark Smolenski -S Date: 2024.03.06 16:21:14 -05'00'

Juanita P. Wilson -S Digitally signed by Juanita P. Wilson -S Date: 2024.03.06 17:06:21 -05'00'

3. CMS Competition Advocate Approval I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

Donald Knode- CA / Date

4. Head of Contracting Activity (HCA) Approval:

I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

N/A – contract action is < $15 million Name / Date

5. Office of Small and Disadvantaged Business Utilization:

N/A – contract action is < $75 million Name / Date

6. OGC Legal Review:

N/A – contract action is < $75 million Name / Date

7. HHS Competition Advocate Approval:

N/A – contract action is < $75 million Name / Date

8. Senior Procurement Executive (SPE) Approval:

Based on the foregoing justification, I hereby confirm the circumstances described above apply and approve the Limited Source Justification.

N/A – contract action is < $75 million Name / Date