JA Marketplace System Integrator CAA Redacted Posting.pdf

JUSTIFICATION FOR AN EXCEPTION TO FAIR OPPORTUNITY

Acquisition Title: Consolidated Appropriations Act (CAA) Modification to the Marketplace System Integrator (MSI) Contract Agency: Centers for Medicare and Medicaid Services Acquisition Year: 2021 Author:

1. Description of Action:

A. Nature

a. ____ New Requirement

b. ____ Follow-On Order

c. __X__ Modification of Existing Purchase Order / Contract Number HHSM-

500-2016-00015I / 75FCMC20F0004

B. Order Against

a. (HHSM-500-2016-00015I) Multiple Award IDIQ Contract Number C. Contract Type (Hybrid)

a. __X__ Firm-Fixed Price

b. ____ Time and Materials

c. __X__ Cost Plus Fixed Fee (CPFF)

i. _X___ Term

ii. ____ Completion

d. ____ Cost Plus Award Fee (CPAF)

e. ____ Other: ___________

D. Projected Cost / Price of contract (Base & All Options): $240,328,603 E. The total estimated value of the proposed sole source action (for modifications only):

$13,840,525 F. Funding Source (s): 0007452 - Titles I (No Surprise Act) and II_(Transparency)

G. ____: Basis for Approval (Far 6.303-1(d)

__X__: Individual Basis

____: Class Basis

H. Project Background:

a. Contractor: Booz Allen Hamilton Inc.

b. Period of Performance:

i. Base Period 7/23/2020 to 7/22/2021

ii. Option Period 1: 7/23/2021 to 7/22/2022

iii. Option Period 2: 7/23/2022 to 7/22/2023

iv. Option Period 3: 7/23/2024 to 7/22/2024

v. Option Period 4: 7/23/2024 to 7/22/2025

c. Dollar Amount Obligated to Date: $123,876,752

d. CMS awarded the task order using fair opportunity under FAR 16.5.

2. Description of Supplies or Services:

The Consolidated Appropriations Act (CAA, the Act) of 2021 became Public Law No: 116- 260 on December 27, 2020. CAA is a $1.4 trillion omnibus spending agreement that encompasses many different provisions. Two acts within the law apply to The Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO): Division BB, Title I, "No Surprises Act." and Title II, "Transparency."

These two provisions require work to support healthcare provided to all commercially insured patients that provides much broader coverage and IT needs than just healthcare obtained through the health insurance exchanges. The Act contains a large number of disparate requirements for insurance reporting, process attestation, and federal operations.

Booz Allen Hamilton (BAH) provides Information Technology (IT) operational support and oversight of the Exchange systems’ components through monitoring, coordination, collaboration, and communication in coordination with the eXchange Operations Center and business stakeholders, security, and program operations through the scope of the Marketplace Systems Integrator (MSI) task order. It also includes integration work for the Marketplace Exchange, which supports healthcare provided by Affordable Care Act (ACA).

At the time of award, CMS did not contemplate that the MSI would be responsible for integrating the IT supporting healthcare for all commercially insured patients therefore this work was considered out of scope and required justification. BAH already facilitates integration tasks for MSI that is also required to stand up new the IT infrastructure for the No Surprises Act; therefore, the MSI is best positioned to support the establishment of the shared services platform and defining operations such as system monitoring and hosting. The MSI contract provides a firm foundation of planning and process implementation that is critical to ensure development efforts operate smoothly as CCIIO adapts to engagement with development contractors.

CMS previously approved a justification to provide out of scope CAA work and CMS added CAA integration support, however, circumstances have changed the estimate of the scope and the time frame required for support. As mentioned, the CAA had several provisions which are going through regulatory development, and the process of discovery has uncovered additional system integration which makes it more difficult to separate the system needs of the CAA from the ACA. Three examples pointing to this increased need follow.

First, while the expanded number and type of insurance entities were considered, CMS now recognizes that there will be expanded responsibilities for enforcement of provisions as they affect healthcare providers. This requirement is mainly the result of the provision that prohibits balance billing (sending bills to consumers for remainder of costs for services provided) under any but the most circumscribed conditions. This new set of work has resulted in requirements to update the software used for enforcement action to allow for automated integration with our customer relations management solutions, and must be implemented by the first quarter of CY2022.

Second, under the CAA, there are conditions which consumers may call in to file a complaint about particular healthcare provider billing practices. This provision is narrow, and CMS anticipated that it could incorporate those consumer calls into the service desk. This would have allowed the use of a single infrastructure. However, discovery led to an approach which addresses broader complaints and requires routing complaints to appropriate help desks across different government agencies. This approach requires a more extensive type of long-term integration.

Third, discovery has also led to an appreciation of interdependencies and mutual effects between the CAA and ACA and marketplace work. One provision of the CAA is for reporting of prescription drug pricing information. The law describes this collection as happening from “plans” which are largely outside of the ACA requirements. However, CMS determined a less burdensome way to accomplish the collection would be at the level of the insurance companies who are covered by, and tracked under, the ACA. Additionally, certain elements of CAA required data might be obtained from Pharmacy Benefit Managers who are covered under a provision of the ACA. These overlaps require integrated data and reporting structures.

Due to these changes and the expectation that more integration points will be identified, CMS will revise its requirements for the work starting in 2021, and continuing forward into future years. Under the old approach, CMS established a separate task associated only with the CAA work. The new approach is to integrate the work directly into the four pre-existing tasks. There is some administrative and tracking work that will be continued under Task 5 and CMS will obligate and track the CAA funding under a separate contract line item.

With this modification to the task order we expect to have the systems updated and the operations in place during option period 1, then evaluate operations and adjust during option period 2. As a result, the period of performance to support the services required by the Act is anticipated to begin on September 17, 2021 and continue through option periods 1 and 2 of the MSI award ending on July 22, 2023. After option period 2, CMS anticipates it will award a separate contract for a CAA System Integrator should additional integration services be necessary.

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)];

_X_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 [FAR 16.505(b)(2)(i)(B)];

The Act contains a large number of disparate requirements for insurance reporting, process attestation, and federal operations. By Tri-Agency agreement, CCIIO is undertaking virtually the entire IT build associated with these efforts, which will affect not only marketplace and non-marketplace private insurers, but will also require outreach and engagement with the population of the Employee Retirement Income Security Act of 1974 (ERISA) and self-insured plans which is estimated to number above 1.5 million firms. Fifteen provisions of the bill were identified as having implications for IT, which have been summarized into seven different work streams, six of which have operational deadlines within the next 8-9 months.

Booz Allen Hamilton (BAH) is the only responsible contractor at this time who can provide the required program management support. BAH’s experience as the Marketplace System Integrator (MSI) affords them unique understanding of the Cloud environment interconnections of CCIIO processes, inter-organizational (Government and Application Development Organizations) and operational knowledge that only BAH currently possesses, and CMS cannot accept any delay in commencement with the critical work described herein.

The implementation of the new Act requires CMS to act quickly to ensure new policies, and procedures are available for external stakeholders (e.g. Issuers, Third Party Administrators, Pharmacy Billing Managers) to meet compliance requirements by the effective dates ranging from December 2021 to mid-year 2023. BAH is currently serving in this role and has all necessary personnel, knowledge, and skills to operate as the System Integrator for this work. A new contractor would not benefit the Government and would significantly increase the operational risk in meeting the legislative timeline set forth. Furthermore, the amount of time and effort necessary to bring a contractor up to BAH’s operational effectiveness would create an unacceptable delay and simply will not meet the Government’s immediate need.

____ 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

___ 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:

CMS expects that the IT infrastructure will be operational by the end of the second option period of the MSI contract which ends on July 22, 2023. CMS anticipates the award of a separate contract for a CAA System Integrator should new integration services be required after the infrastructure for the Act is operational.

5. State any other facts supporting the justification:

None

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

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:

I will perform a cost analysis evaluation of the separate cost elements and profit to determine a fair and reasonable price for the effort.

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.

Contracting Officer / Date

Additional OAGM Approvals:

I hereby confirm the circumstances described above apply and approve the justification for Exceptions to Fair Opportunity.

OAGM Division Director / Date

OAGM Group Director / Date

09/01/2021

Alicia J. Joseph -S Digitally signed by Alicia J.

Joseph -S Date: 2021.09.01 07:44:54 -04'00'

Tiffany T. Jackson-dickey -S Digitally signed by Tiffany T. Jackson-dickey -S Date: 2021.09.01 07:56:41 -04'00'

Ryan P. Kooy -S Digitally signed by Ryan P. Kooy -S Date: 2021.09.01 08:12:34 -04'00'

Andrew Mummert -S Digitally signed by Andrew Mummert -S Date: 2021.09.01 08:59:10 -04'00'

Benjamin M. Simcock -S